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Primary Health Care in Nigeria: From Conceptualization to Implementation

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Abstract

Primary Health Care (PHC) is a grass-root management approach to providing health care services to communities. Since the concept was first published in 1978, various countries have attained different levels of progress in implementing the strategy. This paper reviews the historical concepts that have driven primary health care in Nigeria. Current efforts at revitalizing primary health care in Nigeria include the Midwives Service Scheme (MSS), PHC Reviews, National Health Management Information System (NHMIS), and the Maternal Newborn and Child Health (MNCH) Week. In all, the role of the people, government, and health workers as critical stakeholders needs to be well defined and pursued in order to maximize the benefits of primary health care. INTRODUCTION Since the global target of Health for All was declared in 1978, primary health care (PHC) has been adopted and accepted universally to be the approach to achieving this lofty goal. The world will only become healthy when we achieve Health for All-the developed and developing nations alike, the poor and the rich, the literate and the uneducated, old and young and women, children and the elderly. The primary health care system is a grass-root approach meant to address the main health problems in the community, by providing preventive, curative and rehabilitative services (Gofin, 2005, Olise, 2012).
Journal of Medical and Applied Biosciences
ISSN: 2277 -
0054
Volume
6
,
Number 2,
201
35
Primary Health Care in Nigeria: From Conceptualization to Implementation
1Aigbiremolen, A.O., 1Alenoghena, I., 2Eboreime, E., 1Abejegah, C.
1Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
2National Primary Health Care Development Agency (NPHCDA), Abuja, Nigeria.
E-mail: drphonsus@yahoo.com
ABSTRACT
Primary Health Care (PHC) is a grass-root management approach to
providing health care services to communities. Since the concept
was first published in 1978, various countries have attained
different levels of progress in implementing the strategy. This
paper reviews the historical concepts that have driven primary
health care in Nigeria. Current efforts at revitalizing primary
health care in Nigeria include the Midwives Service Scheme (MSS),
PHC Reviews, National Health Management Information System
(NHMIS), and the Maternal Newborn and Child Health (MNCH)
Week. In all, the role of the people, government, and health
workers as critical stakeholders needs to be well defined and
pursued in order to maximize the benefits of primary health care.
Keywords: Primary Health Care, Management, Nigeria.
INTRODUCTION
Since the global target of Health
for All was declared in 1978, primary
health care (PHC) has been adopted
and accepted universally to be the
approach to achieving this lofty goal.
The world will only become healthy
when we achieve Health for All- the
developed and developing nations
alike, the poor and the rich, the
literate and the uneducated, old and
young and women, children and the
elderly. The primary health care
system is a grass-root approach
meant to address the main health
problems in the community, by
providing preventive, curative and
rehabilitative services (Gofin, 2005,
Olise, 2012).
As defined in the Alma Ata
declaration, primary health care is
the “essential care based on
practical, scientifically sound and
socially acceptable methods and
technology, made universally
accessible to individuals and families
in the community through their full
participation, and at a cost that the
community and country can afford to
maintain at every stage of their
development in the spirit of self-
reliance and self-determination”
(WHO, 2012).
Primary Health Care in Nigeria: From Conceptualization to Implementation
36
The principles of primary health
care underscore the great value of
the approach. These principles which
include essential health care,
community participation, equity,
intersectoral collaboration, and use
of appropriate technology are the
driving forces behind the efficiency
of primary health care as the hope
of achieving universal health
coverage. This means that primary
health care is meant to provide
services to the majority of the
people based on needs without
geographical, social or financial
barriers through their involvement
in the planning, implementation and
evaluation of health programmes. It
implies drawing resources from
within and outside the health sector
and utilizing technologies on the
basis of suitability.
HISTORY AND
CONCEPTUALIZATION
In Nigeria, primary healthcare was
adopted in the National Health
Policy of 1988 (FMOH, 2004) as the
cornerstone of the Nigerian health
system as part of efforts to improve
equity in access and utilization of
basic health services. Since then,
primary health care in Nigeria has
evolved through various stages of
development. In 2005, primary
health care facilities were found to
make up over 85% of health care
facilities in Nigeria (FMOH, 2010).
