Health For All And 1978 Alma-Ata Declaration

By Rasheed Shuaibu,

The international Alma-Ata declaration of 1978 identified primary health care as the key to the attainment of health for all. Since the declaration was made, “Health for all,” has not been achieved in many countries including Nigeria. The COVID-19 Pandemic further revealed our health system challenge amid the Coronavirus disease which have shown billions of naira budgeted for the Health sector in the last 21years of unterrupted democracy, we have been enjoying have not add any significant value for Nigeria to attained “health for all” after the declaration in 1978.

The Basic Health Care Provision fund which is meant to cater for all the primary healthcare centers across the 774 local government areas (LGAs) in the country was significantly reduced from N44.4bn to N25.5bn a decrease of more than 42.5 percent the budget for health is not even up to 8% as against the 15% the agreement they held with the health sector union.

According to the Chairman Lagos Chapter of the Association of General and Private Medical Practitioners of Nigeria Dr. Tunji Akintade “Must we wait for every pandemic before the federal governments do what is right for the health sector? Isn’t it also bad enough that of all the donations and grants received not a single sanitizer was given to private facilities or bodies”.

Just when we were complaining that initial budgetary provision of N 44.5 billion for 2020 was a far cry from Abuja Declaration of the African Union which recommended a provision of 15 percent of annual national budget of African counties (including Nigeria) to the health sector.
Under no circumstances should health funding take a back burner. The government needs to have a rethink on this in the overall best interest of the Nigerian people.

According to the World Bank and World Health Organization (WHO), at least half of the world’s population still lacks access to essential health services.
The failure of many countries to achieve health for all led to the 2018 declaration of Astana. It is a global commitment that aims to strengthen PHC systems as an essential step towards achieving Universal Health Coverage (UHC).
The primary healthcare approach is the most effective way to sustainably solve health and health system challenges.The Declaration of Astana 2018, therefore reaffirming comprehensive primary healthcare as the key to achieving UHC.
Nigeria is experiencing a dual epidemic of communicable and non-communicable diseases (NCDs). In 2017, the top ten causes of death in Nigeria were lower respiratory infective, neonatal disorders, HIV/AIDS, malaria, diarrheal diseases, tuberculosis, meningitis, ischemic heart disease stroke and cirrhosis.
A selective primary healthcare approach that focuses on specific diseases and condition will not effectively address the dual epidemic of communicable disease and Non-communicable Disease (NCDs).
Vertical health programmes have helped to address some of the public health challenges in low medium income countries (LMICS) including Nigeria. However they Undermine the Successful Implementation of primary healthcare unless vertical health programme are integrated into the national health plan. Comprehensive PHC is preferred to selective PHC because disease specific.

Health interventions place an enormous burden on weak health systems in LMICS. Expanding access to quality health care for poor and vulnerable population requires. The expansion in the utilization of community based health worker (CHWs) and the establishment of PHC as a policy focus such efforts would reduce the rising burden of diseases and health care cost in Nigeria.
Under the leadership of Professor Olikoye Ransome-Kuti; between 1986 and 1992, Nigeria adopted primary healthcare in 52 local government areas (LGAs) as models and subsequently expanded PHC to all LGAs, seeing improvement in population health outcomes. The then Minister for health was able to achieve this feat due to his focus on PHC.

Evidence suggests that Nigeria has over 30,000 primary healthcare facilities across the 36 states and Federal Capital Territory (FCT). However only 20% of these PHC facilities are functional. Studies have shown that health systems based on strong PHC improve the management of NCDs, reduce mortality from NCDs reduce infant and under five mortality, reduce maternal mortality and increase life expectancy at birth.
Going forward, Nigeria needs to shift from the present curative model to a preventive model that keeps the population healththeir rather than waiting for them to fall sick before they have an encounter with health care provider. The curative model and selective PHC approach have proven to be ineffective in addressing the public health challenges Nigeria faces and in meeting the health needs of the low income population.

This shift from a curative model to a preventive model will require strong political will and sacrifice on the part of all stakeholders including the private medical establishment to ensure that primary healthcare is made the cornerstone of the Nigerian health system. This will be a major step towards achieving health for all, universal health coverage and the sustainable development goals (SDGs)
Stakeholders in the health sector have expressed concern over the decline in routine primary healthcare services amidst the coronavirus (COVID-19) pandemic in Nigeria. In a recent online dialogue convened by Good Governance Team (GGT) in collaboration with Health Reform Foundation (HERFON), with the support of a German green foundation , Heinrich Boll Stiftung(HBS)Abuja county office.
The participants agreed that infrastructure is a major problem. “No electricity, no running water for majority of PHCs and without electricity, how are the facilities going to work 24/7 (some PHC even use candle light, lantern, and fossil fuels to conduct night emergencies)”.

Shuaibu is of the Good Governance Team,Abuja

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