In this interview with LARA ADEJORO, Dr. Faisal Shuaib, Executive Director of the National Primary Health Care Development Agency, discusses the challenges of revitalising the country’s primary healthcare centres and plans for improvement
The Federal Government promised to revitalise primary care centres but according to a report, only 6,000 of the country’s 30,000 PHCs are operational. What is delaying the promise made to revitalise the centres?
The Federal Government announced the revitalisation of 10,000 primary healthcare PHCs across the country, targeting at least one PHC per political ward. To facilitate this process, the NPHCDA, based on budgetary provisions by the National Assembly under constituency projects, facilitated the renovation of various PHC facilities spread across the country, to achieve national standards defined as “Level 2 PHCs.”
A review of this strategy, however, revealed that it is insufficient to meet the FG’s target and that a more comprehensive approach is needed to address other aspects such as human resources, particularly skilled birth attendants (midwives), onsite accommodation to ensure 24-hour service delivery, and effective systems to ensure essential medicine and commodity availability, among others.
This led to the Minister of Health, through the NPHCDA, launching the PHC Re-Imagining Strategy to enable a holistic transformation of the PHC landscape in Nigeria at the Presidential PHC Summit in 2022.
The PHC Re-Imagining strategy, based on a four-point agenda, is currently in play, mobilising resources from the government, existing donor-funded programmes, and importantly, the organised private sector, to drive PHC transformation across Nigeria. The strategy targets a total of 8,800 PHCs, at least one per political ward, to be fully transformed into standard Level 2 infrastructure, the full complement of the PHC workforce, and the delivery of comprehensive PHC services over the next few years. This is to place Nigeria firmly on the path to achieving the Sustainable Development Goals and Universal Health Coverage by 2030.
Currently, based on the National PHC Survey conducted by the NPHCDA in 2022, there are a total of 27,000 PHC facilities, with up to 95 per cent providing various degrees of health services with various degrees of functionality. However, only 29 per cent are assessed to be at the desired level of the national standard. A total of 3,433 facilities have been successfully revitalised through constituency projects from the National Assembly, state efforts, and our partners.
The most critical delay has been the mobilisation of financial resources for the PHC Re-Imagining strategy, which is currently ongoing. Already the private sector has pledged to transform 774 PHCs — one per LGA—and based on current committed funding from the FG through the BHCPF and partner-based funding from the IMPACT project, we expect to add 3,000 to 5,000 PHCs over the next year to 18 months.
What policy do we have in place to address the state of PHCs in the country?
Based on its mandate, the NPHCDA provides leadership for PHC development and implementation, working with and through the states alongside our partners. To enable this, the NPHCDA is implementing various policies and strategies to improve the state of PHC systems and service delivery across the states. The actions of the NPHCDA are currently guided by two principal policies, which are the Primary Health Care Under One Roof policy and the overarching PHC Re-Imagining strategy.
The PHCOUR reform agenda is a strategy aimed at reversing the fragmentation in primary health care delivery, especially at sub-national levels, by centralising PHC management, resources, and responsibilities under the State PHC Boards.
The PHC re-imagining strategy targets a total of 8,800 PHCs (at least one per political ward) to be fully transformed with standard Level 2 infrastructure, a full complement of the PHC workforce, and delivering comprehensive PHC services that meet the needs of Nigerians. This is to place Nigeria firmly on the path to achieving the SDGs and the UHC by 2030.
What is the agency doing to campaign against apathy regarding vaccination in the country, especially in the northern parts of the country?
The apathy towards COVID-19 vaccination in the country is largely due to rumours, misinformation, and disinformation that are fueling apathy and hesitancy. Hesitancy to the COVID-19 vaccines is a global phenomenon, and not limited to Nigeria. Meanwhile, the northern states have performed far better than the southern states. As of January 3, 2023, the first nine best-performing state positions for COVID-19 vaccination daily reporting are being occupied by northern states, except Osun State, which is in the third position.