Historically, there were three major
attempts at evolving and sustaining a
community and people oriented
health system in Nigeria. The first
attempt occurred between 1975 and
1980. The fulcrum of this period was
the introduction of the Basic Health
Services Scheme (BHSS). The Basic
Health Services Scheme came into
being in 1975 as an integral part of
Nigeria’s Third National
Development Plan (1975 79)
(Dungy, 1979, Adeyomo, 2005) and
was structured along “basic health
units” which consisted of 20 health
clinics spread across each LGA,
which were backed-up by four (4)
primary health care centres and
supported by mobile clinics serving
an approximate population of
150,000 each. The drawback of this
attempt was the non-involvement of
local communities who were the
beneficiaries of the services. This
led to the inability to sustain the
Scheme at the close of the third
national development plan period.
A second attempt which was led by
late Professor Olukoye Ransome-Kuti
occurred between 1986 and 1992
(Kuti et al, 1991). This period was
characterized by the development
of model primary health care in fifty
two (52) pilot local government areas
all of which were implementing all
eight components of primary health
care. A key result of this
dispensation was the attainment of
80% immunization coverage for fully
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37
immunized under-five children.
Meticulous application of the
principle of active community
participation and focus on issues
relating to health systems
strengthening (HSS) was largely
responsible for the success
recorded.
The National Primary Healthcare
Development Agency (NPHCDA) was
established in 1992 and heralded the
third attempt to make basic
healthcare accessible to the
grassroots. During this period, which
spanned through 2001, the Ward
Health System (WHS) which utilizes
the electoral ward (with a
representative councilor) as the
basic operational unit for primary
health care delivery was instituted.
This was in response to the
devolution of Primary Healthcare to
the Local Governments by the then
military government. The Ward
Minimum Health Care Package
(WMHCP) which outlines a set of
cost effective health interventions
with significant impact on morbidity
and mortality was also developed.
The package took into cognizance
the nation’s burden of disease,
current trends in disease prevalence
and priority diseases of national
importance. The Ward Minimum
Health Care Package was developed
within context of the Ward Health
System and aligned with the
millennium development goal (MDG)
targets of Nigeria. To drive this new
policy over 500 hundred model
health centres were established
across the nation by the federal
government (NPHCDA, 2012). These
centres served as a fulcrum for the
establishment of the Ward Health
System and the community
mobilization as Ward Development
Committees, which is constituted of
selected community representatives,
were established around the model
primary health care centres.
While it was logical that Primary
Healthcare, which is community
oriented, be established around the
tier of government perceived to be
closest to the people, the sudden
devolution of primary health care to
the local government areas may have
had negative implications on
sustainability of quality as that level
of governance is also known to have
the weakest technical capacity.
Again the Federal Government’s
intervention by building model health
centres for the local government
areas, though well-conceived, was
paradoxical to the newly initiated
principle of devolution of healthcare.
While this intervention may have
been sustainable under the unitary
military dictatorship, its
sustainability was challenged by the
advent of democracy in 1999.
Primary Health Care in Nigeria: From Conceptualization to Implementation
38
ONGOING PRIMARY HEALTH CARE
REVITALIZATION INITIATIVES
Although the National Primary
Healthcare Development Agency
(NPHCDA) had some modest
achievement in its early years, it was
not until the advent of democratic
governance that it earnestly began
to formulate, establish and
implement policies that would secure
its place as the steward of primary
health care in Nigeria. Particularly
noteworthy amongst these are
reactivation of routine immunization,
polio eradication initiative, midwives
service scheme (MSS), primary
healthcare reviews, integrated
primary healthcare governance,
strengthening of the National
Health Management Information
System (NHMIS), and the bi-annual
Maternal Newborn and Child Health
Weeks (MNCHW).
Reactivation of Routine
Immunisation (RI) is being effected
through the development of required
policies and tools provision of
bundled vaccines and cold chain
equipment and active participation in
the entire immunisation process. The
fusion of the National Programme on
Immunization (NPI) with National
Primary Healthcare Development
Agency (NPHCDA) in 2007 marked a
major stride in the delivery of
integrated PHC services in Nigeria.
