What Have Change In The Implimentation Of Primary Health Care Under One Roof, By Rasheed Shuaib

The 2020 budget provides an idea of the government’s priorities for the New Year. How high does citizen’s health care rank.

In his address to lawmakers, President Muhammedu Buhari, said his administration is interested in improving the lots of the health care sector and this was a major reason for the increase in value added tax (VAT) rate draft as communicated through the finance bill from 5% to 7.5%.

Components of the budget that directly affects the health sector in Nigeria include the N44.5 billion earmarked for the basic health care provision fund (BHCPF). The goal of the fund is to substantially increase revenue and improved primary health care (PHC) as contained in the Country National Health Act.

Nigeria continues to battle with the COVID – 19 pandemic each day with cases rises. With the corona various spreading across the country, coupled with the poverty, poor performance of the health system. The hand to mouth economy of the majorly poor and highly densely populated hinterlands. There is no better time and justification to challenge the government to finish the construction of health centres across the country.

Now that the National Council on Privatization (NCP) has approved the draft legislative framework on health sector reform aimed at granting Nigerians access to quality health care.

In a statement by Mr. Laolu Akand ,the spokesman to the Vice President of Nigeria said “Millions of Nigerians would benefit from the initiative that the critical point is that this Buhari administration is proposed reforms will ensure that Nigerians who can’t afford to pay for it, would begin to receive efficient health care services once the new system takes off”.

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The secretary of the NCP and Director General of the Bureau of Public Enterprises (BPE), Mr. Alex Oko said “what is very clear is the COVID-19 pandemic situation globally has revealed certain lapses and challenges as far as the health care delivery system in Nigeria is concerned and that council in its wisdom has actually started to consider a total review of the health sector about a year ago pre the advent of the corona virus pandemic”.

Primary Health Care Under One Roof (PHCUOR), is Primary Health Care (PHC) reform agenda driven by the Federal Government of Nigeria (FGN). This reform seeks to reverse the fragmentation of the PHC deliver at sub national levels (states and LGAs) by centralizing PHC management, human resources, financial and operational responsibilities under one state level body, the State Primary Health Care Board (SPHCB).

In 2011, the 56th National Council on Health (NCH) adopted primary health care under one roof as a national policy for implantation by the states and FCT. Further to the adoption the 58th NCH in 2013 adopted the PHCUOR implementation guidelines. The guidelines call for specific structural changes around nine pillars namely: Governance and ownership, legislation, minimum service package (MSP), repositioning, system development, operational guidelines, human resources, funding sources and structure and office set up. Base on these nine pillars a score card was developed to track state government progress on the implementation of the PHCUOR reforms along the pillars.

The policy is based on the principle of “three ones” one management, one plan and one monitoring and evaluation system. The purpose of the PHCUOR scorecard is to systematically assist the state and FCT identify areas within the PHCUOR framework that they required support.

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The PHCUOR scorecard 4 assessments revealed that as at June 2018 35 states and the FCT have established their SPHCBs. It further revealed the gap between the best performing and the least performing states, zones and pillars in the country. The best performing states were Gombe (76%), Niger (70%), Bauchi and Nasarawa (70%) while the worst performing states were Akwa Ibom (0%), Edo state (18%), Kogi (25%). The best performing zone was North East (62%) while the worst performed zone was south south (39%).

The scorecard 4 assessments focused on the process of implementing the PHCUOR policy at the states and LGAs level and not on PHC service delivery at the facility and household levels. Therefore high performance on the scorecard cannot be interpreted to mean high performance on health outcome.
It has been 9 years now from the implementation of PHCUOR that have being in operational. The question is what has change since then. We are yet to have the details on how much percentage will be cut down from the present N44.5 billion. Which represent 8% from the initial approved budget of N10.59 trillion. The new budget proposals stand at N10.27 trillion. This is based on the global economic realities as a result of the corona virus pandemic as well as recent crises in the oil market.

At the time world is opening up discussions about how the practice of the health care could be innovate Nigeria health system is struggling with the basic health issues.

President Association of Local Government of Nigeria (ALGON), Hon. David Alabi “Phc are in adequate infancy and proportion to the 200 million inhabitants. At an event organized by Premium Times, Chiedo Nwankwo a health and gender expert stressed that Nigeria had failed to properly fund the health sector using the country failure to meet the 15% bench mark agreed upon in the Abuja declaration in 2001.

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The danger of neglecting health care has again been brought to the fore, our leaders must be held account table.


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