Improving Primary Health Care (PHC) facilities in Nigeria and ensuring that they are better positioned to meet 80-90% of the health needs of the citizens will require a collaborative effort of government and individual stakeholders.
In Ako community, just a few kilometres from Abuja City Gate, Favor Onoje is now a happy mother. In 2023, she experienced a series of complications during her first pregnancy. "My blood pressure was alarmingly high, and I had partially lost my sight. I was in bad shape, and my husband abandoned me and my unborn child to faith." However, Dr Chito Nwana stepped in at the right time. She raised the alarm and referred me to Kuje General Hospital for surgery and paid for the surgery. Thanks to her, my child and I are fine and doing well". Favour said.
Primary Healthcare Centres (PHCs) require significant resources for infrastructure, human resources, medical supplies, and ongoing operational costs which the government plays an important role in funding. A multipronged approach ensures a more resilient and adaptive healthcare system capable of efficiently responding to the population's needs.
A women-led collaboration
Improving PHCs must be a collective responsibility involving community members, government, and the private sector. One such collaboration is the PHC project spearheaded by the Vaccine Network for Disease Control (VNDC)- a woman-led organisation dedicated to delivering impactful programmes focused on women, adolescents, and children to improve healthcare access in underserved communities.
The project, which began as a pilot in 2021 within the FCT municipal, had an initial needs assessment conducted. The needs assessment aimed to assess the state of primary healthcare centres within Abuja Municipal, intending to improve them. The outcome of the assessment revealed major deficits in electricity, water supply, infrastructure integrity, human resources, security, and service delivery.
The project, began in 2021 with funding from the United States Agency for International Development (USAID) Integrated Health Program (IHP) -supported coalition and went on to raise at least 50 million naira through voluntary contributions. These funds were directed towards the revitalisation of four PHCs (Gosa, Area II, Damangaza and Kuchingo PHCs) within the municipal. Following the completion of the pilot, the project further evolved into the "Micro-Adopt a PHC initiative".
Micro-Adopt a PHC
The Micro-Adopt a PHC Initiative, currently being implemented in the Federal Capital Territory, is an innovative resource mobilisation and accountability model aimed at supporting the government in providing essential primary healthcare services through PHCs within communities in Nigeria. The model is a system-flexible adoption process where individuals, communities, or organisations can identify various aspects of PHC service delivery or infrastructure chain to support through a system referred to as "adoption".
Similar to the "Adopt-A-Highway" programme in the United States, Adopt-A-PHC involves a multi-stakeholder process aimed at establishing and sustaining a long-term partnership between health facilities and individuals or organisations. The goal is to enhance community support for primary healthcare. This initiative is also characterised as a "public-private resource mobilisation and accountability initiative" designed to aid the government in delivering essential primary health services to underserved communities. It utilises existing philanthropic mechanisms such as personal donations and corporate social investments (CSIs) from private businesses to generate domestic funds for primary healthcare.
The adoption process was expanded into a detailed practical guide by Vaccine Network for Disease Control (VNDC). This guide stipulates the stepwise process and responsibilities for intending adoptees and the government. The adoption model allows local organisations and community members to take ownership and demand accountability across the various service delivery or infrastructural chains within the PHCs. The guide also clearly stipulates how community members who opt in can be levied as a means of supporting the PHCs within their communities.
"Through the Micro-Adopt a PHC Initiative, we aimed to create a sustainable system for the healthcare centres that involved everyone. This inclusive approach, where even the market woman can contribute has nurtured a sense of ownership in these communities, empowering the community members to hold all stakeholders, including the government, accountable for the quality of these facilities."- Chika Offor, CEO, Vaccine Network for Disease Control.
A look at Gosa Primary Healthcare Centre
Gosa PHC is one of the many PHCs that has benefitted from the Micro-Adopt a PHC Initiative. It is located in the heart of the Abuja Municipal Area Council and was established in 2014. However, several years after the establishment of Gosa Primary Health Care Centre, it became a shadow of itself due to neglect and underfunding. This situation led to its adoption by, Dr Chito Nwana, a Consultant Gynaecologist and founder of the Tabitha Medical Centre. Dr. Chito herself, a gynaecologist, decided to adopt the Maternal Newborn and Child Health component in the health centre after a medical outreach her team had organised in Gosa community.
"I have been here since 2019, and to be honest, the situation was terrible before this intervention, so bad, sometimes I have to spend my transport to support patients with drugs". Mrs Phoebe Ifeanyichukwu , Assistant Officer in Charge, Gosa Primary Healthcare Centre said.
So far, over 377 patients have benefited as a result of the adoptions within Gosa PHC with 166 females, 25 males and 106 children. Some of the services that benefitted from the adoption include the reproductive health unit, prenatal, labour and delivery unit, postnatal and child health and tuberculosis care.
"The Maternal Newborn and Child Health rates have greatly improved since the adoption in 2021 with over 300 persons benefitting directly or indirectly from this support". Mrs Phoebe shared.
Strengthening this model
One potential challenge in the VNDC model, is the issue of equitable distribution of donor resources. Since adopters may decide which facilities they wish to invest in and how much they are willing to invest, in any chosen facility, some facilities -- and communities -- may receive significantly less support than the others.
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Another challenge lies in the bureaucratic bottlenecks of getting the Memorandum of Understanding (MOUs) signed. Dr Chito also highlighted some of the challenges she faced engaging with the government. She highlighted that while progress is being made, the absence of a clear implementation framework for engagement has resulted in lower-than-expected impact. "Getting a Memorandum of Understanding (MoU) signed can linger for up to a year, and even subsequent approvals for various initiatives is often delayed". She said. The government can streamline such bureaucratic processes by developing a standardised and expedited process for the signing of MOUs between adopters and the government.
Encouraging individual participation can be beneficial for such a project, however a key concern for such initiatives is the sustainability. Micro-level adoption suffers resource constraints and because it is typically reliant on individual goodwill, an adopter's support may come to an end, at any time. Primary Healthcare Centres (PHCs) remains the most inclusive and cost-effective way to provide health services and for achieving Universal Health Coverage (UHC). However, to address the scalability and sustainability challenges of the Micro-adopt a PHC initiative by VNDC, it is crucial to implement a more structured and inclusive approach that ensures equitable distribution of donor resources, streamlines bureaucratic processes, and enhances long-term sustainability.
Other models that seek to leverage private sector funding include Private Sector Health Alliance of Nigeria's Adopt-A-Health Facility programme and the PharmAccess Access to Finance framework.
