Primary, secondary health centres have collapsed, says minister

The Federal Government yesterday said primary and secondary
healthcare centres in the country have collapsed.

Health Minister Professor Isaac Adewole stated this on the floor
of the Senate.

He listed 14 states that failed to indicate interest in the
basic healthcare provision fund created to enhance primary
healthcare services.

The minister was invited to brief the Senate on the poor state
of teaching hospitals in the country.

Adewole told the lawmakers that the collapse of primary and
secondary healthcare centres was responsible for avoidable pressure
on the teaching hospitals.

Nigerians, the minister said, had lost confidence in primary and
secondary healthcare centres due to their collapse.

He said teaching hospitals were not expected to treat malaria
but to handle complicated health challenges.

Adewole stressed the need for the country to invest in primary
health centres to function effectively and dissuade people from
going to teaching hospitals.

The minister said 14 states had not keyed into the basic
healthcare provision fund initiative.

They are: Kebbi, Jigawa, Akwa Ibom, Cross River, Gombe, Rivers,
Borno, Zamfara, Ondo, Benue, Taraba, Nasarawa, Ogun and Sokoto.

He described the approval of the Basic Healthcare Provision Fund
as a game changer in the Health sector.

Adewole, who noted that the states had abandoned healthcare to
the extent that everything is handled by the Federal Government,
insisted that “we cannot succeed with this”.

The minister said 22 other states had complied with the
conditions required to benefit from the scheme.

He added: “We have, through your (National Assembly) support,
some funds. You approved it to enable us provide healthcare basic
fund. It is a game changer. We have spent almost a year developing
the guideline and, over the last weeks, we have started a rollout.
As at the last count, 22 states have registered for the basic
healthcare provision fund.

“What we have done with the fund is to structure it in a way
that money will flow from the Central Bank of Nigeria (CBN) to the
primary healthcare facilities, bypassing all obstacles.

“Last week, we succeeded in moving out funds from the CBN to the
agencies, and from the agencies, it will go to the primary
healthcare. As of today, 14 states are yet to show interest in the
basic healthcare provision fund.

“Because senators represent the entire country, I want to
quickly seek your permission to tell you the states. It is
unfortunate because this is a game changer.

“These funds provide free ante-natal care, free delivery, take
care of malaria, screen for tuberculosis, hypertension and
diabetes.”

Adewole also said: “We have 22 teaching hospitals in the
country, 20 Federal Medical Centres and 17 specialist hospitals all
over Nigeria under the direct purview of the Federal Government.
Most states also have teaching hospitals to provide tertiary
care.”

“The teaching hospitals, by design, constitute the apex of
healthcare in any country. For us in Nigeria, they represent the
topmost and, by design, they are expected to receive referrals and
manage complicated cases.

“For them to function effectively, they depend on functional
primary healthcare, functional secondary healthcare centres. When
these two levels of care are functioning, 90 per cent of ailments
can be taken care of by the primary and secondary health care
levels.”

“In other words, only 10 per cent of Nigerians who require care
will need to go tertiary health institutions. The PHCs handle 70
per cent and secondary health institutions 20 per cent.

“However, over the last couple of years, we have a major
challenge. The healthcare system can be described as a pyramid; the
pyramid has PHCs at the base, secondary at the middle, while the
tertiary at the top.

“We can also liken the healthcare system to a building. The
primary healthcare is the foundation, the secondary is the wall and
the tertiary is the roof.

“The problem we had is that the foundation is bad: the wall is
weak and we are only concerned about the roof. Under the Ibrahim
Babangida administration, the then Minister of Health, (the late)
Prof Olikoya Ransome-Kuti, invested and concentrated a lot of
attention on the PHCs because it is the foundation and is also in
keeping with the declaration in 1978 that countries should invest
in PHCs because it is the healthcare that is the closest to the
people.

“However, for some other reasons, this effort collapsed after a
few years. When the Olusegun Obasanjo administration came, there
was a lot of concern for the tertiary and it invested in the
tertiary. But that is like investing in the roof when there are no
walls and no foundation.

“When this administration came, we did a quick diagnostics and
said that for the health system in Nigeria to function properly, we
needed to restructure the pyramid.

“This pyramid, which is at the top, must be put on the base.
What we found is that Nigerians have no confidence in the primary
and secondary. Everybody would go to the tertiary.

“When we are training, you cannot enter the University of Ibadan
Teaching Hospitals without a referral letter; you must be referred
from a primary or secondary. But because the primary and secondary
have collapsed, people just walk into the tertiary health
centres.

“Somebody had malaria and could not be admitted because there is
no bed. The teaching hospitals are not expected to take care of
malaria. In fact, they are expected to take care of complicated
cases.

“What we have done through your support, and I must publicly
commend you and the Senate for approving the Basic Healthcare
Provision Fund, it is a game changer.”

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