DR AHMADU ADAMU MUAZU COLLEGE OF HEALTH SCIENCE AND TECHNOLOGY BOTO

CHE 215 “INTRODUCTION TO PRIMARY HEALTH CARE”

CHEW 100 LEVEL (SET 3) 2023

BY

AA

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INTRODUCTION TO PRIMARY HEALTH CARE

CHE 215 100 LEVEL

DURATION: 30 HOURS

UNIT: 2 UNITS

OBJECTIVES: On completion of this course, students should be able to:

1. Describe the concepts of Health.
2. Explain the Concept of PHC
3. Understand the Development of Health System

CONCEPT OF HEALTH
Definitions of Health:
Health is the level of functional and metabolic efficiency of a living organism.
In humans it is the ability of individuals or communities to adapt and self-manage when
facing physical, mental, psychological and social changes with environment. The World
Health Organization (WHO) defined health in its broader sense as “Health is a state of
complete physical, mental and social well-being and not merely the absence of disease
or infirmity”.
The Three (3) Dimensions of Health
The three (3) dimensions of health as contained in the WHO’s definition referred to:-
1. Physical Health:-This means adequate body weight, height and circumference as per age and
sex with acceptable level of vision, hearing, locomotion (movement), acceptable levels of pulse
rate, blood pressure, respiratory rate, head circumference etc. The body structure and function
should conform to the laid down standards within the range of normal development and functions
of all body systems.
2. Mental Health:-Mental health refers to that “state of well-being in which the individual
realizes his or her own abilities, cope with normal stresses of life, work productively and fruitfully
and can afford to make a contribution to his or her community”. A mentally normal person has the
ability to;
i. Mix up with others.

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ii. Makes friends.
iii. Behave in a balanced manner.
iv. Keep himself/herself tidy and observes adequate personal hygiene.
v. Well oriented to time, place, persons and environment.
vi. Not unduly suspicious of others.
vii. Happy and enjoys life with others.
viii. Thinks positively.
ix. Has normal development.
x. Productive to the society and nation.
xi. Emotionally stable.
xii. Realizes his/her short comings, strengths and abilities.
3. Social Health:-This means ability of a person to adjust with others in his social life, at home
and at work place. People interact, inter-relate, inter-depend on one another and play their
effective roles in accordance with the situation they find themselves. This is what is termed as
social wellbeing.
This also covers areas like:-
i. Income level
ii. Literacy
iii. Occupation and working conditions
iv. Marital harmony
v. Family institution
vi. Social groups, cultural and behavioural patterns of the society Stressful situations etc.
4. Spiritual dimension: You will agree that another important dimension which could be
examined is the spiritual dimension. This includes a study of principles of ethics, beliefs,
purpose in life and commitment to some higher being. Spiritual well-being is not in
isolation from mental well-being of a person. It is now believed that spiritual values
influence our behaviour and mental wellbeing e.g., if you do meditation, it helps to keep
you free of mental worries and stresses of daily life and gives freshness and peace of
mind. To sum up the above discussion on dimension of health we can say that
Today, three types of definition of health seem to be possible and are used.

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  The first is that health is the absence of any disease or impairment.

 The second is that health is a state that allows the individual to adequately
cope with all demands of daily life (implying also the absence of disease
and impairment).
 The third definition states that health is a state of balance, an equilibrium
that an individual has established within himself and between himself and
his social and physical environment.

THE LAYMAN’s CONCEPTOFHEALTH

To the layman, health simply means a state of wellbeing i.e. the absence of
disease .Infact, what constitutes disease varies from culture to culture, from society to
society and from community to community. There are community in Nigeria where the
passage of blood in the urine by males regards as normal. Because this phenomenon is
regard as the counter part of menstruation in the female. In fact, a male who has
reached the age or puberty and adolescent experience this passage of blood in the
urine is thought to be abnormal. Unknown to this phenomenon is a sign of the
disease.