Nigeria has recently developed a
National Routine Immunization
Strategic Plan (2013-2015) which
highlights the Reaching Every Ward
with RI services (REW);
Accountability Framework for RI in
Nigeria (AFRIN) and Back to the
Basics: Health System
Strengthening, as its pivot
strategies. In keeping with the
determination of the nation to
interrupt the transmission of the
wild polio virus (WPV) by December,
2014, the NPHCDA stepped up its
polio eradication drive with the
establishment of the Polio
Emergency Operation Centres;
strengthening of the national and
sub-national immunization plus days
in addition to community
sensitizations and various
stakeholder meetings as strategies
to overcome socio-cultural and other
barriers to achieving this target.
The Midwives Service Scheme
(MSS) is a national initiative
designed to improve the quality of
(and access to) maternal and child
health services with the overall goal
of morbidity and mortality
reduction. The MSS utilizes a
cluster model of hub and spoke
arrangement in which four (4)
selected primary health care
facilities with capacity to provide
Basic Essential Obstetric Care
(BEOC) are clustered around a
General Hospital with the capacity
to provide Comprehensive
Emergency Obstetric Care (CEOC)
and which serves as a referral
facility (NPHCDA, 2013a). The
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scheme currently covers 250
clusters comprising of 1000 primary
health care facilities and 250
General Hospitals in Nigeria.
Quarterly Primary Healthcare
Planning and Reviews (PHC Reviews)
were introduced in 2010 to monitor
the progress in implementation of
PHC component of the National
Strategic Health Development Plan
(NSHDP). The reviews currently
utilize the Diagnose-Intervene-
Verify-Adjust (DIVA) model. This
methodology provides real-time
evidence to inform policy decisions
at all levels of decision making
across six (6) determinants of PHC
outcomes. These include availability
of commodities, human resources
and geographical accessibility
representing the supply side
determinants while on the demand
side, initial utilization, continuity and
quality coverage are examined during
the reviews. A key constraint in
sustainability of this intervention is
the poor buy-in of the various state
governments. Although all the thirty
six (36) plus the federal capital
territory have been trained on this
methodology, the NPHCDA reports
that as at 2013, only Lagos, Kaduna
and Nasarawa states have initiated
some level of institutionalization of
the process.
Attempts at addressing the series
of management challenges
confronting primary health care in
Nigeria have led to the renewed
interest in the establishment of a
unified state level structure that
should have the responsibility of
coordinating the management of
primary health care
systems/services (NPHCDA, 2013b).
Hence the need to integrate primary
healthcare governance within the
concept of ‘PHC Under One Roof’.
The PHC Under One Roof Initiative
aims to strengthen the primary
healthcare system through the
implementation of the Principle of
“Three Ones”- One Plan, One
Management and One Monitoring and
Evaluation System- for Primary
Health Care.
In response to the challenge of poor
health data management, the
Federal Ministry of Health (FMOH)
took leadership in the harmonization
of routine data collection tools in
2013. The harmonized National
Health Management Information
System (NHMIS) tools and revised
HMIS policy were developed and
adopted by the 56th National Council
on Health in 2013. The implication is
the institution of the web-based
District Health Information
Software (DHIS 2.0) as the national
platform for all health related data
Primary Health Care in Nigeria: From Conceptualization to Implementation
40
in Nigeria (FMOH, 2013). Nationwide
capacity building on this system and
policy is ongoing with support from
development partners and non-
governmental organizations.
Although data reporting rates have
increased since the commencement
of this system, the quality of routine
health data in Nigeria still leaves
much to be desired, this is further
compounded by the poor private
sector compliance and buy-in into
the NHMIS.
The bi-annual Maternal Newborn
and Child Health Weeks (MNCHW)
was launched by the Federal
Ministry of Health in 2009 to
provide the much needed platform
for the delivery of cost-effective
interventions aimed at reducing the
existing high morbidity and
mortality rates in children
(NPHCDA, 2011; Ordinoha, 2013).
During the week, primary healthcare
services are offered in health
facilities, from house to house, and
at community stations. The services
offered include immunizations,
anthropometry, distribution of food
supplements, distribution of
mosquito nets and health education.
IMPLEMENTING PRIMARY
HEALTH CARE IN NIGERIA
The great idea of grass-root health
care delivery as encapsulated in the
principles of primary health care
requires the strong commitment of
all stakeholders to make it work.
