Rh “Rhetoric! Realism! Results!!! Health Care in Nigeria.”

1. Rh“Rhetoric! Realism! Results!!!Health Care in Nigeria.” Adetokunbo O. Lucas, MD

2. Outline • Primart Care • Primary Health Care (PHC) • Realism: - PHC in Nigeria • Resukts • Rhetoric

3. Primary Care Pre-Alma Ata • Stand alone - poor linkage to other tiers • Top down – minimal community involvement • Inequitable allocation & access • Arbitrary, non-scientific No "NAFDAC" number

4. Basic Health Services Primary Care Level CURATIVE SERVICES HEALTH EDUCATION HEALTH STATISTICS MATERNAL & CHILD HEALTH ENVIRONMENTAL HEALTH

5. International Conference on Primary Health Care, September 6–12, 1978 Alma Ata, USSR

6. Alma Ata Declaration 1978 Primary health care is essential health care based on practical, scientifically sound & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation, & at a cost that the community & country can afford to maintain at every stage of their development in the spirit of self‑reliance & self‑determination.

7. Alma Ata Declaration 1978 • Primary health care is: • essential health care • based on practical, scientifically sound & • socially acceptable methods & technology • made universally accessible to individuals & families in the community • through their full participation, & • at a cost that the community & country can afford to maintain at every stage of their development in the spirit of self‑reliance & self‑determination.

8. 7 Pillars of PHC • Foundation of the health system • Focus on priorities • Equity • Science/Evidence based • Culture sensitivity/social relevance • Community participation • Sustainability & self-reliance "NAFDAC" number

9. #1 Foundation

10. #1 Foundation (contd.) …should be sustained by integrated, functional & mutually‑supportive referral systems, leading to the progressive improvement of comprehensive health care for all, & giving priority to those most in need;…."

11. Strengthening Referral System TERTIARY SUPPORT SUPERVISION REFERRAL SECONDARY PRIMARY

12. #2 Equity and social justice .....made universally accessible to individuals & families in the community.

13. #3 Science/Evidence Based "…is based on the application of the relevant results of social, biomedical and health services research and public health experience;…"

14. #4 Priorities “addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly. "

15. #5 Culture sensitivity/Social relevance • …socially acceptable methods & technology; • ….reflects & evolves from the economic conditions & socio-cultural & political characteristics of the country & its communities.

16. #6 Community Participation • The people have the right & duty to participate individually & collectively in the planning & implementation of their health care. • ..requires & promotes maximum community & individual self‑reliance & participation in the planning, organization, operation & control of primary health care…….

17. #7 Sustainability & self-reliance ......at a cost that the community & the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination."

18. PHC in Nigeria

19. Committee on National Health Policy Chairman: Adetokunbo O. Lucas Members Professor Umaru Shehu – Eminent academic Chief Lambo, President, Association of Traditional Healers Etc.

20. Committee on National Health Policy • Recommended a health system based on PHC • Linked to National Development Goals • Report – 1984 • Several Ministers of Health ignored report • No formal action until 1988 Professor Olikoye Ransome-Kuti National Health Policy - 1988

21. Second National Development Plan • A free and democratic society • A just and egalitarian society • A united, strong & self-reliant nation • A great and dynamic economy • A land of bright & full opportunities for all citizens Professor O. Aboyade

22. Realism

23. #1 Integrated Health System • Fragmented services • Poor co-ordination among 3 tuers of government • The most critical component of PHC (Primary Care) is assigned to the weakest, poorest and least stable governments

24. #2 Equity • Equity & social justice • Universal coverage with basic health services • Conditioned by national resources

25. #3 Science/Evidence Base • Promote ESSEMTIAL NATIONAL HEALTH RESEARCH • Objective assessment of needs and opportunities • Science based decision ,making at every level of the health services

26. #4 Priorities Selection of interventions on the basis of: • Burden of disease • Cost • Cost effectiveness

27. #5 Cukture Sensitivity • Listening to the people • Adapting interventions in relation to beliefs & preferences • Advocacy and education to encourage bedt choices #

28. #6 Community Participation Full partnership • Planning strategies/projects • Delivery of services • Monitoring • Evaluation • Contributions in cash & kind

29. #7 Financing health services • Affordable • Sustainable • Allocation based on agreed priorities • Balance between primary care and other services

30. RESULTS

31. Health Statistics: Nigeria Consistently poor performance Limited progress `

32. Ghana 113 Cameroun 164 Nigeria 187 Angola 181 Kenya 140

33. Under-five mortality rate/1000 live births (1990 – 2005)

36. Diphtheria-Tetanus-Pertussis immunization among one year olds GHANA NIGERIA

37. Where do we go from here? PHC

38. Where do we go from here? • Advocacy - key stakeholders • Strengthening health care units • Optimising referral system • Training managers • Financing • Accommodating culture

39. 2. Strengthening Primary Care

40. From Primary Care Conclusion To Primary Health Care

41. Primary Health Care • Health system • Priorities • Equity • Evidence based • Culture • Participation • Sustainability PRIMARY CARE

42. Honouring His Memory Make PHC Real in Nigeria