Development of Nigeria Health System since Independence

Before 1988 there was no comprehensive document regarded as National Health Policy.
Most of the decisions and direction of health care programmes were encapsulated in the
development Plans.
• First Ten Year Development Plan for Development and Welfare 1946-1956
 The Walter-Harkness Plan (1946-1956) was the first attempt to officially plan for
development of health services in the country. It was conceived as a modest
framework which the population should be able to maintain financially and which
would be capable of being developed gradually into something approaching the
real needs of the country. The Plan however did not live its full course. A new
constitution was adopted in 1952 which divided the country into three regions and
transferred some of the powers of the Colonial government to elected Regional
Representatives who were Nigerians.
Regional Health Plans in the period 1952-1962
 The first regional policy paper on health was produced by the then Government of
Western Nigeria. The Governments of the Northern and Eastern Regions also

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 produced their health programmes between 1952 and 1962. They were mostly
noncommittal on those new issues introduced by the Government of the Western
Region. The Federal Minister of Health tried without success in 1963 to introduce
the Health Insurance Scheme in Lagos.
The Six Year National Development Plan 1962-1968
 This was jointly produced by all the governments of the Federation in 1962 for the
period 1962-1968.
 This was the first post-independence development plan.
The Second National Development Plan 1970-1974
 The health plan formulated in the second National Development Plan of the
Government of the Federation of Nigeria had the following main objectives.
Restoration of the health facilities and services which were destroyed during the
civil war.
The Third National Development Plan 1975-1980
Basic Health Services Scheme (BHSS): The Basic Health Services Scheme was the strategy
formulated for achieving these objectives but it failed to achieve most of its objectives
and targets.However, some progress was made in the development and intermediate
manpower training.
The Fourth National Development Plan 1981 -1985
The National Health Policy 1988 , This was the first time a National Health Policy
predicated on the Alma-Ata declaration of 1978 which promoted “health for all by the
year 2000” The key elements of the NHP include;
 National Health Care Systems.
 National Health Strategy
 National Health Information System
 National Health System Management.
 National Health Manpower Development
 National Health Technology
 National Health Research
 National Health Care Financing
The goals of the 4th national health development plan was to provide, within the limit of
available resources a comprehensive health care system offering promotional, protective,
restorative and rehabilitation services to the increasing proportion of the population at
three levels namely:
 1. Primary or Basic Health Care: To provide health care services
delivered in health centre, clinic and outpatients department of hospitals in rural
sub-urban and urban areas.
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  2. Secondary Health care: To provide health care services, part
of which is to be provided in hospitals, to serve as referral services to
support the basic and specialist services for individuals.
 3. Tertiary Health Care: To be provided in specialist and
teaching hospital and institutions to support the basic and secondary levels of
health care.

The National Health Policy 1996

 Primary Health Care as the cornerstone of the Nigerian Health System and the
strategic objectives has remained the same.It should be mentioned that the 1996
revision was not formally endorsed (by the National Council on Health and FEC)
while the 2004 revision was endorsed and published.
The Revised National Health Policy 2004
In line with the health sector reform agenda the National Health Policy was revised in
2004. The elements of this policy include;
 The National Health Systems and Management
 National Health Care Resources
 The National Health Interventions
 National Health Information System
 Fostering Partnership for Health Development
 National Health Research
 National Health Care Laws

Diagram Illustrating Federal, State and Local Government Health System

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Note
 Federal government is responsible for Tertiary Health care
 State government is responsible for Secondary Health care
 Local Government is responsible for Primary Health Care

FACTORS AFFECTING HEALTH CARE IN NIGERIA

1. Cultural Factors: Culture is the way people live which has evolved over a long
period of time and goes from generation to generation. The components of culture are;
custom, believe and practices, taboos and habits. Some cultures are beneficial while others
are harmful to health; for example a woman keeping away from her husband in terms of
sex after delivery till child weaning is a beneficial culture in that it checks unwanted
pregnancy and give the reproductive organs time to properly go back to their normal shape
(Involution). Though this culture is gradually fading off as a result of modern family
planning methods.
Some unbeneficial or rather harmful customs like throwing away the first breast milk after
child birth in that its dirty, or refusal to give an egg to children in that it will prompt them
to be thieves are harmful cultural practices and because colostrums is the best part of breast
milk for new born while egg is rich in protein needed by children for proper development
and growth in no way contributes to the child’s bad behaviour. Culture differs from tribe to
tribe, race to race. Harmful cultures should be discouraged.
2. Social Factors: This is the relationship of man with his environment and it
embraces: Education, which liberates one from ignorance and even disease. Ignorance of
where to obtain health service, and the importance of health services constitutes much to
disease and death in both Nigeria and globally. Lack of amenities such as good road,
Electricity is responsible for in adequate distribution of food and health services including
referrals. This lead to scarcity in some areas and wastage in other areas and it affects
health. Insecurity of life and properties due to lapses on the side of law enforcement and

