Facts And Fallacies Of Primary Healthcare Delivery In Rural Communities

I was shocked to learn of the demise of a couple of rural dwellers last year in Anambra and Benue States owing to an out break of some water borne diseases. My shock stemmed from the fact that these were communities which had hitherto been covered by the authorities under the primary health care system.
In Nigeria people still die in large numbers from malaria and dysentery, both preventable diseases. Despite this obvious lapse in the “health care knowledge set” of rural dwellers and the relevant authorities, our leaders in Abuja and the various state capitals and major urban centres keep thumping their chests on the successes of such phantom schemes as National Primary Health Care Scheme, MDG’s etc. Upon several enquiries at the ministry of health in Abuja one was regaled with such euphemism as “The federal government is committed to implementing several measures to improve primary health care delivery.”
What exactly does primary health care delivery mean? I was informed by experts (and we have a lot of them these days) that primary health care refers to “socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems … in a way that gives priority to those most in need. (It) maximises community and individual self-reliance and participation and involves collaboration with other sectors. They include the following: health promotion, illness prevention, care of the sick, advocacy and community development.
It goes without saying that any objective appraisal of the above would immediately conclude that there is no primary health care in our rural communities. Majority of our population live in the rural areas. And of this non-metropolitan population, almost 80 percent is dispersed across more than 13,500 rural and remote communities with fewer than 6,000 resident doctors. Collectively these communities have a population of approximately 98 million people.
 Almost three-quarter of these small communities lie in the rural and remote areas farthest from large population centres and are all losing population and experiencing economic hardship.
It has been observed that our rural dwellers face significant health disadvantage and generally, mortality and illness levels have increased to almost three times the rate in major urban centres. It goes without saying that these rural areas face a higher prevalence of health risk factors and are further disadvantaged by reduced access to primary health care, PHC providers and health services (in part a function of health and medical workforce shortages), leading in turn to lower utilisation rates than in urban areas and consequent poorer health status for rural dwellers.
Often these isolated rural and remote communities are too small to support traditional models of health delivery locally, so dwellers are forced to access care from larger urban centres. Unfortunately, access to health services provided in larger centres remains a problem for many residents of rural and isolated settlements. In many cases, their inability to access health services when required results in health needs not being adequately met, lack of continuity of care and an absence of monitoring of the effectiveness of services in terms of health outcomes. 
Then one is forced to ask what has become of the National Primary Health Care Scheme? What are the justifications for the disbursement of large sums in the name of the provision of primary health care delivery? What has become of the local government comprehensive health centres championed by the Obasanjo administration?
It is clear that ‘models of care in rural and remote areas must differ from those in metropolitan communities, incorporating strategies to account for these problems.’ 
Sharing of knowledge on the basics of preventing those preventable diseases must be invigorated, training, seminars and workshops must be frequently organised to equip local government area health personnel to deal with the issues militating against primary health care delivery in the rural communities.
In order to address these access and service problems, specific measures targeting rural health must be emphasised as an integral part of the transformation agenda of the Jonathan Presidency. Policymakers should be put under increasing pressure to strengthen the link between evidence, policy development and programme implementation. 
Although numerous approaches and models of service delivery have been trialed in rural and remote areas in the past, inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programmes to other sectors. 
It has become evident that there is an ongoing need to improve poor health outcomes in rural and remote communities through improved access to health services and that the time is apt to build upon whatever achievements have been recorded in the past.
The National Primary Health Care Development Agency should lead the efforts in revitalising this important health care initiative in the country. As we welcome Dr. Ado Muhammed, as the new executive secretary, we urge him not to stand and stare but to hit the ground running.

Sir Chukwu Jideani
08051789348 (SMS Only)


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