The cholera epidemic in Nigeria has affected nearly 100,000 persons and killed over 3,000 this year due to poor hygiene practices, lack of water facilities and inadequate medical intervention. However, amid this seeming humanitarian crisis, 918 primary health care centres in 32 states have remained closed, thereby worsening the plight of the poor who use these facilities.
Reports say that 81 of these centres have been closed permanently, while 837 are shut temporarily. Out of the 32 states, war-ravaged Borno has the highest number of closed health centres, accounting for 220 out of the total. It is followed closely by Adamawa with 170 PHCs. Some other states include Katsina, Kebbi, Kwara, Nasarawa, Taraba, Yobe, Kaduna, Ekiti, Niger, Ogun, Osun, and Oyo.
PHCs are the first point of contact to keep people well and improve their quality of life. And according to the World Health Organisation, primary health care is the provision of basic essential health services, including preventive, curative, and rehabilitative care. In Nigeria, about 30,000 PHCs are spread across 9,565 wards in 774 Local Government Areas. With most of them under the control of LG authorities, many are in rural and low-income communities and are the first line of defence for such communities.
But the continuous closure of these facilities tellingly illustrates the ingrained insensitivity and failure of Nigeria’s public sector, both at the national and sub-national levels. Since the President, governors and other top government functionaries mostly obtain health care overseas, it is not surprising that the poor are mercilessly forced to bear the brunt of the government’s inefficiency. Truly, this culture of contempt for citizens by the government is pervasive.
The development is emblematic of a much bigger problem: the weakness of the LGs. The LG tier of government has been grossly underfunded by the states, which see them as mere appendages and routinely divert their allocations. This has undermined their effectiveness and hampered service delivery. For instance, the primary schools, which are mainly under the LG control, have been left derelict, ditto for the roads. So emasculated have they become that in some states like Lagos, revenue-yielding LG functions like regulation of outdoor advertising and waste disposal have been hijacked by the state. Thus handicapped, LGs can barely operate PHCs. Consequently, universal health coverage in Nigeria stands at a paltry five per cent.
At the United Nations high-level universal health coverage meeting in 2019, Nigeria, along with other countries, committed to strengthening primary health care. WHO recommends that every country allocates an additional 1.0 per cent of GDP to primary health care from government and external funding sources but this has been a pipe dream for Nigeria despite the promulgation of the National Health Act.
According to the Act, about 1.0 per cent of the Consolidated Revenue Fund should go into the Basic Health Care Provision Fund along with contributions from donor agencies. The fund is mainly for primary health care. Sadly, the Act has failed to make any impact as the Federal Government continues to blame states for failing to provide the needed counterpart funding. The Minister of Labour and Employment, Chris Ngige, says only about three states have been able to access the fund due to the challenge of counterpart funding. The story is like that of the Universal Basic Education Fund, which has failed to yield the desired result in the nation’s shambolic education sector because of the failure of states to pay their counterpart funding.
Though other pressing matters compete for government funding, health care is a social investment, a right that should not be toyed with. The Sustainable Development Goal III regarding good health and well-being, which Nigeria has pledged to, targets a reduction of maternal mortality, ending all preventable deaths under five years of age, fighting communicable diseases, ensuring reduction of mortality from non-communicable diseases, granting universal access to sexual and reproductive care, family planning and education; and achieving universal health coverage among others. Primary health care remains the fulcrum of the health sector without which nothing can be achieved. The Bill and Melinda Gates Foundation argues that nations that saw the greatest improvements in key health indicators like child mortality, including Ethiopia and Rwanda, succeeded in large part by investing in primary health care.
But with the continuous neglect of primary health care, it is not surprising that Nigeria has some of the worst health indicators in the world, witnessing periodic outbreaks of Lassa fever, cholera, meningitis, and yellow fever. Nigeria shoulders 10 per cent of the global disease burden. It has the highest rate of malaria infections and deaths, and the third-highest HIV burden. The so-called “giant of Africa” is the world capital of deaths of children under the age of five. It has the highest maternal mortality rate and the highest number of children born with HIV.
Revitalising the primary health system goes beyond just funding; it requires purposeful planning, visionary leadership, and dedication. This way, Rwanda, with a GDP of less than 0.5 per cent of Nigeria’s, achieved 90 per cent universal health coverage in a country that just 25 years earlier had been ravaged by civil war.
The WHO cites a nexus between economic growth and a thriving health sector. It says countries that invest in building resilient health systems, based on strong primary health care, make an investment that will pay a rich dividend for decades to come. But with such meagre investments in the health sector, it is not surprising Nigeria now holds the unenviable title of the world poverty capital.
For too long, states have abandoned their duties to the Federal Government even though health is on the concurrent legislative list. There is also a heavy reliance on foreign donor agencies, which is unsustainable. States can encourage private sector investment in health care by providing tax incentives. Governors can save funds by stopping the frivolous habit of sponsoring pilgrimages, weddings, building religious centres, creating more traditional stools, and ending practices that discourage foreign direct investments.
The WHO Astana declaration 2018 states that primary health care is the most inclusive, effective, and efficient approach to enhance people’s physical and mental health, as well as social well-being and a cornerstone of a sustainable health system for universal health coverage. Nigeria, which also pledged to this declaration, must give primary health care its needed attention.