2.12
Mission Statement of National primary health care development agency
(NPHCDA)
2.12. 1The Mandate
2.12.
2 Departments
2.13
Collaborations of The National
Primary Health Care Development Agency (NPHCDA)
2.13.5 CHAI Clinton health access Initiative:
2.14 Roles of the national primary
health care development agency
2.15
Challenges of the National Primary Health care Development Agency
(NPHCDA)
2.16 Problems of
primary health care programme implementation at Local
Government
Area (LGA) levels in Nigeria.
CHAPTER
3
3.0 Methodology
CHAPTER
FOUR
4.0
Discussion
CHAPTER
FIVE
CONCLUSION
AND RECOMMENDATION
5.1
Conclusion
5.2 Recommendation
REFERENCES
CHAPTER ONE
INTRODUCTION
1.1 Background
of the Study.
The concept of primary health care has had a significant
influence on the populace in many less-developed countries. However, there is
little understanding of the origins of the term. Even less is known of the
transition to another version of primary health care, best known as selective
primary health care. During the final decades of the Cold War (the late 1960s
and early 1970s) the US was embroiled in a crisis of its own world hegemony—it
was in this political context that the concept of primary health care emerged.
By then, the so-called vertical health approach used in malaria eradication by
US agencies and the WHO since the late 1950s were being criticized. New
proposals for health and development appeared, such as John Bryant’s book Health
and the Developing World (in 1971), in which he questioned the
transplantation of the hospital-based health care system to developing
countries and the lack of emphasis on prevention. According to Bryant, “Large
numbers of the world’s people, perhaps more than half, have no access to health
care at all, and for many of the rest, the care they receive does not answer
the problems they have ,the most serious health needs cannot be met by teams
with spray guns and vaccinating syringes.
Another important influence for primary health care came from
the experience of missionaries. The Christian Medical Commission, a specialized
organization of the World Council of Churches and the Lutheran World
Federation, was created in the late 1960s by medical missionaries working in developing
countries. The new organization emphasized the training of village workers at
the grassroots level, equipped with essential drugs and simple methods. In
1970, it created the journal Contact, which used the term primary
health care, probably for the first time .By the mid-1970s, French and Spanish
versions of the journal appeared and its circulation reached 10 000. It is
worth noting that John Bryant and Carl Taylor were members of the Christian
Medical Commission and that in 1974 collaboration between the commission and
the WHO was formalized. In addition, in Newell’s Health by the People,
some of the examples cited were Christian Medical Commission programs while
others were brought to the attention of the WHO by commission members. A close
collaboration between these organizations was also possible because the WHO
headquarters in Geneva were situated close to the main office of the World
Council of Churches. Another important inspiration for primary health care was
the global popularity that the massive expansion of rural medical services in
Communist China experienced, especially the “barefoot doctors.”This visibility
coincided with China’s entrance into the United Nations (UN) system (including
the WHO). The “barefoot doctors,” whose numbers increased dramatically between
the early 1960s and the Cultural Revolution (1964–1976), were a diverse array
of village health workers who lived in the community they served, stressed
rural rather than urban health care and preventive rather than curative services,
and combined Western and traditional1
The landmark event for primary health care was the
International Conference on Primary Health Care that took place at Alma-Ata
from September 6 to 12, 1978. Alma-Ata was the capital of the Soviet Republic
of Kazakhstan, located in the Asiatic region of the Soviet Union. According to
one of its organizers, the meeting would transcend the “provenance of a group
of health agencies” and “exert moral pressure” for primary health care. A Russian co-organizer claimed that “never
before [have] so many countries prepared so intensively for an international
conferences. Three key ideas permeate the declaration: “appropriate
technology,” opposition to medical elitism, and the concept of health as a tool
for socioeconomic development. Regarding the first issue, there was criticism
of the negative role of “disease-oriented technology. The term referred to
technology, such as body scanners or heart-lung machines, which were too
sophisticated or expensive or were irrelevant to the common needs of the poor.
Moreover, the term criticized the creation of urban hospitals in developing
countries1
When the country gained its independence in
1960, healthcare was not among the first things government officials thought
about. They focused more on the medicine that cured rather than prevented
illnesses. However, 15 years later, National Basic Health Services Scheme
(NBHSS) was created, where primary health care served as the basis for the
whole idea. It was meant to provide medical training and healthcare facilities,
although it neglected the use of new technology and community cooperation.
Unfortunately, NBHSS remained just an idea, as there were problems with
implementing it. Consequently, until 1985, Nigeria remained without primary
health care. In 1985, Nigerian government chose a new Minister of Health,
Olikoye Ransome-Kuti. And that was when thing started to look up. During his
time in office, he managed to introduce primary healthcare into all of the government
areas, ensure immunization of children by making it free, create a national
health policy, emphasize the importance of preventive medicine, encourage
vaccination and introduce a nationwide campaign against HIV/AIDS. He also
relocated responsibility for primary healthcare to the local governments. That
way, secondary healthcare fell onto the shoulders of the state government, and
tertiary health care became the federal government’s responsibility. To control
the implementation and continuation of the idea of primary healthcare, creation
of the National Primary Health Care Development Agency was done in 1992.
