In 2013 an expert said primary healthcare was dead in Nigeria. Today, the story remains unchanged. Dr Vickie writes…
In the neighborhood where I grew up, there was a woman that we all called upon anytime anyone got sick. We didn’t know what she studied – or whether she actually studied in the first place, but as far as the neighborhood was concerned she was ‘Mama Nurse’.
Mama Nurse was widely famous and extensively well respected because anytime she was called upon for any ailment, her management protocol often worked – at least to the best of my knowledge. We believed so much in her expertise and medical prowess to the extent that we were able to stop self-treatment and medication.
Back then, I used to wonder why most people didn’t go to the hospital but chose to talk to Mama Nurse instead then. But when I actually gave it a deeper thought, I realised that while everyone desires to have the best care, the present day medical consultation fee in the hospitals would be more than enough to buy all the drugs someone would need – especially in cases of malaria which is the most popular ailment in children that is associated with fever.
Let’s think about Mama Nurse together one more time,. What is peculiar about her? The answer is simply that she makes life easier for young mothers. If you are one, she will treat your child and the entire family, supply all the drugs on time to prevent any delay and collect whatever money you have at the moment then you will pay the remaining whenever you can get money. Her medical financing system helped a lot because more people became her clients. Instead of using herbal concoctions to treat their children, they succumbed to the advice of the learned and got treated by Mama Nurse.
When I eventually sought for knowledge at the Ibadan-based School of Hygiene located at Eleyele in the heart of the city, my training exposed me to the treatments Mama Nurse used to give my siblings and neighbors. While some of them were quite questionable, the fact remained that she was able to save a lot of children that would have died from preventable diseases like malaria, diarrhea, measles and other preventable childhood diseases of significant infant mortality importance.
From Mama Nurse, I’d like us to also put the primary healthcare system into perspective.
With the knowledge that I got from my education at the School of Hygiene, I began to tell my mum to take my siblings to the primary healthcare center in our community whenever they got sick. This was probably due to the fact that I could relate – and was aware of the unity of management offered there using the ‘standing order’ which enables them to treat patients the same way and get the same results. The community health workers are well taken care of, they know the people in the community and the people therein know them, they play with the children, they are the ones that majorly encourage mothers to ensure adequate immunization, and they reassure pregnant mothers during antenatal care.
Their tools are basic and simple – road to health chart to monitor child growth, shirker strip or tape to monitor malnutrition, heamatocrit paper to determine the red blood cell level of patient. They also ensure continuity of care, they make sure that essential drugs and consumables are available at all times. Community health workers visit homes during and after treating a member of – or the entire family. I knew that it is a lovely medical experience and i trust them enough to entrust the care of my siblings in their hands, their good hands. But things changed.
For me, the change in perception of the healthcare system began with the medical school. Like I previously noted, everyone desires the best of care and as one goes higher, medical care gets better and cost increased. So, how does the primary healthcare center compare with the tertiary hospital?
The first obvious fact is the thoroughness of investigations. If a patient presents with just fever, we will check for all the possible causes of fever and confirm it’s malaria before commencing treatment and by then, the patient would have already spent five or more times what he or she would have spent in the primary healthcare center. But a lot of them have the money unlike those that go to the PHC centers who are often unprepared for the cost of healthcare.
Secondly, there is hierarchy in medicine, the first in line are the young doctors – the house officers. They will attend to the patient and ensure all investigations are carried out after which another group of doctors will review the patient before the consultant. The doctors with more years of experience will see the patient. whic means that you are sure of adequate management.
Now, if you are in my shoes, where will you prefer to go to in case of health emergency?
Primary health care started well, and was able to survive in some countries including Ethiopia, but in Nigeria, it is gradually fading away. A lot of the buildings are dilapidated, workers not well treated, no training and retraining of health workers, the newer graduates are not getting employed, no electricity, no modern day equipment for investigations. There is fatigue in caring for people when most of government workers are not being paid. The health centers that got destroyed or collapsed are not being rebuilt and this often comes with dire consequences even when they are poorly reported.
Fuca village, the epicenter of Lassa fever this year has no functioning PHC center. In such a situation where the much acclaimed first point-of-care is not functioning, what are the communities expected to do? According to media report, they said when people fall ill, they would take them to the bush so that they will die here since it is believed that for the village’s market to thrive, some people must die. The disease was serving as a means to a diabolic end. As awful as that may seem to be, let me assure that it was true. It happened in this same country. This is why I strongly believe that the time is now for us to quickly restructure our healthcare system which I consider to be a very serious business. But it cannot be done by the government alone.
How many people in the urban area really care about the healthcare system until their mothers have cancer or siblings have kidney diseases? If they have enough money, I believe they would prefer the tertiary institution whenever they fall ill. While this may work, they and the rest of us are missing out on a lot, a more personal and effective medical care system.
Let me ask you a question and I want you to be really honest about it. Can you really take your family to a PHC center?
I know many people can afford tertiary healthcare, many can also afford medical tourism to places like Dubai and elsewhere. But what about the rest? I strongly believe that the masses are enough reason to scale up our health system. Like the minister rightly said recently, the ideal pyramid should sit on the base not the tip, the tip should be the tertiary institutions where only chronic cases or cases that require specialized care should go, all minor ailments should present at the base, which is supposed to be PHC centre. The failure of the base to function is the reason why our tertiary facilities are flooded with all sorts of case while the communities that cannot afford the care are the ones largely responsible for the country’s bad health statistics.
If we really want to make meaningful impact in the health sector, I believe that the way forward is still primary healthcare. The model just has to changed and should be consolidated and enhanced to meet the needs of the people. Our people deserves to be well taken care of, I’m talking of the young ones, pregnant women and the elders, among others. It is only a strong and vibrant primary healthcare system that can properly take care of them.
In 2013, one of Nigeria’s prominent health scholars, Prof Asuzu declared that primary healthcare was dead in Nigeria and following year we reported that the system is underutilised. About three years later, the story is yet to change although hundreds of millions of dollars had been borrowed to revamp the system. We can’t continue like this, we just can’t.