Stakeholders are those persons or
groups that have vested interest in
the delivery of primary healthcare
services and in healthcare decisions
(AHRQ, 2014). The key primary
health care stake holders include
the people, the government, and the
healthcare workers. The people need
to own primary health care through
adequate community mobilization.
Community mobilization is the
process of arousing the interest of
the people and encouraging them to
participate actively in finding
solutions to their problems (Olise,
2012). When the communities are
involved in the planning,
implementation and evaluation of
primary healthcare services, they
will not perceive them as being
dumped on them. Community
mobilization is a veritable tool for
engendering support for primary
health care, especially in the rural
areas where over 66% of the
Nigerian population live and the
worst health indices are found (NPC
and ICF Macro, 2009; FMOH, 2010).
Aspects of community mobilization
include community entry, community
dialogue, and operation of
development and health committees.
Government at all levels must
express, in practical terms, political
commitment through funding,
capacity building and system
support. They must put money where
their mouth is and translate the
great ideas behind primary health
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care into great programmes and
great services. Primary health care
services are not third-class services
meant for third-class citizens.
Therefore, adequate provision must
be made in national, state and local
budgets for quality healthcare
delivery using the primary
healthcare system. The role of
government is critical in promoting
access to essential and quality
health services (FMOH, 2010). This
can be channeled through the
building and maintenance of
infrastructure, training and
retraining of the workforce, and
provision of materials and equipment
for effective health care.
Health care workers involved in
primary healthcare delivery in
Nigeria include doctors,
nurses/midwives, community health
workers, laboratory
scientists/technicians, and health
assistants among others (Africa
Health Workforce Observatory
AHWO, 2008). To make primary
health care work, workers need to
contribute their quota to improving
quality service delivery and achieving
clients’ satisfaction. This they can
do through innovative utilization of
available resources, encouraging
patient participation in their care,
and promoting healthcare worker-
patient communication (Babatunde et
al, 2013). The disposition of
healthcare workers is very
important in enhancing public
perception and utilization of primary
health care services. Commitment to
duty, empathy, and a listening ear
are desirable traits in primary
health care workers that can
enhance service delivery.
CONCLUSION
The concept of primary health care
is still relevant to achieving
equitable and quality health care for
all Nigerians. However, a persistent
effort at implementation at all levels
is necessary to maximize the
benefits of this people-oriented
approach to health care.
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Vol. 6, No. 2, Pp. 35 – 43.
... The initiative thus became unsustainable for the government by the end of the third National Development Plan period. [7,9] Between 1986 and 1992, the late Professor Olikoye Ransome-Kuti, then Minister of Health, piloted a model PHC system in 52 ...
... LGAs. [6,7] Careful application of the principle of active community participation was largely responsible for the healthcare successes noted during this period. [7,9] In 1992, the National Primary Health Care Development Agency (NPHCDA) was created, heralding the third attempt to make PHC accessible to the grassroots. [7] The Ward Health System (WHS), which utilizes the electoral ward as the basic operational unit for PHC delivery, was established, and, subsequently, the Ward Minimum Health Care Package (WMHCP) was developed in 2001. ...
... [7] The Ward Health System (WHS), which utilizes the electoral ward as the basic operational unit for PHC delivery, was established, and, subsequently, the Ward Minimum Health Care Package (WMHCP) was developed in 2001. [7,9,10,11] However, five years down the line, service utilization, communities' response and participation were still below expectations. [12] This has been attributed to instability in governance during the military era, and the lack of visionary leadership and preparedness on the part of LGAs to shoulder all the responsibilities associated with the management of PHC. ...
... Politically, Nigeria operates a three-tier political system with a democratically elected federal government at the national level, state governments in the 36 states and the Federal Capital Territory, each of which is subdivided into local government areas (LGAs) managed by local government authorities [21,24]. Within the Nigerian health system, the local government authority manages the development, operation and provision of PHC services under the guidance of the National Primary Health Care Development Agency (NPHCDA) [24,25]. The state governments perform a technical role-training staff, overseeing the activities at the local government level and providing secondary health services while the federal government provides strategic oversight and manages the tertiary health services [21,24]. ...