Judging from his achievements, he would have done so much more for the
healthcare system in Nigeria. However, in 1993, after seven successful years as
the Minister of Health, Olikoye Ransome-Kuti was removed from the post during
the military takeover. The era of effective and innovative primary healthcare
then came to a close. Twenty-four years after the leadership of Professor
Olikoye Ransome-Kuti, the need to strengthen the PHC in Nigeria is relevant as
ever before.2
In 1992, the National Primary Health Care Development Agency
(NPHCDA) was established to ensure that the PHC agenda is continued and
sustained. The establishment of NPHCDA and the 30,000 PHC facilities across
Nigeria provide an opportunity for the effective implementation of PHC in
Nigeria. Therefore, governments have to maximize the opportunity provided by
existing PHC facilities to make PHC sustainable in order to strengthen Nigeria’s
health-care system. The running of PHC facilities would be more effective if
federal and state governments took over their administration from the local
governments. The Primary Health Care Under One Roof
(PHCUOR) policy was formulated in 2011 to address the problem of fragmentation
in PHC and ensure the integration of PHC services under one authority. Its
impact is yet to be felt on health status and utilization of PHC in Nigeria
since PHC under one roof became a national policy only few years ago. The inability of PHC centers to
provide basic medical services to the Nigerian population have made both
secondary and tertiary health-care facilities experience an influx of patients.
This has had its toll on the secondary and tertiary levels of care.2
1.2 Statement of the Problem
The current state of PHC
system in Nigeria is appalling with only about 20% of the 30,000 PHC facilities
across Nigeria working. Presently, most of the PHC facilities in Nigeria lack
the capacity to provide essential health-care services, in addition to having
issues such as poor staffing, inadequate equipment, poor distribution of health
workers, poor quality of health-care services, poor condition of
infrastructure, and lack of essential drug supply2. Nigeria allocated 4.6% and 3.5% of the total gross
domestic product (GDP) to health in 2009 and 20010 respectively, although
health allocation was increased to 5% in 2012, it is still way below the 11%
GOP recommended by WHO and like most allocations, it is badly managed and is
nothing near what is necessary to clear the back log in health investment
carried out through the years .
In 2005, the federal ministry of health estimated a total of 23,640 health
facilities in Nigeria of which 85% are primary health care facilities, 14%
secondary and 0.2% tertiary. Wide regional variations exist in health
indicators across the zones. Infants and child mortality in the north, west and
eastern zone are in general twice the rate in southern zone while maternal
mortality in the northwest and northeast is over six times the rate recorded in
the southwest zone. There are also wide variations in the rate across regions,
socio economic, rural urban residence. These indicators does not converge
toward achieving the MDGs in Nigeria3.
Primary health care in
Nigeria has suffered a setback since the failure of the basic health service
scheme (BHSS) of 1975-1980. Failure of
BHSS were for many reasons such as poor commitment of federal ministry
of health bureaucrat, Poor budgetary allocation to scheme, non involvement of
community participation, the scheme was politised, the principle of primary
health care were not applied, refusal of new cadre of health staff (community
health workers, comm. health assistants, comm. Health supervisors and community
health officers), failure in equipping schools of health technologies with man
power with the skill to set up of PHCs.. Enormous quantity of sophisticated
equipment were contrary to principle of self reliance and appropriate
technology. Most of the buildings were not complemented, medical equipment were
delivered but remained unused for many years (if ever). Individuals and
companies were paid for equipments that were never delivered and work that was
never done, to mention but a few.4
1.3 Justification of the Study
The need to evaluate the
activities of the National Primary Health care Development Agency (NPHCDA), the
current parastata set by the federal ministry of health in delivery of primary
healthcare to the grass root, the need to inquire more about its achievement,
the functions played in health planning and implementation, the used of
appropriate technology in health care delivery system as design by the national
primary health care act, the need to trace the underlying factors that serves
as constraints to health policy makers, the need to ascertain if primary health
care activities meets the need of the individual through diagnostic, curative,
promotive and preventive means are all paramount issues that have necessitated
this review.
1.4 Objectives of the study
Broad objectives
The broad objectives of this
review is to address the roles of national primary health care development
agency (NPHCDA) on primary health care units in Nigeria.
Specific objectives
I.
To identify the problems militating against
primary health care in Nigeria.
II.
To evaluate the performance indicators
used in determining primary health
activities in Nigeria.
III.
To assess the effectiveness of National
primary health care development agency (NPHCDA) on primary health care units in
Nigeria.
IV.
To make necessary recommendation on the
role of national primary health care development agency (NPHDA)
V.
To make necessary recommendations on the
role of national primary health care development agency (NPHCDA).
1.5
Definition of terms
v Health:
a state of complete physical, mental, and social well-being and not merely the
absent of disease or infirmity.
v Health
policy: The decisions, plans, and actions that are
undertaken to achieve specific health care goals.
v Health
system: This is the organizations of people, institution,
and resources that delivers health care services to meet the health need of a
target population.
v Primary
health care (PHC): Is defined as an essential
health care based on practical, scientifically sound and socially acceptable
method and technology made universally accessible to individuals and families
in the community through their full participation and at a cost the community
and country can afford to maintain at every stage of their development in the
spirit of self reliance and self determination.
v Agency:
An organization or business performing a particular service on behalf of
another person or group.
v Development:
An event constituting new stage of change in a change situation.
v Alma ata: The capital of soviet
republic of Kazakhstan where the first international conference on primary
health care took place.
v Principles:
This are fundamental rules, norms, or values that represent what is desirable
and positive for a person, group,
organization or community and help in determining the rightfulness or
wrongfulness of its action.
-
It is also a general scientific theorem
that has numereous special application across a wide field.
v Basic
health service scheme: An agency established for primary
health care delivery.
v Health
indicators: Quantifiable characteristics of a
population which researchers used as supporting evidence for describing health
of a population
Login To Comment