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executive agencies and on the side of the individual and environment also lead to ill health.
Poor water supply is in fact another major arm of social factors that affects health as it lead
to much communicable diseases, infection and infestation of micro and macro organisms.
3. Economics Factor: Poverty due to unemployment has been made worse by
inflation. Poor management of resources by the leaders in Nigeria and other nations of the
world have led to much scarcity and want especially to the rural dwellers and it affects
health adversely.
4. Personal Factors: Embraces attitude towards self, which drastically affect health.
Such attitudes are poor personal hygiene and dirty habits which can lead to infection and
infestation of different types, negative attitude towards health matters can greatly affect
health.
5. Environmental Factors: Comprises of pollution of air, water and soil, improper
refuse and industrial waste disposal and poor housing. Polluted environment caused
different types of systemic infection. Improper refuse disposal causes accident of different
types and breading of pest and vectors. Poor housing exposes one to extreme climatic
conditions like heat or cold. Poorly ventilated house leads to different types of
communicable disease and respiratory tract infection. There is also risk of accident in a
poorly constructed house.
6. Political Factors: Favours and one-sidedness amongst the executive to communities
that gave them their votes in terms of equity, quality distribution and allocation of
resources to those communities. Political vanguard amongst the jobless youth which lead
to injuries, loss of body parts and lives during rallies, and creating enabling conditions for
drug abuse among youth all in race to succeeds a throne or sit of power.

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CULTURAL THEORIES OF DISEASES CAUSATION IN NIGERIA
(a). Cause of the ancestors: This is the theory of the belief that any affliction or ailment is
caused by the spirit of the ancestors, which must have been provoked by the sick person in
one way or the other.
(b). Cause of the act of God: This theory believe that any sickness happening to man is
the act of God either as punishment or reward for actions of the sick person.
(c). Cause and effect: This theory believes in the retributive justice and claims that any ill
health and disease is as a result of some wrong deeds.
(d). Witches and Wizards: There is also a believe that some men (wizards) and some
women (witches) have magical powers, which they use to be witched people. Their
bewitchment could be in the form of harm or even killing the subject. Reason of their
attacking a person is attributed to either jealousy , revenge, to win a competition, meet with
the expectations of in the world of witchcraft, or to pay for his/her own share of human
flesh/blood from other partners.
(e). Sorcery: Some people are believed to have mystical (Magical) powers, which they use
to protect themselves or cause harm and illness to others. Sorcerers can employ various
means like poisoning, invoking sickness or using sand from the victims foot mark to inflict
him/her.
These believes in this factors are the reasons such societies choose and strongly
adhere to the sort of remedies and practices seen among them. An average Nigerian still
has the view that traditional medicine is more efficacious for the treatment of mental
illness, Fracture and others com[pared to the orthodox treatment.
Religion as a part of culture also plays important role on how members view and manage
illness. They employ prayers and incantations. Some religions would not accept drugs or
blood transfusion .