... The health workers in this study described collaborations between different specialities which can provide a foundation for integration of PCC. The Nigerian PHC system promotes the PHC-underone-roof model where all services required by an individual are expected to be available at a single visit without any need for special clinics [25,35]. Two-way referrals between the primary, secondary and tertiary care levels direct patients from higher to lower levels and vice versa depending on the need [35]. ...
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Background Preconception care (PCC) services aim to improve reproductive health outcomes through the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. Countries that have deployed PCC services have policies that guide the services provided. In Nigeria, PCC is poorly developed and is often provided in an opportunistic manner with no guidelines in place to direct the provision. This study explored the opinions of policymakers and health workers about the feasibility of deploying PCC services in the country. Methods This study was a qualitative exploration of opinions about PCC service deployment within the Nigerian health system in which 39 in-depth interviews were conducted with policymakers at the federal and state tiers of government as well as health workers at the tertiary, secondary and primary levels of health care. The transcripts were analysed thematically using a hybrid of deductive and inductive coding on MAXQDA 2018 qualitative data analysis software. Results Four main themes emerged from the data—issues around policy for PCC, service integration and collaboration, health system readiness and challenges to PCC service deployment. While noting that the country has no PCC policy, participants identified existing policies into which PCC can be integrated. The participants also described the importance of policy to PCC provision and provided information on existing collaborations that can help the policy development and implementation process. Although many of the participants believed the health system is prepared for PCC deployment, they identified challenges related to policy formulation and implementation, including financial challenges that could hinder the process. Conclusion Deployment of PCC services in the Nigerian health system is achievable as there are existing health-related policies into which the guidelines can be integrated. However, there is a need to consider the possible implementation challenges and address them as part of the planning process.
... Politically, Nigeria operates a three-tier system with a democratically elected federal government at the national level, state governments in the 36 states and the Federal Capital Territory, each of which is subdivided into local government areas (LGAs) managed by local government authorities 21,24 . Within the Nigerian health system, the local government authority manages the development, operation and provision of PHC services under the guidance of the National Primary Health Care Development Agency (NPHCDA) 24,25 . The state governments perform a technical role -training staff, overseeing the activities at the local government level and providing secondary health services while the federal government provides strategic oversight and manages the tertiary health services 21,24 . ...
... The health workers in this study described collaborations between different specialities which can provide a foundation for integration of PCC. The Nigerian PHC system promotes the PHC-under-one-roof model where all services required by an individual are expected to be available at a single visit without any need for special clinics 25,35 . Two-way referrals between the primary, secondary and tertiary care levels direct patients from higher to lower levels and vice versa depending on the need 35 . ...
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Background Preconception care (PCC) services aim to improve reproductive health outcomes through the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. Countries that have deployed PCC services have policies that guide the services provided. In Nigeria, PCC is poorly developed and is often provided in an opportunistic manner with no guidelines in place to direct the provision. This study explored the opinions of policymakers and health workers about the feasibility of deploying PCC services in the country. Methods This study was a cross-sectional exploration of opinions about PCC service deployment within the Nigerian health system in which 39 in-depth interviews were conducted with policymakers at the federal and state tiers of government as well as health workers at the tertiary, secondary and primary levels of health care. The transcripts were analysed thematically using a hybrid of deductive and inductive coding on MAXQDA 2018 qualitative data analysis software. Results Four main themes emerged from the data – issues around policy for PCC, service integration and collaboration, health system readiness and challenges to PCC service deployment. While noting that the country has no PCC policy, participants identified existing policies into which PCC can be integrated. The participants also described the importance of policy to PCC provision and provided information on existing collaborations that can help the policy development and implementation process. Although many of the participants believed the health system is prepared for PCC deployment, they identified challenges related to policy formulation and implementation, including financial challenges that could hinder the process. Conclusion Deployment of PCC services in the Nigerian health system is achievable as there are existing health-related policies into which the guidelines can be integrated. However, there is a need to consider the possible implementation challenges and address them as part of the planning process.
