“Primary health care is essential healthcare 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 the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.
Universal health coverage means that people should have equitable access to quality health services where and when they need them and this should be based on strong, people-centred primary health care.
Good health systems are rooted in the communities they serve. Primary Health Care (PHC) is meant to be the portal of entry into the health care system, and it is aimed to tackle the main health problems of a community by providing preventive, curative, promotive and rehabilitative health care. Increasing access to treatment can be achieved by leveraging on the primary health care by providing first contact, continuity, and integration of care.
In Nigeria, a significant proportion of the populace live in rural areas and the general household survey facilitated by the World Bank for the National Bureau of Statistics found that 75% of rural respondents reside within two kilometres of a public PHC facility, while 95% resided within eight kilometres. This suggests that many communities are inproximity to PHCs centres in Nigeria, however, proximity alone does not gurantee access to quality health care.
Studies have found that despite the geographic access, the PHCs presently serve less than 20% of the population and most of the PHCs are in deplorable condition. It is also often perceived as care for people of low socioeconomic status. Nevertheless, the role of PHC centres in providing access to care for the populace in a sustainable manner is pivotal to achieving universal health coverage. However, far too few people are receiving appropriate services in PHC in resource-constrained settings like Nigeria which begs the question:what does it mean to have a healthcare facility in a community if that facility cannot provide the care people need?
In Nigeria, inadequate infrastructure, limited staffing and inadequate resources continue to affect healthcare delivery especialy in underserved communities. A study conducted by Kress et al using secondary data sources showed that although the number of PHC centres at the ward level exceeds the minimum requirement set by National Primary Health Care Development Agency (NPHCDA), health workers knowledge and ability to correctly diagnose common diseases was 43%. In order for PHCs to function effectively, proper structuring needs to be developed within the PHC centres includes skilled personnel, diagnostic tools, infrastructure, essential medications and effective referral systems to facilitate effective management of diseases. Thus, how do we assess the service readiness of the PHCs in rural local areas across the country.
How effective are the tools: case notes, continuation sheets, patients’ vaccination record card, computers, telephone, electricity, and other basic infrastructure required for PHC’s efficiency in management of diseases. Are there verifiable data on the challenges, barriers, and ways to improve access to health care in the rural communities available?
Information on the capability of PHC centres to manage communicable and non-communicable disease are limited, making it difficult to plan appropriate responses, identify gaps and assess the quality and effect of services provided. Are essential medications available? Are the available diagnostic tools functional? Is there a need for additional health workforce? What challenges have been identified that prevents people from accesing hewlthcare?
These questions deserve a greater attention as it can help policymakers, and stakeholders unerstand the challenges in healthcare delivery and develop appropriate interventions. Critical areas to be strengthened; closing the gap between what is needed and what is currently available to reduce the burden, healthcare cost and human suffering due to the lack of access to healthcare at the facility and the community levels.
One major opportunity lies in the adoption and scaling up of the use of technology to improve duty of care, systems, processes, procedures, workflows, training, and capacity building for knowledge management, efficiency and effectiveness. This however should not be seen as a replacement for basic resources required as its efficiency is dependent on a reliable infrastructure, personnel and funding.
Target 3.8 of the SDGs underscores the need to attain universal health coverage for all. The seismic events of 2020 led to wide disruptions in healthcare globally. Evidence informed analysis infers that the most important pathway towards achieving universal health coverage is accessible and affordable primary health care. Unfortunately, the poor state of the PHCs in the country make the target seem like a mirage.
Essentially broader perspectives are to be promoted towards strengthening health systems, while promoting evidence-based programming through implementation and research for private sector intervention.
Ultimately, access to basic health services is more than the distance between the facolity and the community but also about whether the facility has the necessary resources to provide quality care.
Achieving a universal health coverage is beyond having a healthcare center but ensuring that it remains, functional, accessible and capable of providing quality health services. Having a PHC is only the start, ensuring that it delivers proper services sustainbly is what truly matters.
