By Eze Onyekpere
Primary health care (PHC) is seen as an entry point for improving Universal Health Coverage (UHC). PHC is part of the tripod that includes secondary and tertiary health care. These two terms, UHC and PHC are part of the right to the highest attainable standard of physical and mental health which accrues to all individuals without discrimination on the grounds of sex, religion, political opinion, place of birth, orientation, etc.
UHC is not limited to PHC but includes interventions at the secondary and tertiary levels of care. However, PHC is the foundation for UHC. PHC as defined by World Health Organisation (WHO) and the United Nations Children Fund (UNICEF) is: “A whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment”.
WHO and UNICEF further articulated three interrelated and synergistic components of PHC as follows: “Meeting people’s health needs through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course, strategically prioritizing key health care services aimed at individuals and families through primary care and the population through public health functions as the central elements of integrated health services. Systematically addressing the broader determinants of health (including social, economic and environmental factors, as well as individual characteristics and behaviour) through evidence-informed policies and actions across all sectors; and empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self-carers and caregivers”.
PHC is the first level of contact for citizens and the community with the national (and state) healthcare system. It focuses on the primary health problems in the community, providing preventive, curative, rehabilitative and promotional health services. It engages the broad determinants of health through a multi sector/stakeholder approach anchored on the understanding of the complex interplay of factors that lead to improved health. Essentially, PHC would include issues related to nutrition, supply of safe water, sanitation, maternal, new born and child health, immunization and family planning. Others include health education and community mobilisation and control of communicable diseases, etc.
The task of the National Primary Health Care Development Agency (NPHCDA) provides further insight on the constituents of PHC. NPHCDA states that it controls preventable diseases, improves quality of care, engages the community, develops a high-performing and empowered workforce, improves access to basic health care services, strengthens institutions and partnerships. Primary health care is defined in the NPHCDA Act as including: “care designed to prevent disease and promote health and out-patient care, including general medical care, maternal and child health care, domiciliary health care and rehabilitation and nursing care, including home visits.”
In Nigeria, PHC is funded from the government budget and through other funding sources including aid and grants from international and other development partners. Ideally, it should be operated by the third tier of government, being the local government councils. Effective PHC systems ought to be inclusive ensuring that no one is left behind, equitable, efficient and cost-effective in order to enhance people’s physical and mental health, as well as social well-being. It builds resilience, engages the upstream determinants of health, while attacking factors (beyond health) most frequently associated with disease conditions in epidemiological analysis.
WHO and UNICEF further state that PHC is critical for realizing UHC because: “PHC plays a key role in reducing household expenditure on health by addressing the underlying determinants of health and by emphasizing population-level services that prevent illness and promote well-being. This both reduces the need for individual care and can avoid the escalation of health issues to more complex and costly conditions. Empowered people and communities are key advocates for increasing financial protection for health services. PHC is a cost-effective way of delivering services, so focusing on PHC is the best-value way for countries to move towards universal access. The involvement of empowered people and communities as co-developers of services improves cultural sensitivity and increases patient satisfaction, ultimately increasing use and improving health outcomes. In addition, there is considerable evidence that health systems based on primary care services that are first-contact, continuous, comprehensive, coordinated, and people-centred have better health outcomes. In many countries, the majority of people who do not currently have access to care are disadvantaged. PHC is optimally placed to address this, because of its emphasis on tackling the determinants of health, which underpin vulnerability. Additionally, in most countries, the PHC focus on community-based services is the only way to reach remote and disadvantaged populations”.
Against the background, a greater focus on PHC to make it efficient and effective will contribute in no small measure to improving Nigeria’s health indicators.
Onyekpere writes from Lagos