National Health Fellows Programme: An Idea Whose Time has Come, by Rahma Olamide Oladosu
Health is a human right and everyone, irrespective of location or socioeconomic status has a right to healthcare at their point of need. For a heavily populated country like Nigeria where there are income inequalities, there is a need to examine the healthcare system through the lens of health equity, which is accessible, affordable, and offers medical assistance for all that need it. This brings to the fore the importance of primary healthcare which is the bedrock of every health system and should be the first port of call for most Nigerians when seeking good health.
Primary Health Care (PHC) provides the most viable route towards achieving the aforementioned mandate. Primary Health Care is defined as a whole-of-society approach to health and well-being based on the needs, peculiarities and preferences of individuals, families and communities.
Generally, PHC serves as the first contact of individuals, families and communities with the national health system. It is a deliberate and systematic effort to develop a health care system that caters for the needs of majority populations and poor citizens, at an affordable and sustainable cost and with a guarantee of quality service through government primary health care centres and faith-based clinics in rural and suburban areas.
Given the importance of primary health care, nations across the world devote considerable efforts and resources towards establishing and maintaining viable PHC systems. As a signatory to the United Nations’ Charter and member of the World Health Organisation (WHO), Nigeria has the mandate to do the same and indeed has made efforts to provide primary healthcare to its citizens.
Nigeria operates a three-tier system of health care delivery in which the federal government is responsible for the provision of health services at the tertiary level (teaching hospitals), the state governments provide same through secondary hospitals, while the local governments deliver health services through the primary health care centres (PHCs).
However, primary health care service delivery is extremely poor in Nigeria and it is in fact, one of the worst performing ones globally.
With the coverage of promotive, preventive, and primary health care interventions being low, the universal health service coverage index – defined as the average coverage of tracer interventions for essential universal health coverage – are a dismal 39%. As a result, Nigeria significantly underperforms on key health outcomes as maternal mortality rate is 243 per 100,000, Proportion of births attended by skilled health personnel are 58.6%, Under Five Mortality Rate is 89 per 1000 births, and Neonatal mortality rate is 37 per 1000. These indices are unsatisfactory and have far reaching implications on the health and wellbeing in Nigeria.
The absence of a fully developed and functional primary health care system continues to constitute a development challenge in Nigeria. The situation has threatened the achievement of health-related Sustainable Development Goals (SDGs) as well as other health objectives. Efforts by successive governments towards the realisation of a functional primary health care system has often been beset by diminutive efforts at accountability, data gathering, openness and sustainability. Other limiting factors include limited institutional capacity, corruption, unstable economic, and political context and poor financing.
Also, the increasing brain drain, and deficient sizes of the health workforce has put a major strain on the PHC system, with the existing workforce preferring employment in the secondary and tertiary healthcare systems, thus leaving the PHC systems underequipped.
In his response to this challenge and determination to construct over 8,800 new primary healthcare centres across in the country, President Bola Ahmed Tinubu, recently approved the establishment of the National Health Fellows Programme, with young Nigerian fellows to be engaged in all the 774 local government areas in the country.
He said the sole reason for this is to have young well-trained fellows who will serve as fiduciary agents to monitor and track Primary Healthcare Centre development and performance, which is to be assiduously measured against all financial inflows to the centres nationwide and the programme subsequently boosting the workforce in PHC system in the process.
All of this came right after the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, had reaffirmed the unrelenting commitment of the present administration in transforming the healthcare system to attain Universal Healthcare Coverage for Nigerians.
The Minister, who made this statement recently when he convened the 6th meeting of the BHCPF Ministerial Oversight Committee in Abuja stated that health transformation, renewal and accessibility would be achieved with the approval of a Sector Wide Approach (SWAp), and the Health Sector Renewal Investment Program (NHSRIP).
While speaking on the elevation of Nigeria’s primary healthcare delivery through SWAp, the assessment revealed the need for reforms in the Basic Healthcare Provision Fund (BHCPF) its programmes, operations, fiduciary system of accountability and public trust adding that all states and Federal Capital Territory have committed to a remediation plan, pledging to improve health services for Nigerians.
Dr. Pate, who served as the CEO, National Primary Healthcare Development Agency (NPHCDA) between 2008 – 2011, announced the approval of N25bn for the Agency and the National Health Insurance Authority gateways.
“Recognising the need for a more robust governance structure and clearer guidelines, the Ministry and its development partners are committed to making healthcare services accessible to Nigerian women, children and for all citizens, especially those in the vulnerable groups”
“The goal, in line with NHSRIP is to reduce the necessity for patients to travel long distances for care thereby qualitatively and equitably improving the overall health and wellbeing of Nigerians”, he asserted.
He further stated that the guidelines will be revised to cover health services rendered to the indigent population while aiming to reduce maternal mortality rates, out- of- pocket payments and standardised quality of healthcare across primary healthcare facilities.
Pate assured that for NPHCDA gateway, the revision will include measures to address inequalities, provide additional resources for state supervision, support frontline workers, ensure availability of drugs and commodities at over 8,500 Primary Healthcare Centers across Nigeria and strengthen financial management, transparency and accountability.
The focus of President Tinubu and Professor Pate on primary health care is quite commendable. What is even more interesting is that the latest initiative is aimed at building up solid human capital for primary health care subsector which has suffered from the tendency of health workers to seek greener pastures elsewhere.
