For the first time, medical officers, who are primarily custodians of healthcare of the citizens at the grassroots' Primary Healthcare Centres across the country, came together last week to brainstorm on the level of decadence at this tier of healthcare and how to move forward to ensure an effective care for over 70 per cent of Nigerians.
Opening the discussion was Professor of Public Health and Community Medicine, University College Hospital, Ibadan, Michael Asuzu, in a presentation titled: "An effective primary healthcare as the bedrock of a healthy nation: Wither Nigeria?"
He traced the antecedents of primary healthcare to the Alma Ata Declaration, among others, and the failure of the past administrations to fulfil many of the obligations and treaties that ought to make PHCs work in the country's system.
Asuzu also traced the burden and stunted growth in PHCs to self-infliction by governments, saying; "The decayed culture of making the medical officer of health take responsibility for his constituency, dearth of facilities and incentives to work with and poor environment, all contributed to the killing of primary healthcare in the country."s
Citing the recent outbreak of Ebola Virus Disease, Asuzu said this should indeed be a wake-up call for the government to realise how germane medical officers are as custodians of peoples' health.
He observed that the medical officers were indeed responsible for most of the surveillance and contact tracing as well as care, "which really underscores how valuable they are to controlling many of the infectious diseases ravaging communities."
Suggesting ways out of the imbrolglio, Asuzu listed "the establishment of the office of medical officers for all the LGAs, train and learn how to administer them properly, establish the offices of the district and zone community nurse-midwives, train and learn how to administer them properly, learn the proper nature of the medical and health practices and their teams and assist to have them run well, with all the adequate provisions thereof and Lend a voice and hands in the national reforms that are needed in these regards."
Speaking on the challenges facing PHC prior to the 2007 reforms in Lagos State, Associate Professor Olayika Olabode of the University of Lagos identified poor coordination by local governments, poor community participation, dilapidated infrastructure, inadequate personnel and staff motivation among others.
She, however, observed that with the new health reforms, there was largely a turnaround in the health system for PHCs in Lagos, pointing out that even as government has made effort to rebuild to some extent, the population and attendants at the refurbished PHCs are still overwhelming, largely because many adjoining states are yet to reach the level of standard in the state, prompting overcrowding and inadequacy of facility and overwork of staff.
She encouraged among others, "the need for engagement of private practitioners in public-private partnership initiatives for government facilities and Health Insurance Schemes and training of medical officers as Medical Officers of Health (Distance Learning)", as some ways to solving the problems.
Discussing how financing is key to PHC, Commissioner for Health, Dr Jide Idris, observed among others, population, ability to mobilise enough money to meet desired expenditure, disease burden, economic structure, huge informal sector, budgetary allocation and demand from other ministries, departments and agencies, high out-of-pocket system and how private facilities provide healthcare for over 55 per cent of the population in the state as well as challenge of quality issues and human resource challenges continue to plague healthcare delivery.
He, however, noted that in spite of the challenges to healthcare, healthcare insurance remains the model to solving most of the financing issues generated by health.
According to Idris, "Health risks are usually insurable; in that health crises occur to individuals mostly independent.
"In health insurance there is usually interval between time of payment and time of use of healthcare services. This makes it possible demand for health care services by members who ordinarily could not afford the real cost of services.
The commissioner was not mindful of the risks to health insurers though saying that some of these are income, religion, ethnicity and the quality of care expected by the insured but insisted that community-based health insurers remained the viable option because it gives ownership in the hands of the people who are in the position to monitor and evaluate, with government as supervisor.
Source: Daily Independent
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