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THE INFLUENCES OF CULTURAL THEORIES ON HEALTH.
It influences health negatively because it makes people to:
 To refuse modern health care.
 To reject self and regard self as a victim of wrath of God and ancestors
 Instead of looking for medical services, they go to perform sacrifices and rituals to
appease the God and the spirit of ancestors.
 Because of wrong perception to the cause of ill-health, their attitudes towards
prevention of illness are also wrong. Instead of maintaining personal and
environmental hygiene; adhering to health education on food and nutrition and going
for regular check- up, they devotes much of their resources to incantation and
sacrifices that are not helpful.
Healthcare seeking behaviour (HSB) has been defined as, "any action or
inaction undertaken by individuals who perceive themselves to have a health
problem or to be ill for the purpose of finding an appropriate remedy" Health
seeking behaviour can also be referred to as illness behaviour or sick-term
behaviour, people resort to seeking health in different ways which will be
discuss below
COMMON SOURCES OF HEALTH CARE IN NIGERIA
1. Traditional sources: By native doctors and herbalist through singing of incantations,
consultations of oracles and sacrifices, use of herbs, animal and mineral matters.
2. Homeopathic sources: By untrained and unskilled individuals who belief that they
know how, Sometimes they combine traditional methods with some orthodox
method.
3. Prayer House: By individuals who claims God anointing and directives. They use
fasting, prayer and counselling. Some of them perform sacrifices.

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 4. Orthodox source: This is scientific method by trained and skilled health service
providers of different categories. They provide health services through presumptive
and differential diagnosis, aseptic medical and surgical management.
HEALTH TEAM IN HEALTH CARE DELIVERY

A health team: can be defined as a group of an individual’s /person with different

background, knowledge and skills who work together to give health care to the people.

Members of health team include those working together, e.g. drivers, cleaners
(supporting staff) are all part of a health team and their work should be recognized as
that of a technical staff.

Composition of health team

1. Community health officers

2. Nurses and midwives
3. Public health officers
4. Environmental health officers
5. Pharmacists
6. Medical laboratory scientists
7. Health information officers
8. Dental therapists
9. Traditional birth attendants(TBA) volunteers village health workers(VVHW)
10.Drivers
11.Cleaners

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Characteristics of a good health team

1. aimed t a common goal

2. Have clear line of communication
3. Clear means of coordinating and cooperation in all function related to their goal
4. Agreed on working procedures
5. Respect for every member of the team
6. Hold regular meeting
7. Work in the community e.g health centers, people home and community places
8. Encourage community participation and identifying problems and seeking
problems.

Functions of a health team

1. School health services

2. Follow up patient to their home
3. Promote community participation
4. Works as a mobile team
5. Identify diseases that required early referral
6. Educate the community on children nutritional status and other health problem
7. Educate the community on how to improve water quality
8. Ensure antenatal services
9. Encourage environmental sanitation.
10. Give feedback to the concern authority

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Challenges militating against good teamwork at the PHC level

 Lack of motivation from the authority

 Inadequate facilities in the operational canters
 Mal-distribution of task and resources
 Lack of proper understanding among the members
 Bias from the team leader
 fragmentation among the team members
 Inadequate supervision
 Lack of job satisfaction

Definition of Primary Health Care (PHC)

WHO 1978 Alma Ata conference defined Primary Health Care as an essential care based
on practical scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through their full
participation and at cost that the community and country can afford to maintain at every
stage of their development in the spirit of self-reliance and self-determination.

Rational/Need For Primary Health Care

I. To make health care available and accessible to people wherever they live and
work
II. The technology use to provide the services must be maintainable by the people
within the community(S.S.S)
III. Promote community participation and enhance self-reliance
IV. To reduce morbidity and mortality among high risk group e.g. children and elderly
mothers

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 V. To provide adequate and effective health care at the grass-root level by involving
the individual, family and community.
VI. To prevent illness in the community through health education.

COMPONENTS/ELEMENTS OF PHC

The Alma Ata declaration stated eight essential elements of PHC .for now, however,
mental health and dental health are included bringing the elements of PHC to ten,
depending on the country , the component may be more but In Nigeria they are ten at
this moment.

