Neglected Primary Healthcare System Impacts Nigeria’s Epidemic Preparedness

In Nigeria, the healthcare system operates at three levels: tertiary, secondary, and primary. Each level corresponds to specific responsibilities assigned to the federal, state, and local governments. However, in recent years, the focus has primarily been on the Federal Government, while the states and local governments have received less attention and support.

According to Isaac Adewole, a former minister of health, primary healthcare falls under the purview of local governments, not the Federal Government. Adewole emphasized that while the Federal Government manages federal medical centers and university teaching hospitals, state governments are responsible for general hospitals, and local governments concentrate on primary healthcare. This allocation of responsibilities is established through the National Primary Health Care Development Agency (NPHCDA).

Unfortunately, the local government system in Nigeria is largely dormant, and state governors have been accused of interfering with its operations, including the functioning of primary healthcare centers (PHCs). In many states, local government chairmen are appointed by governors rather than elected, leading to a lack of autonomy and effectiveness within the local government system.

The Primacy of Primary Healthcare in Epidemic Preparedness

The importance of primary healthcare was recognized globally in 1978 during the Alma-Ata Conference in Kazakhstan. Leaders affirmed that primary healthcare is the first point of contact for individuals, families, and communities, providing essential healthcare services where people live and work. The Alma-Ata Declaration highlighted the integral role of primary healthcare in the overall health system.

Forty years later, in 2018, global leaders reaffirmed the significance of primary healthcare through the Astana Declaration in Kazakhstan. The conference emphasized that strengthening primary healthcare is the most effective approach to enhancing physical and mental health, social well-being, and achieving universal health coverage (UHC) and Sustainable Development Goals. Despite these declarations, primary healthcare in Nigeria continues to suffer from neglect and inadequate funding.

Dr. Claire Standley, a public health expert, emphasizes the need to revitalize the community approach to healthcare, which is at the core of primary healthcare. By strengthening the foundation of the health system, Nigeria can improve access to quality healthcare and move closer to achieving universal health coverage.

Impacts of Poor Healthcare Funding on Epidemic Preparedness

States play a crucial role in epidemic preparedness, and it is their responsibility to ensure the healthcare sector is adequately prepared to respond to health emergencies. Dr. Francis Faduyile, former president of the Nigeria Medical Association, states that when states fail to fulfill this duty, the healthcare system becomes fragile and unable to function effectively. Inadequate funding and preparation for epidemics lead to increased expenditure, personnel shortages, and weakened healthcare systems.

Dr. Ugochukwu Golibe, another public health expert, highlights the interconnectedness of states within Nigeria. When one state struggles with healthcare funding, it affects neighboring states due to population movement. Therefore, the campaign for adequate healthcare funding should be a collective concern for all states.

One critical aspect of preparedness is having enough hospitals in remote communities. While Nigeria has over 39,000 operational hospitals and clinics, these numbers are still inadequate to meet the growing population’s healthcare needs.

Need for Released Budgeted Funds

Allocating a specific amount for healthcare is essential, but it is equally important to ensure that the allocated funds are released and utilized. Some states allocate a small percentage of their budgets to healthcare but fail to release the full budgeted amounts within the designated year. This lack of financial commitment hampers the ability to strengthen the healthcare system and adequately prepare for epidemics.

For instance, in 2021, Oyo State allocated N13.7 billion for healthcare, but only N9.8 billion (71.3 percent) was released. While a release rate above 70 percent is considered a success by some, experts argue that full allocation and utilization are necessary to drive progress in the healthcare sector.

Dr. Faduyile emphasizes that financing healthcare is a wise investment. He urges states to allocate more funds to healthcare and ensure the proper functioning of PHCs, as they play a critical role in epidemic preparedness and response.