Nigeria has continued to intensify efforts to address the issues of vaccine hesitancy and apathy using community structures like the Ward Development Committees, our traditional and religious institutions, as well as other influential, and opinion leaders. The FG, through the NPHCDA, inaugurated the Northern Traditional Leaders Committee on Primary Health Care, chaired by the Sultan of Sokoto, in its effort to mobilise the communities and create demand for immunisation and other PHC services.
In addition, traditional leaders’ committees for the South West and South East have recently been inaugurated. The traditional leaders’ committees have been meeting regularly to address issues around demand creation for COVID-19 vaccination, routine immunisation, and other PHC services.
The COVID-19 response in Nigeria also provided the country with an opportunity to improve demand generation for immunisation through the implementation of integrated communication and demand generation activities.
There has also been sensitisation of the public, civil society organisations, and professional bodies on the usefulness of the COVID-19 vaccines. Key messages and answers to frequently asked questions have been developed and shared with the public and through social media platforms.
Additionally, to improve the coordination of the communication and demand generation activities at the national and sub-national levels, the COVID-19 Crisis Communication Centre was established. As enshrined in the SCALES 3.0 strategy for integrated COVID-19 vaccination, the decentralisation of communication and demand generation activities has resulted in improved engagement and awareness of the communities leading the increase in vaccination coverage.
These have aided in the effective and efficient management of rumors, misinformation, and disinformation that have contributed to apathy and hesitancy regarding COVID-19 vaccination and routine immunisation.
With the help of our partners and donors, the NPHCDA has also increased public education on adverse events following vaccination, which is one of the major causes of apathy toward immunisation. People are now more aware of AEFI and understand what to do whenever they experience such an occurrence. This is also improving public confidence in the immunisation programme.
The WHO reported that Nigeria recorded 1,027 cases of circulating vaccine-derived poliovirus type 2 in 2021. Why are we still recording cases in the country despite being declared wild polio-free in 2020?
The WPV status of Nigeria is still intact, but there are some remnants of polioviruses called cVPV2 still circulating in the environment as a result of poor environmental sanitation, and these are potentially dangerous and can infect vulnerable children who have not been vaccinated through the RI system, which is a very important component for us to maintain our WPV-free status.
We have adequately mounted the needed response to these outbreaks through house-to-house polio mass vaccination campaigns, and by the end of December 2022, we had been able to drastically reduce the number of these detections in children by over 90 percent. Right now, our plan for 2023 is to build on these gains by continuing to improve RI coverage rates in all Nigerian states as well as conducting quality polio mass vaccination campaigns in states with the highest risk of cVPV2 transmission, until we reach every child, no matter where they are located.
But despite the efforts you said have been made, Nigeria is still recording cholera, Monkey pox, measles, and meningitis.
The country has continued to make efforts to reduce the number of cases of these diseases by instituting various public health measures, including vaccination. Typically, the country launches supplementary immunisation campaigns to vaccinate the population in order to boost herd immunity against vaccine-preventable diseases.
Despite the pandemic that disrupted many planned activities globally, it is on record that GAVI commended the government of Nigeria for the significant progress and achievement of 57 per cent coverage during the 2021 Multiple Indicator Cluster Survey/National Immunisation Coverage Survey reports. Nigeria was among the very few countries in the world that could sustain and improve their routine immunisation performance. There has also been a significant reduction in the number of recorded cases and outbreaks of measles and meningitis in the country in the last three years.
The Federal Government, through the NPHCDA, has ensured that most of the planned campaigns will be implemented nationwide in 22 states in 2022. The campaigns for Kogi and Bayelsa states were rescheduled for January 2023 because of the flood the state experienced, which hindered their preparation for a quality campaign.
Cholera is endemo-epidemic in Nigeria and some other countries in the region. Every two to three years, there is a surge in the number of cholera cases and epidemics. The country has been making several efforts to interrupt this cycle by improving surveillance and public awareness about the disease. It is important to note that some of these cholera outbreak cases in 2022 are also attributable to flooding in various parts of the country.
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