1. Education concerning prevailing health problems and method of preventing

and controlling them: health education becomes an organic instrument of
empowering community on specific health issues the primary health care
workers should be prepare to carry out health promotion, counseling and
screening for preventable diseases in the community. The following areas of
immunization, treatment of simple heath problems, prevention and management
of STDs and promotion of environmental sanitation and others must be
emphasized.
2. Promotion of adequate food supply and proper nutrition: the ability to
diagnose, manage and prevent mal-nutritional problems is a key issue in this
component. This approach will prevent severe malnutrition in pregnant and
lactating mothers as well as reduce the prevalence of under weight and
malnutrition among the children, the elderly and other vulnerable groups in the
community.
3. Provision of adequate water supply and basic sanitation: water is essential
element in human life and basic necessity of life.it constitutes a major

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 percentage of fluid in the body and helps in transportation of nutrients and cells
to various parts of the body. Major health problems are preventable diseases
associated with the consumption of unwholesome water and lack of
environmental sanitation.
4. Maternal and child health including family planning: this focuses on the
protection of mothers and children that reduces the rate of morbidity and
mortality in mothers and children through access to quality antenatal care which
provides comprehensive quality care for both pre and post delivery.it is
necessary to promote and protect the health of mothers and children through
ANC services and encourage inter-sectoral support and coordination in PHC
resources for child health .family planning must be encourage as well as being
practiced.
5. Immunization against major infectious diseases: the community health
practitioners should integrate specific services aimed at increasing immunization
coverage among children of 0-5 years against childhood killer diseases such as
pertussis, measles diphtheria, tetanus poliomyelitis and TB. It will be recalled that
these diseases are responsible for child morbidity and mortality. Children and
pregnant mothers must be immunized so that they can benefit from the health
services provided for them. Immunization also safeguarding both mothers and
children from immunizable diseases.
6. Prevention and control of locally endemic diseases: the process involves to
carryout early detection and recognition of diseases; initiate prompt and
appropriate treatment as well as referrals to proper level of care. Provides basic
preventive care to high risk children, undertake specific measures to prevent and
control endemic disease e.g. disinfecting, disinfestation and other measures.

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 7. Appropriate treatment of common diseases and injuries: PHC emphasizes on
initiation of simple diagnostic procedures, provide emergency care including pre-
hospital care; counsel sick persons and refer patients to appropriate health care
facility as at when necessary.
8. Provision of essential drugs: one key indicators for the successful
implementation of PHC strategy is the availability of essential drugs at all levels of
health care delivery system. Essential drugs are drugs that satisfy the health care
needs of the majority of population.
9. COMMUNITY Mental health: it is an integral part of health it is also a
component of PHC in Nigeria.it is the factor that has to do with the capacity of
the individuals a group and the environment to interact with one another in ways
that promote the feeling of well-being.it is concerned with the optimal
development and use of such mental abilities as thinking, feeling, reasoning,
understanding and behavior required for normal levels of functioning and the
factor that can disturb this functioning.
10.Dental health: PHC activities should include oral health education especially
tooth decay and prompt treatment or avoidance of an action that promote
dental problems in the community.

Others include the following:-

 Primary eye care

 Care of handicapped
 Care of aged
 Care of adolescence
 Promotion of occupational health

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Principles of Primary Health Care

1. Available: simple means health care services must be available to all people
wherever they live and work and that service must be maintain at all time
2. Accessible: health care services should be very close to individual, family and
community at least not more than(5) km away such that people can benefit from
the services render in the community
3. Affordable: the community, disable and aged must be in position to buy drugs and
afford technical services at a cheaper rate through government subsidy
4. Acceptable: convince the community members about their beliefs, customs and
perception about causation of diseases and persuade them to accept the health
services
5. Equitable distribution of health resources: means that primary health care services
should be made available and the personnel , the equipment must be shared
equally in various health facilities within the urban and rural community
6. Appropriate technology: means that the method , materials and techniques must
be scientifically sound and easy to use by the community and acceptable(evidence-
base) to treat certain health conditions e.g. (S.S.S) salt sugar solution in diarrhea
case
7. Inter-sectoral collaboration: it is a known fact the component of PHC can not be
provided by the health sector along, therefore, PHC requires the supplies of other
sector to achieve its goal, such as national e.g. ministry of agriculture, education,
housing and water resources or international/NGOs e.g. save the children,
UNICEF,WHO,MSF, e.t.c.

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 8. Integrated health services: means to provide preventive, curative and promotive
health care services at the same time and some place (health facility) which will
lead to client satisfaction.

