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.”