By Eshiet AKPANUMOH
Primary healthcare was declared the model for global health policy at a 1978 meeting of health ministers and experts from around the world. Primary healthcare requires a change in socioeconomic status, distribution of resources, a focus on health system development, and emphasis on basic health services. Considered too idealistic and expensive, it was replaced with a disease-focused, selective model. After several years of investment in vertical interventions, preventable diseases remain a major challenge for developing countries. The selective model has not responded adequately to the interrelationship between health and socioeconomic development, and a rethinking of global health policy is urgently needed.
According to the Resolution 29 taken by the National Council on Health (NCH) during its 54th Meeting in May 2011, it was noted that, “the thrust of the National Health Bill in strengthening Primary Health Care (PHC) through the creation of PHC Boards/Agencies and the PHC Development Fund”. The Council at the meeting also noted efforts in “Bringing PHC under One Roof” in line with the provisions of the National Health Bill, as well as the importance of enacting relevant State legislation and regulations that will facilitate the implementation of National Health Bill. The Council therefore approved the Implementation Guide on Bringing PHC under One Roof (PHCUOR) as a working document to be used by the three tiers of government and approved that all states establish Primary Health Care Boards.
This resolution was prompted by the realized need to strengthen healthcare delivery system in the country in line with the Universal Health Coverage sometimes referred to as Universal Health Care, Universal Coverage, or Universal Care, defined as a health care system that provides health care and financial protection to all citizens of a particular country. The Universal Health Coverage is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes. Universal health care is not one-size-fits-all and does not imply coverage for all people for everything.
Introduced since 2004 initially as the PHCUOR Concept, this has been implemented in several states with sustained success recorded in some like Jigawa (under Gunduma Health Board), Rivers (under Primary Healthcare Mgt Board- PHCMB), while Lagos and Kano have theirs (under Primary Health Care Development Agency- SPHCDA). Records also has it that all states in the Niger Delta had before now made striking progress with this concept of healthcare development; and with the recently passed bill for a law to provide for the establishment of the Akwa Ibom State Primary Health Care Development Agency by the Akwa Ibom State House of Assembly, the state has taken the last spot in the queue.
As described by the World Health Organization, the Universal Health Coverage is a situation where citizens can access health services without incurring financial hardship. This health policy framework is of central importance. It can be determined through three critical dimensions: WHO IS COVERED, WHAT SERVICES ARE COVERED, AND HOW MUCH OF THE COST IS COVERED. Thus, in the development of universal health systems, it is appropriate to recognize “healthy public policy” (Health in All Policies) as the overarching policy framework, with public health, primary health care, and community services as the cross-cutting framework for all health and health-related services operating across the spectrum from primary prevention to long term care and end-stage conditions. Although that perspective is both logical and well-grounded in the social ecological model, the reality is different in most settings, and there is room for improvement everywhere.
With the three dimensions aforementioned, this concept targets the accessibility and affordance of healthcare services, with critical consideration on rural settlers and low-income earners. This is so because the consequences of an ineffective healthcare delivery system are more telling on these ones who are forced to deal with the problems of non-availability of primary healthcare facilities and inability to afford the higher ones common in the urban areas. However, even when the latter is less a problem, the need for the former cannot be undermined as it is the most commonly reached for the rural settlers. This also provides for strong referral linkages where people with complicated ailment can have proper referrals to specialist hospitals for medical solution.
Research has shown that developing countries face a number of challenges in providing effective health care for their populations. Due to the challenge of limited money to fund health care, large sections of their population may be difficult to reach. This is because they may live in rural areas where roads and other access means may be poor or the physical landscape may be difficult to cross. Therefore, providing basic primary health care in local settings is a way to meet some of these challenges.
Undoubtedly, it was against the backdrop of this reality that the Akwa Ibom State House of Assembly saw the need to set the stage, through the Speaker Onofiok Luke sponsored HealthCare Bill, for the state government to provide solutions to the issue of loosely binding healthcare delivery policies, provide reliable records to aid effective planning and implementation of healthcare activities in the state, and enable capacity development and improved healthcare delivery skills through training and re-training of its providers, as well as create a linking working network amongst the stakeholders in all sectors.
In addition, the state government now has the stage set for solutions to the issue of ill-funding and improper maintenance of health facilities in the state. Both ill-funding and improper maintenance play contributory roles against proper healthcare delivery in the state. Primary healthcare centres are far less funded with equipments and drugs which are indispensable to medical care. Here, the law aims at providing permanent solutions to this by proposing an agency that will take over, as part of its primary responsibilities, the duty of overseeing the running of all primary healthcare facilities located in the state including making provisions for, and maintaining all infrastructures and equipments and as well, employ and discipline staff of the facilities under its direct supervision. The last shall check the issue of callous and irresponsible attitude to duty.
An effective running of the agency proposed by this law will have direct bearing on the Akwa Ibom masses through increased health care and improved life expectancy for all. It will guarantee basic health care for the people even when budget and manpower is limited. This concept keeps training costs at very low rates. In India for instance, training cost for a health worker stands at $150 per year. Under this concept, the health workers are locally known, respected, accepted and trusted. Also, the Universal Health Coverage suggested Self-help Schemes, if adopted by the state government through the proposed agency, will allow local communities to look after themselves, improving their confidence. And in implementing the Self-help Schemes, emphasis is laid on prevention during sensitization and awareness creation, as the belief is that preventing sickness in the first place saves the government money on health care provision costs.
Research has also shown that countries with a healthier population are wealthier as the people are more productive. According to a WHO report, attempts have been made by many countries using the Universal Health Coverage model to establish a development of local clinics to work together to prevent and treat disease. On the whole, it is established that a focused aid on primary health care is very effective, much more so than building large hospitals which will only deal with limited cases.
Finally, in all considerations, let the Akwa Ibom State House of Assembly be given this commendation for setting the pace for a harmonized Primary Healthcare sub-system in order to overcome the current chaotic approach to healthcare delivery, structural constraints and improve coordination. This singular act of legislation, if fully implemented, will go as far as establishing a unitary, integrated and decentralised management structure and sub-systems; preposition the states for a successful implementation of the National Health Act, as well as achieve effective service delivery for improved health outcomes. While hoping and praying that the state governor gives accent to the law and subsequently make speedy move to set the agency running, it gives a high sense of satisfaction knowing that provisions for this very important health need have been taken thus far.
Eshiet Akpanumoh is a medical practitioner based in Ajaokuta, Kogi State.