THE BASIC LEVELS OF HEALTH SYSTEM IN NIGERIA

The Nigeria health system operates under 3 (3-tiers) interrelated levels, namely; federal,
state and local government. The federal government coordinates the affairs of university
teaching hospitals, federal medical centres (tertiary healthcare) the state manages the
various general hospitals (secondary healthcare) and the local government focuses on
dispensaries (PHC.) which are regulated by the federal government through (NPHCDA)
National Primary Health Care Development Agency.
Fig. 1: Organizational Structure of the 3-Tiers of the Health System in Nigeria
FEDERAL LEVEL
The Federal Directorate of PHC

Honourable minister of health

Director General - Health

Director of PHC Directorate________________________

___________________________________________________________
Asst. Director of Asst. Director Asst. Director MCH/FP Asst. Director Planning
monitoring Epid., Nutrition, Health Education manpower development
and Evaluation.

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STATE LEVEL
State directorate of PHC

Honourable commissioner for health State PHC implementation

committee
Director General-Health

Director for PHC (state PHC Coordinator)____________

Asst. Dir. Div. of Epid. , Asst. Dir. Div. of PHC Asst. Dir. Div. of PHC
Nutrition, Health Edu., Training and manpower devt, Essential drugs
Planning, monitoring
LOCAL GOVERNMENT LEVEL
The LGA health department
Local government chairman________________________

Supervisory councillor For Health Local govt. PHC Development. Committee

___________________________

PHC Coordinator Experienced

Community
Health Officer

Asst. Co- Asst. Co- Asst. Co- Asst. Co-ord , Asst. Co-ord ,
ord ord ord Planning

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MCH/F E..P.I Esstt Sch. Health monitoring &Eva
PNutritio disease Drugs Prog
Control

Health care delivery in Nigeria is therefore rendered as follows

a. Primary level
b. Secondary level and
c. Tertiary level
Functions of the 3 - Tiers (Level) of Health Care
a. THE LOCAL GOVT. (primary level)
This is the 1st level providing primary health care services to the local community. Its
emphasis is-on preventive care. The functions are:
i. Mobilizes, motivates and involves community members through their chiefs,
traditional rulers, religious leaders and other avenues in identifying and taking
decisions, planning solution to their health problems using their own available
resources.
ii. Recruits, trains and promotes the delivery of PHC services by disciplined staff
iii. Plans and organizes local strategies to deliver PHC services in the LGA.
iv. Enforces and supervises environmental health laws
v. Implements PHC services such as MCH/FP, health education, treatment of minor
ailment, immunization etc.
vi. Facilitates referral services
vii. Liaises with state and federal govt. on primary health issues in the area.

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Members of the health team at this level are:
• Medical officer of health – chairman
• Community health officers
• Community health Extension workers
• Junior health Extension workers
• Voluntary Village Health workers (VVHW) and TBAs
• Registered Nurses and Midwives
• Environmental health Officers
• Medical laboratory and
• Pharmacy Technicians
• Dental therapist,
• Medical health record officer etc.
This level of operation takes place at health facilities, such as health post, health clinics,
primary health centres, Comprehensive health centres

b. THE STATE GOVERNMENT (secondary level)

This level provides services for more serious cases that might have been referred from
the primary health centres Functions are:-
i. Establishes secondary health facilities
ii. Organization and management of health training institutions - nursing,
midwifery, health Technology,
iii. Formulates the states' health policies
iv. Translates and executes federal health policies
v. Recruitments and disciplines staff
vi. Setting of standard for private hospitals and clinics

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 vii. Liaises with international agencies on health issues
viii. Carries out research activities
ix. Offers in-patients and out-patients services such as diagnostic, medical and
surgical treatments, blood transfusion services, MCH / Family Planning services
and referral to tertiary institutions when necessary.
Members of the slate level health team are: -
• Medical Doctors
• Registered Nurses/Mid-wives
• Pharmacists,
• Laboratory Technologists
• Radiologists and
• Other supportive staff.
Facilities used are the specialist and general hospitals.
c. THE FEDERAL GOVERNMENT (tertiary) level
This is the apex of health care delivery in Nigeria. Functions are as follows: -
i. Formulates national health policies
ii. Provides funds for manpower training, establishes specialized training and
research institutions, e.g. medical schools, Teaching hospitals and research units
iii. Provision of funds for capital projects etc. for the states and local government
levels health department respectively,
iv. Monitors and supervises projects and programmes at the state and local govt.
health departments
v. Sets standards for state and local govt. health departments
vi. Liaises with international organizations on health care matters

