By Victor Okeke
A core aspect of primary health care (PHC) is that it operates in the local community and seeks to address all health problems of all people. The aims of primary health care overlap with those of universal health coverage, which aims to ensure access to essential health services and safe, effective and affordable essential medicines and vaccines for all people. Thus, strengthening primary health care and the attainment of universal health coverage are both important current national health policy initiatives in Nigeria. Primary health care is essential and affordable care that is accessible to everyone in the community, and includes health promotion, disease prevention, health maintenance, education and rehabilitation.
The concept of universal health coverage, as noted in the United Nations’ 2015 Sustainable Development Goals, is an aspiration to provide all people with access to essential high-quality health services and to safe, effective and affordable medicines and vaccines, while ensuring financial risk protection by providing care regardless of a person’s ability to pay for it. It is clear from these two definitions that there is overlap between the aims of primary health care and universal health coverage; indeed, many have noted that primary health care is essential to achieving universal coverage. Strengthening primary health care therefore represents a fundamental shift from health care delivery focused on treating disease toward health systems that address the specific health needs of patients and communities.
Inherent in strong primary health care is reduced reliance on professional care by supporting people to develop and maintain autonomy and to take responsibility for aspects of their own health. In Nigeria’s Sokoto State, the health status indices are among the worst in the entire. Vaccine-preventable diseases and infectious and parasitic diseases continue to exact their toll on health and survival of the Sokoto people, remaining the leading causes of morbidity and mortality. Current health indices are poor in the state as indicated by the Nigeria Demographic and Health Survey (2018 NDHS). Crude Birth Rate is 41.7 per 1000, Infant Mortality Rate is 100 per 1,000 live births, Under Five Mortality Rate is 166/1000 live births and Maternal Mortality Rate 850/100,000. Current use of contraception, any method is 2.1%, with any modern method as 1.9%. Other maternal health indicators in the state include 13.8% receiving antenatal care from a health professional, 6.8% , percentage of pregnant women whose last live birth was protected against NNT, percentage delivered by a health professional is 5.1%; and percentage delivered in a health facility is 4.4%. For this reason, the Centre for Social Justice (CSJ) Nigeria is working to improve health outcomes in Sokoto State under Development Alternatives Incorporated’s (DAI) implementation of the USAID Nigeria, State Accountability, Transparency, and Effectiveness (State2State) project.
The programme is focused on budgeting for Primary Health Care (PHC) as an entry point for improving universal health coverage in Sokoto State. PHC is the first point of contact of an individual with the health system. The overall goal of the programme is to contribute to improvement in universal health coverage in Sokoto State through reforms of the PHC. The project has three objectives: (1) to engage for the improvement of service delivery in primary healthcare through the budgeting process (2) to build the capacity of state and non-state actors on transparency, accountability and effectiveness in the primary healthcare delivery and budgeting process (3) to increase advocacy, civic and media engagement on improving primary healthcare services. These will ultimately improve Sokoto State’s movement towards universal health coverage and the realisation of SDG 3 and the goals of the National Health Policy (NHP). These objectives address the identified problems of poor primary health care indicators which are far off from the requirement of the Sustainable Development Goals (SDGs), National Health Policy, etc. the other challenges are poor funding and low domestic resource mobilisation for health.
To achieve universal health coverage in Sokoto State and indeed in the whole of Nigeria, reforms should focus on strengthening primary health care to ensure equity and cost containment. These reforms should be built around three pillars: everyone — including the poor and patients with the greatest health needs — must have access to care; the health care must be of good quality; and accessing health care should not be prevented by financial barriers.
Universal health coverage is expected to increase the use of health care facilities by members of lower socioeconomic groups, which might be expected to increase health care expenditure in the short to medium term, given that people with high unmet health needs will begin to access care. Anticipating spending increases could deter governments from making the investment required to achieve universal health coverage, which is why health care reform needs to be understood and committed to over the long term, with a particular focus on strengthening primary health care.
Strong primary health care will improve population health through integration of primary care services with public health, thus lowering overall health care expenditure over time, improving the performance of the health care system and ensuring the provision of improved equity and access for everyone. The improved efficiency and cost-effectiveness of care are found in enduring and substantial savings in other parts of health care provision. This is why primary health care should be regarded as a core component in realising the ambitions of universal coverage as a sustainable development. It is also expected that health system reforms should be monitored with indicators that reflect the core characteristics of primary health care: continuity of care, person and population-centredness, coordination of care, prevention, health promotion and patient autonomy.
Okeke is a programme officer with the Centre for Social Justice, Nigeria
