Nigeria continues to be the second-largest contributor to maternal and child mortality globally, many years after the Alma-Ata declaration in Kazakhstan, which called for expanding the perception and scope of hospitals and doctors beyond just hospitals and doctors to include social determinants and social justice.

Primary healthcare (PHC) is the foundation of the healthcare system: it is a level at which non-emergency, preventative health issues should be managed or resolved. The first level of contact of individuals, families and communities with the national health system is the primary health centre, so communities must be able to afford the cost of healthcare at these centres to avoid more serious and expensive tertiary healthcare in hospitals. Thus, it is also important that a country can afford to maintain primary health centres at every stage of development.

PHC is also the level at which health promotion and education efforts are undertaken, and where patients in need of more specialised services are connected with secondary care. Primary health care was established essentially to bring health closer to the people, in the community, and through their full participation.

Currently, the state of the PHC system in Nigeria is shocking: only about 20% of the 30,000 PHC facilities across Nigeria  are fully functional. The rest of the PHC facilities cannot provide essential primary healthcare services. Centres face problems including: poor staffing, poor distribution of health workers, poor quality of health care services, poor condition of infrastructure and lack of supply of essential drugs.

The inability of PHC centres to provide basic medical services to the Nigerian population has increased the influx of patients to secondary and tertiary healthcare facilities. This has led to long queues in these hospitals and worse patient experiences. The Nigerian government spends less than 4% of its budget on healthcare,  and instead, the country depends on donors and NGOs to finance its health projects. Response and management of diseases are left in the hands of foreign partners. 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 under equipped.

Nigeria spends too little on health and this is at wide variance with the 15% target set at the Abuja Declaration in 2001.e main challenge is the immense difficulty of providing quality healthcare in semi-urban and rural areas. The weak healthcare system at the primary level is a major cause of the poor numbers that continue to dog Nigeria’s maternal and infant mortality rates. Healthcare should not only be affordable but available when it is needed especially for pregnant women and young children. This is why Nigeria needs a clear national healthcare strategy with a focus on skilled personnel, access and quality infrastructure. Nigeria also suffers relatively high levels of infant mortality (the probability of dying between birth and the first birthday) and child mortality (the probability of dying between the first and fifth birthday).

The poor remuneration of healthcare workers has also led to their right to greener pastures. The state of the hospitals, inter-practice rivalry and noncompetitive payment do not encourage them to stay. According to Africa Check, the UK registry for doctors shows that,“5,250 Nigerian doctors are in the UK (as at 25 April 2018)—a 10% rise in less than one year or an average of 12 every week.” While the government tries to accelerate investments in roads and rail, there has been gross underfunding of capital expenditure in the health sector. How sustainable is this for a healthy country? Nigeria has had to depend on international funds such as Global Fund, GAVI and others.  Total allocations to tertiary hospitals comprising university teaching hospitals, federal medical centres and federal teaching hospitals, amounted to N309.5 billion in 2019, up from N155.98 billion in 2016. About 92.55% of allocations to federal government-owned hospitals are expended on recurrent expenditure items, primarily personnel costs, and to a lesser degree, overhead costs.

Nigeria cannot continue to underfund its tertiary health institutions or allow them to operate in an environment of poor accountability. It is sad to see Nigerians, suffering from complicated medical ailments, begging on social media platforms to be able to afford medical treatment.

Sources: Harvard Public Health Review, TRACKA, Existential Questions