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 vii. Organizes tertiary institutions, accepting referrals and providing
specialized care like rehabilitative services.
Members of the team are:
Specialists like:-
• Ophthalmologists
• Otolaryngologists
• Gynaecologists
• Obstetricians
• Consultants, Professors
• Pharmacists
• Laboratory Scientists
• Radiologists
• Psychiatrists
• Dermatologists
• Statisticians
• Nurses/Midwives, (specialists in all branches of medicine).
They operate in teaching and specialist hospitals like orthopaedic, psychiatry, etc.
Rational for the 3-tiers:-
1. To ensure prevention and treatment of common problems from the grass-root
level.
2. To facilitate (he referral and treatment of more serious cases to a more
specialized centre.
3. To avoid waste of resources

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Policy issues in health care delivery
The Nigeria National Health policy identified Primary Health Care (PHC) as the main focus
for delivering an effective, efficient, qualitative, accessible and affordable health services
to a wider proportion of the populace through;
• Promotion of community participation in planning, management, monitoring and
evaluation of the local government primary health care (PHC) system
• Improve inter-sectoral collaboration in Primary health care delivery
• Enhancing functional integration at all levels of the health system
• Strengthening of the managerial process for health development at all levels.
The reviewed National Health Policy recognized the Local Government Area as the
operational level for primary health care implementation. The National Primary Health
Care Development Agency (NPHCDA) which was established by Decree 29 of 1992 has a
mandate to periodically monitor and evaluate the National HEALTH Policy, especially as it
relates lo primary health care, resources nationally and internationally for the PHC, and
most importantly provides technical support, coordinates and develops strategies for the
effective implementation of PHC nationwide.
The Ward Minimum Health Care Package (WMHCP): was developed to address this
current strategy to deliver PHC services, and consists of a set of health interventions and
services that address health and health related problems that would result in substantial
health gains at low cost to government and its partners
Concept and Development of the Minimum Health Care Package
• In February 1994, at the 16th WHO Regional Programme Meeting held in Yaoundé,
Cameroon, participants from African countries including Nigeria met to discuss issues
relating to acceleration of the attainment of Health for all through PHC.
• The meeting recognized the need for each member country of WHO in the African
Region to organize a National Programme Meeting (RPM.16C). This was to serve as a
forum for presentation of the Minimum District Health for all Package, which was
extensively discussed at that meeting.
• Strategies for implementing the package were developed.
In August 1994, six months

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• After the Yaoundé meeting, the then Hon. Minister of Health and Social Services, in
collaboration with the WHO, Nigeria and the National Primary Health Care Development
Agency, organized a four day stakeholders meeting aimed at developing a Minimum
District Health Care Package for Nigeria for the acceleration of HFA through PHC
• A package that came out of that meeting consisted of thirteen (13) components each
with objectives and strategies to be implemented between 1995 and 2000.
• In 1996, each of the 36 States and selected LGAs developed a Plan of Action to
implement the package.
• In January 1998, report of supervisory visits conducted to ascertain level of
implementation indicated that most of the selected LGAs had 4 – 5 components in their
plan of action; however, level of implementation of MHCP was low.
• In June 1998, a National Review Meeting to discuss progress report was convened, and
a resolution by the meeting, brought the number of components to four namely:
 Child Survival (IMCI & Routine Immunization)
 Safe motherhood (ANC, Delivery, Postnatal Care, FP)
 Control of Communicable diseases of public health importance (Malaria, TB,
HIV/AIDS)
 Health Information, Education and Communication.
• At a national review meeting held in Port Harcourt in 2001, an additional component
was incorporated into the package, namely: Nutrition. State and LGAs presentations at
the review meeting indicated low implementations of components of the package.
The meeting re-emphasized the need for government to fund the package in line with the
recommendation of WHO-AFRO of 1994.
• It also observed that socio-economic indicators had worsened; level of unemployment
was high, while morbidity and mortality statistics were unacceptably high. Cost of health
services had gone beyond the reach of majority of Nigerians.
• The meeting recommended the need to strengthen budgetary allocation to health. The
reviewed package was renamed Ward Minimum Health Care Package (WMHCP) in line
with the introduction of the Ward Health System (WHS) in 2001. However constraints in
costing the package undermined its widespread dissemination and utilization.
• In 2005, the NPHCDA in collaboration with WHO convened a meeting to update the
WMHCP and adopt instruments for its costing. At this meeting, the Control of Non
Communicable diseases was incorporated as the sixth component