... Despite the advent of orthodox health care, in developing countries, Nigeria inclusive, traditional health care continues to provide services and are still being utilized by the populace (Oyerinde, Harding, Amara, Garbrah-Aidoo, Kanu, Oulare, Shoo, & Daoh 2012;Bergstrom & Goodburn 2001, Kassaye, Amberbir, Getachew & Mussema, 2006. Fifty-three years since the introduction of orthodox health services in Nigeria, about 64% of pregnant women still utilize traditional birth attendant services, despite the availability of primary health centres across the country (National Population Commission and ICF International, 2013, Aigbiremolen Alenoghena, Eboreime & Abejegah, 2014). Factors like the care, the respect, accessibility, affordability and prayers by the traditional birth attendants have been discovered to be some of the reasons why most women prefer and utilize traditional birth attendant services (Akpabioet al 2014; Imogie, Agwubike & Aluko, 2002) Sixty percent of new-borns die before their first birthday globally (UNICEF, 2008). ...
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... Long years of military rule, subsequent dwindling of the budgetary allocation on health and the poor attitude of government towards the development of healthcare facilities has left WASH facilities in many PHCs either nonfunctioning or functioning with poor WASH facilities. As of 2005, PHCs made up over 85% of healthcare facilities in Nigeria (Federal Ministry of Health (FMOH) 2004; Aigbiremolen et al. 2014). Nigeria's healthcare is classified according to a three-tier system, namely tertiary, secondary, and primary healthcare. ...
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Assessment of water, sanitation, and hygiene (WASH) facilities in Primary Healthcare Centres (PHCs) and water source quality in parts of Southwestern Nigeria was conducted. Sixty-one PHCs in urban and rural areas were selected using a stratified random sampling technique. A WASH profile of the PHCs was conducted based on the water source type, type of toilet facilities, and handwashing practice using the Joint Monitoring Programme service ladder for monitoring WASH services in healthcare facilities. Water sources were tested for pH, electrical conductivity , total dissolved solids, turbidity, chloride, nitrate, and E. coli. Boreholes and hand-dug wells are the most prevalent water source type, and flush toilets and pit latrines are the major types of toilet facilities used. All but two PHCs engaged in handwashing practices. Water quality analysis results showed that chloride, nitrate, and turbidity were within the WHO drinking-water standards. Poor water quality and sanitation practices could expose health staff and patients to healthcare-associated infections. The study recommends the construction of safe, secure and accessible water sources and toilet facilities, provision of water treatment facilities, and the training of staff and patients on the significance of handwashing practices.
... Long years of military rule, subsequent dwindling of the budgetary allocation on health and the poor attitude of government towards the development of healthcare facilities has left WASH facilities in many PHCs either nonfunctioning or functioning with poor WASH facilities. As of 2005, PHCs made up over 85% of healthcare facilities in Nigeria (Federal Ministry of Health (FMOH) 2004; Aigbiremolen et al. 2014). Nigeria's healthcare is classified according to a three-tier system, namely tertiary, secondary, and primary healthcare. ...
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Assessment of water, sanitation, and hygiene (WASH) facilities in Primary Healthcare Centres (PHCs) and water source quality in parts of Southwestern Nigeria was conducted. Sixty-one PHCs in urban and rural areas were selected using a stratified random sampling technique. A WASH profile of the PHCs was conducted based on the water source type, type of toilet facilities, and handwashing practice using the Joint Monitoring Programme service ladder for monitoring WASH services in healthcare facilities. Water sources were tested for pH, electrical conductivity, total dissolved solids, turbidity, chloride, nitrate, and E. coli. Boreholes and hand-dug wells are the most prevalent water source type, and flush toilets and pit latrines are the major types of toilet facilities used. All but two PHCs engaged in handwashing practices. Water quality analysis results showed that chloride, nitrate, and turbidity were within the WHO drinking-water standards. Poor water quality and sanitation practices could expose health staff and patients to healthcare-associated infections. The study recommends the construction of safe, secure and accessible water sources and toilet facilities, provision of water treatment facilities, and the training of staff and patients on the significance of handwashing practices. HIGHLIGHTS Status of Water, Sanitation, and Hygiene (WASH) in Primary Healthcare Centres (PHCs).; Disparities in WASH facilities in PHCs with respect to urban and rural settings.; Classification of WASH facilities in PHCs into Joint Monitoring Programme's ‘Basic Service’, ‘Limited Service’, and ‘No Service’.; The impact of poor WASH facilities on the spread of COVID-19.; Government's efforts in improving WASH in PHCs.;
... 14,16 In Kaduna state, limited data exists regarding local prevalence of TB, but a recent analysis of sputum samples from suspected cases in one general hospital using GeneXpert confirmed TB in 17% of samples. 17 Following the Alma Ata declaration in 1978, primary health care (PHC) became the unified global strategy for attaining health for all 18 and since then, Nigeria has made substantial efforts towardsimplementingit. [19][20][21] The current strategy for the delivery of PHC in Nigeria is through the ward health system (WHS) inaugurated in 2001. ...
