=By Funmi Falobi=
There is no doubt that the primary healthcare systems are imperative toward achieving success in the health sector. The centres are the first point of contact to the people especially at the grassroots in accessing healthcare services in the country. They provide the necessary healthcare delivery for the survival of the rural people, especially women and children.
However, while adequate health system is key to the survival of every society, in Nigeria, Primary Health Care facilities are bedeviled by low maintenance culture, inadequate accessibility to facilities and services, unethical attitudes of health personnel, ill-equipped and poor infrastructural services and human resource gaps.
Bothered by this trend, and in order to have more media reportage focusing on primary healthcare systems and its challenges, the Civil Society Legislative Advocacy Centre (CISLAC) organised a media workshop on” Basic Healthcare Funding in Nigeria” for journalists in order to unlocking potential in primary healthcare financing through investigative journalism.
According to Dr. Jibril Bashar, Health Policy and System Development Unit, Ahmadu Bello University, ABU, who was a guest speaker at the workshop, health financing is a shared responsibility in which clients need satisfaction but that due to attitude of healthcare personnel, they are not getting the necessary health outcomes.
Speaking on the topic, “Financing for Primary Healthcare: Harnessing Domestic Funding Opportunities, Enabling Policies and Legislation” he said many people lack financial protection to access healthcare services. He therefore suggested that health care financing mechanism should provide sufficient financial protection so that no individual or household is impoverished because of the need to use health services.
According to him, “Public spending on health is about $7 (N2,500) per capital in Low Income Countries (LICs), over $100 (35,500) in Middle Income Countries (MICs), and $2600 (923,000) in High Income Countries ( HICs). Nigeria‘s out-of-pocket spending is 95.7% instead of the recommended benchmark of 20%.”
He noted that “Nigeria is 75.7% below benchmark: na dthat while “Nigeria is expected to spend N34,260, government is spending N1,671 for individual in 2018”. He noted further that “Most spending is on curative instead of preventive” and that “Nigeria budgets 5.95% instead of 15% for health.”
“Social health insurance accounts for about 1% of all health spending in LICs, 15% in MICs, and 30% in HICs. With the rebasing of Nigeria’s economy during President Goodluck Jonathan administration, Nigeria is now a Middle Income Country (MIC) and this should reflect in our standard of living. The country is no longer eligible for cheap loans to revitalise Public Healthcare Centres (PHCs)”, he added.
“If we have huge amount for concurrent, nothing will come up but capital expenditure will bring development. Funds are limited, needs are insatiable. It’s not possible to give the ministries all the money they need even in developed countries hence, the 15% benchmark in health,” he said.
Speaking on the maternal mortality rate in the country, he said there is delay in identification, delay in decision making, delay in accessing facility and delay at the facility. According to him, “National Health Insurance Scheme (NHIS) will go a long way to reduce catastrophe government spending. It will go a long way in sharing the burden.”
He noted further that “Nigeria has to prioritise public spending in health according to its own morbidity, mortality, and availability of funds. A great degree of impact can be made in making accessible health interventions at a low cost through sustainable domestic financing.”
On the state of PHCs across the country, Bashar urged the media to liaise with legislators saying, “We are far from it but there is room for improvement. We have less than 36,000 doctors in Nigeria, inadequate personnel who don’t derive satisfaction at work, but we believe we will get there. We have our challenges but policies are coming up.”
In her submission, Health Editor, Independent Newspaper, Chioma Umeha, called on the media to focus on public education on communicable and non-communicable diseases, nutrition, maternal/child healthcare. “Without PHC you can’t achieve Universal Healthcare Coverage (UHC). PHC can meet 80% health needs of a person throughout his/her life time,” she said.
In his message, CISLAC Executive Director, Mallam Auwal Ibrahim Musa , said that the situation of primary healthcare worsens, as financial and political commitment from the government is lacking and in cases where there have been pronouncements, they have been partially or entirely not implemented.
“The ultimate goal of the project is to promote policy implementation of government’s commitment to primary healthcare in Nigeria. This is so because, the challenges facing primary healthcare in Nigeria are complex and essentially arising from poor legal and regulatory frameworks and implementation, economic and socio cultural challenges.
“Also, a dearth of infrastructure, health personnel and equipment plaque the Nigerian primary health care system. Thankfully, health is on the concurrent list of the government. This only signifies that if indeed the government wants to pay attention to the prevalent health condition it can easily be achieved through serious implantation of health policies and redeeming of pledges at all levels,” he said.
“With your mandate to informing the public, you have the role to investigate these initiatives of the government to ascertain the progress made since its launch and also engage our state governments to ascertain how they are faring in adopting these initiatives in their development agenda,” he urged the participants.
In addition, the Programme Manager, CISLAC, Chioma Kalu , declared that media play important role if the country will achieve revitalisation of PHCs. According to her, “we feel that if we’re going to ask government to revitalize PHC, the media have important role to play; legislators are also very key and we can’t by any chance ignore the media. To bring about change, the media will write and get attention of duty bearers in PHC. Media should be carried along and do their own investigative journalism.”
Speaking on “Unlocking Potentials from Primary Healthcare through Investigative Journalism” she said it is expected of the media and civil societies to speak up on the deplorable state of health centres in the country, bad attitude of health workers and their being overworked, poor payment, crowding by patients, few health personnel.
Focusing on accessibility to health centres, affordability of health services and attendance at health centres, Kalu said, “It’s time we start doing things differently in this country and have ideas on how to change things in the country. Healthcare affects us directly and media should focus on it. Healthcare actually supposed to be provided by the government. The media should play the watchdog role in order to rebuild the PHC.”
Consequently, participants among others, recommended full-fledged community consultation in planning and processes establishing Primary Health Care to enable ownership, attendance and monitoring; strategic community-oriented advocacy in demanding accountability from the policy and legislative realms and strengthened judicial institutions to enable social equity and justice, and appropriate implementation of existing legislation.