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PRIMARY HEALTH CARE APPROACH OF THE NIGERIAN HEALTH
SYSTEM.
In pursuit of the goals of Nigerian health system, primary health care adopted the
following approaches in order to achieve them. They are:-
1. Down-up (bottom-up) approach
This implies that planning, implementation and evaluation of Primary health care
services should be from the grass root (community level). That means that the processes
would proceed from the community to local government, to the state and then to the
federal government level.
2. Emphasis on Prevention
Primary health care emphasizes more on preventive services e.g. immunization, health
education. etc. Rather than the curative of the previous system. It therefore focuses on
primary (prevention) then secondary (curative), tertiary (rehabilitative) and promotive
health care delivery.
3. Cost recovery
Primary health care services are to be affordable both in terms of money and time. That
does not mean that the services are free of charge, the price payable is to enable the
sustenance of the system.
4. Quality assurance

Primary health care emphasizes a qualitative health care delivery. It be of standard,

scientifically sound, uses appropriate technology and acceptable to community members.
Quality assurance by definition is the systemic evaluation of care based on the pre-
determine standard and the systematic corrections of deficiencies
The Primary Health Care under One Roof (PHCUOR ) policy is a national
policy that was approved in May 2011 at the session of the 54 th National Council of Health
to reduce fragmentation and improve PHC performance thus contributing to better health
outcomes. It aligns with the National Health Act (NHAct) of 2014. Since approval,

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implementation of the Policy was slow mainly because of low political commitment by
subnational PHC actors
Primary Health Care Under One Roof (PHCUOR) is a policy to reduce fragmentation in the
delivery of Primary Health Care (PHC) services which involves the integration of all PHC
services under one authority. Fragmentation has been identified as the most significant
problem facing PHC services, and significantly affects utilisation rates and health indices.
Working with National Primary Health Care Development Agency (NPHCDA) in Nigeria,
Health Partners International, and partners on the PRRINN-MNCH programme, launched
the PHCUOR initiative.

Key elements of the PHC Under One Roof policy

– Integration of all PHC services delivered under one authority
– A single management body with adequate capacity to control services and resources,
especially human and financial resources
– Decentralized authority, responsibility and accountability
– The three ones principle: one management, one plan and one monitoring and
evaluation system
– An integrated and supportive supervisory system
– An effective referral system between and across the different levels of care
– Enabling legislation and regulations

HEALTH CARE SYSTEM

The world health organization defines a health care system as the organization,
institutions, people, and resources whose primary purpose is to promote, restore or
maintain health. it’s commonly agreed that these different types of organizations can only
achieve their goal by working together
TYPES OF HEALTH CARE SYSTEM

There are many types of healthcare systems around the world. Each type has its own
unique features, but they all share the common goal of providing quality care to patients.

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 Government-sponsored health insurance programs like BHCPF, NHIS, IMPACT
 Non-profit community hospitals
 For-profit hospitals
 Voluntary insurance programs like RED CROSS, DOCTORS WITHOUT BORDERS
Alternative health care services are health treatments that are not typically
provided in a traditional Western medicine practice. There are a wide range in practices,
but typically these services focus on creating health through balance between mind,
body, spirit, and environment.
There are different categories of alternative health services.

 “Complementary” treatments are used with standard medical practices;

 “Integrative” practices blend approaches together;
 “Alternative” treatments are in place of conventional medicine.

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