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Background: Despite earlier successes achieved in combating it, cases of tuberculosis in Nigeria are now on the increase, affecting more people and communities. Primary health care in Nigeria is through ward health system, designed to provide minimum health package to the communities including TB services. This study aimed to ascertain the capacity of PHC centres to provide TB services in Kaduna North senatorial district, Kaduna State, Nigeria.Methods: Four out of eight local Government areas in the district were randomly selected and one PHC per ward was recruited in the study. In each facility, questionnaires developed from the TB tracer items of the WHO service availability and readiness assessment tool were administered to the facility in-charges and TB/DOTS focal persons.Results: Forty four facilities were selected from Zaria, Sabon Gari, Makarfi and Kudan LGAs. Almost all facilities (98%) diagnosed TB clinically and 39 (90%) had anti-TB drugs available. National TB guidelines were lacking in 23 (52%) facilities and only 5 (11%) had additional capacity for sputum microscopy. While 35 (80%) TB/DOTS focal persons had received training on TB diagnosis and treatment, only 24 (55%)received training on TB/HIV co-infection and only 8 (18%) received training on multi-drug resistant TB.Conclusions: While TB services are widely available in the district, urgent need exists for all stakeholders to work together towards equipping those facilities with critical infrastructure that will improve their overall capacity, particularly with regards to comprehensive TB guidelines, laboratory diagnosis and personnel training for effective TB management.
... In 1978, following the Alma-Ata declaration, Primary Health Care (PHC) became the world's favoured strategy for attaining health for all (Aigbiremolen, Alenoghena, Eboreime, & Abejegah, 2014). Since then, Nigeria has made several efforts to domesticate this concept (Aregbeshola & Khan, 2017;Moshood, 2020;Oluwasogo & Ibrahim, 2020). ...
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Background: Sexually Transmitted Infections (STIs) are frequently associated with significant morbidity, crippling sequelae and adverse maternal and child health conditions. Despite widespread availability of Primary Health Care (PHC) centres in Kaduna State, the capacity of those facilities to provide STIs services remains unknown. This study aims to assess the capacity of PHC centres to provide STIs services in Kaduna State, Northwestern Nigeria.
... Nigeria affirmed this declaration and has made substantial efforts towards implementing its provisions throughout the federation. 2,3 In Kaduna state, PHC implementation is based on ward health system (WHS) that recommends at least one functional, properly-equipped and adequately-staffed PHC centre per electoral ward. 4 To meet this target, the Kaduna State government, through the state primary health care development agency (SPHCDA) embarked on an aggressive mission of renovating, equipping and staffing selected PHC centres across the state with many of them now fully operational, providing basic health services including routine immunization for infants and pregnant women. ...
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Background: The COVID-19 pandemic continues to disrupt health systems across the globe, preventing access to essential health services. Lockdown measures against the virus may impact negatively on immunization services. This study aimed to ascertain the capacity of primary health care centres in Kaduna North senatorial district to provide routine immunization services amidst a state-wide lockdown.Methods: Cluster sampling was used to select four among eight local Government areas in the district. Facility in-charges and RI focal persons were interviewed using service availability and readiness assessment tool, restricted to immunization tracer items. Paired sample t-test was used to compare the mean number of vaccine doses given in the first quarter of 2020 (pre-lockdown) and the number of doses given in the second quarter (lockdown period).Results: Forty four PHCs were selected from Zaria (29.6%), Sabon Gari (25.0%), Makarfi (22.7%) and Kudan (22.7%). In addition to well-trained RI focal persons, most facilities had vaccines and commodities available. Shortages were noted for EPI guidelines (46%), Meningitis-A vaccine (36%) and certain cold chain equipment (up to 18%). Tetanus-diphtheria (Td-1) doses given during lockdown period were significantly lower than pre-lockdown doses (Mean difference=-45.58, 95% CI: -74.78 to -16.38, d=0.48). No significant difference exists for infant doses.Conclusions: Despite widespread availability of PHC facilities, trained personnel, vaccines and commodities, gaps still exist in service delivery, cold chain practices and vaccine supply management. Lockdown measures significantly disrupted immunization services and effective risk communication was key to achieving sustained utilization.
