Abuja — "Pregnant women and patients requiring medical care are compelled to embark on a two kilometre journey to access fundamental laboratory and scanning services at other facilities, due to the PHC's lack of essential medical equipment and deteriorating infrastructure".
This account came from a weekly Community Health Watch report produced by Nigeria Health Watch, where community reporters share the experiences of people in Niger and Kano State regarding the quality of healthcare they receive at primary health centres.
These stories offer a glimpse into the challenges of healthcare delivery at the grassroots level. Primary healthcare is meant to be the first point of contact for individuals seeking medical services. The Alma-Ata Declaration of 1978, which focused on health equity, laid the foundation for global health by emphasising the critical role of primary healthcare which is supposed to deliver 80 -90% of an individual's health needs in the course of their lifetime. However, this has not been the case even despite the attempts of Professor Olikoye Ransome-Kuti to implement a primary healthcare policy in Nigeria based on the Alma-Ata Declaration.
Key barriers like inadequate infrastructure and funding have limited its success.
Winning an Award for Primary Health Care
So, why are we not seeing improvements in primary healthcare, despite the many initiatives and funds dedicated to improving outcomes? Political leadership plays a crucial role in accelerating progress toward achieving effective primary healthcare. This is why the Primary Health Care Leadership Challenge Fund (PHC-LCF), a strategic initiative designed to address critical leadership gaps within the Primary Healthcare (PHC) system, is vital. Strengthening leadership ensures better decision-making, accountability, and resource allocation in healthcare delivery.
Conceptualised to build the capacity of states to deliver high-quality and sustainable health services to all citizens, the challenge encourages states to fully implement the "Primary Health Care Under One Roof" initiative, as well as the Abuja Declaration and Seattle Declaration. The initiative is a collaborative effort between the Federal Ministry of Health and Social Welfare, the Nigeria Governors' Forum, and the National Primary Health Care Development Agency (NPHCDA), with technical assistance from UNICEF and financial support from the Bill & Melinda Gates Foundation and the Aliko Dangote Foundations.
In its second year of awarding, Borno State emerged as the inaugural overall winner of the Primary Health Care Leadership and Governance Award (PHC-LCF) in 2023. This achievement included both the Overall Best Performing State award and the Zonal Prize for the Northeast.
The selection process for the best performing state was conducted by an Independent Judging Panel (IJP), comprising 17 members who reviewed and validated the report of the Independent Verification Agency (IVA). The IVA assessed 12 key indicators, including leadership and governance, financing, service quality, data quality for monitoring, and service coverage.
In total, 14 awards were presented at the 2024 PHC-LCF. These included:
Six awards for the Best Performing State in each of the six geopolitical zones with a prize fund of $500,000
Six awards for the 1st Runner-up in each of the six geopolitical zones with a prize fund of $400,000
Two special awards: one for Most Innovative State, given to Gombe State, which introduced an electronic system in 2021 to monitor health worker absenteeism. This system, integrated with payroll and performance, saved the state 800 million Naira annually.
The award for the Overall National Best Performing State in 2024 was presented to Anambra State, which earned an additional $700,000 based on the PHC Performance Monitoring Framework. His Excellency, Governor Charles Soludo, accepted the award during the Gala evening, which celebrated this significant achievement. This recognition highlights Anambra State's achievement in delivering primary healthcare services and performance in health system management.
The Role of Citizens in Strengthening Primary Health Care Delivery
"Accountability is the glue that ties commitment to the result." -- Bob Proctor
While the winning states of the Primary Health Care Leadership and Governance Award (PHC-LCF) deserve recognition for their achievements, the real winners should be the citizens of these states. The transformation of the primary healthcare system should ultimately result in the delivery of quality and affordable healthcare, leading to improved health outcomes. This progress requires greater citizen accountability.
Citizens must play an active role in tracking how the funds awarded to states for the PHC-LCF are utilized. In addition, they must hold their governments accountable by demanding transparency and asking important questions about the delivery of primary healthcare services.
For example, a parent with a child suffering from a high fever or diarrhea should be able to visit the nearest primary healthcare facility rather than rushing to a tertiary hospital, which may not be the most cost-effective option. This highlights the need for better integration of primary, secondary, and tertiary care to ensure a seamless continuum of care for all healthcare seekers.
In his keynote address at the PHC Leadership Award, the Coordinating Minister of Health & Social Welfare urged governors to be "deliberate in investing in the health of your people, not only because health is a fundamental human right, but also because the citizens you govern deserve to survive, thrive, and have access to basic healthcare when they need it."
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Initiatives like Tracka play an important role in tracking the implementation of government projects. By using various platforms, they amplify their findings, promoting transparency and accountability. However, accountability must be a collective effort. Communities need to be empowered with information to hold decision-makers accountable for their actions.
The recent Supreme Court ruling on Local Government autonomy now requires local government councils to take greater ownership and accountability for primary healthcare delivery. This shift highlights the need for capacity strengthening in primary healthcare systems. Besides community members also bear the responsibility of monitoring the performance of primary health services.
While this may seem like a complex process, the key to accountability lies in data. This data, which originates from the community, should not only inform decision-making but also serve as a tool for accountability.
So until the next PHC-LCF, citizens must look out for continued improvements in healthcare delivery, transparency in fund usage, and a stronger commitment from local governments to prioritise primary healthcare services.