... The world will only become healthy when the goal of Health for All is achieved. This include the developed and developing nations alike, the poor and the rich, the literate and the illiterate, old and young, women, and children [2]. ...
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Health care service is the main focus for all the developed and developing nations. Provisions of health facilities to all citizens is something that has been declared by the world health organization in Geneva 1978 at the international conference on primary health care Alma-Ata. However, the state of the health care systems in Nigeria is something to be worried looking at the high rate of infant and maternal mortality that usually occurs at the rural or local areas. This is sometimes attributed to lack of participation of local communities in the health care programmes organised by the government and other non-governmental organisations. Therefore, this paper assessed the level of community participation in health programmes organised by health care centres in northern Nigeria. The paper covers three (3) states of Bauchi, Kano, and Nasarawa from North East, North West, and North Central respectively. The paper is a survey research and uses primary data which were collected by means of structured questionnaires and focus group discussion (FGD). The results were analysed using simple percentage and presented using tables. The results were categorised based on demographic data and questions related the objectives of the research. The results show that community people in the selected states usually participate in health programmes Salihu Ahmed, Saadatu Dada Hassan, Usman Bappi-Assessment of Community Participation in Healthcare Programmes by Local Communities in Northern Nigeria EUROPEAN ACADEMIC RESEARCH-Vol. V, Issue 10 / January 2018 5552 at individual levels, traditional leaders as well as religious leaders. Traditional leaders have the highest participation in all the three states with 95% of the responses followed by individual with 94%. Participation of religious leaders is less with 44%. The results also indicate vomiting and diarrhea as the most commonly sign of most diseases among children in the rural areas with 89% response in all the three states. The paper recommends that government and NGOs should create more awareness and sensitization to local communities on utilizing health facilities as well as using indigenes of local communities among the health workers for ease familiarization and acceptability. It aslo recommends periodic meeting between health workers, traditional and religious leaders for mutual understanding towards providing health services to local communities.
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Primary Health Care (PHC) is a grass-root management approach to providing health care services to communities. Since the concept was first published in 1978, various countries have attained different levels of progress in implementing the strategy. This paper reviews the historical concepts that have driven primary health care in Nigeria. Current efforts at revitalizing primary health care in Nigeria include the Midwives Service Scheme (MSS), PHC Reviews, National Health Management Information System (NHMIS), and the Maternal Newborn and Child Health (MNCH) Week. In all, the role of the people, government, and health workers as critical stakeholders needs to be well defined and pursued in order to maximize the benefits of primary health care.
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The basic problems in delivery of health care in the United States and in Nigeria are similar; the major differences are in magnitude. Nigeria's Basic Health Services Scheme, now being implemented, is a bold effort to make quality health care accessible to the entire population. American health planners should look to such developing countries for concepts adaptable to our own health care delivery system. In developing primary care programs in particular, they should consider three basic components of the Nigerian scheme: (1) delegation of appropriate responsibilities to non-physician health providers in order to augment physician manpower in underserved areas; (2) location of training centers in environments similar to those where the trainees will serve; and (3) use of home-based care records to increase patient participation in health care.
National Strategic Health Care Development Plan
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Council Communique: 56 th National Council on Health (NCH) Meeting, Held at the Civic Centre, Ozumba Mbadiwe Road
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FMOH, Nigeria, (2013). Council Communique: 56 th National Council on Health (NCH) Meeting, Held at the Civic Centre, Ozumba Mbadiwe Road, Victoria Island, Lagos State 26 th -30 th August, 2013.