WHAT IS THE FUTURE OF PRIMARY HEALTH CARE?

WHAT IS THE FUTURE OF PRIMARY HEALTH CARE?

By Fiyinfoluwa Sanwo

What is primary health care?

Primary care is the grassroots level of care. You may not immediately recognize primary health care, but it is essentially the first level of contact that you have with the health care system. That could mean seeing your family doctor, health unit, pharmacy, or clinic. Or it could mean phoning an advice line staffed by health professionals or even attending a self-care workshop to learn how to take a more active role in your health.

Primary health care involves treating short-term health problems, managing longterm health conditions such

as diabetes, and even helping you learn how to prevent injury and illness. Prevention is a key objective of primary health care.

The current state of primary care in Nigeria. Amongst the many areas of decadence in the Nation, the condition of primary care is, unfortunately, topping the list. With a total population of approximately 182 Million, Nigeria has some of the poorest healthcare outcomes in the world. The current state of the primary care system in Nigeria is appalling with only about

20% of the 30,000 Primary care facilities across Nigeria working. Presently, most of the Primary care facilities in Nigeria lack the capacity to provide essential healthcare services, in addition to having issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of healthcare services, poor condition of infrastructure, and lack of essential drug supply.

According to WHO, the primary healthcare approach is foundational to achieving the shared global goals of Universal Health Coverage (UHC) and health-related Sustainable Development Goals (SDGs). However, from the number of people that die from accidents in the home to road accidents, to the number of mothers that die during childbirth to malaria deaths to malnutrition; the statistics paint a dreadful picture of Nigeria’s healthcare system. As our population continues to grow at a rate of 4% the need for healthcare reform has never been more urgent.

Challenges of Primary care in Nigeria

Placing treatment over prevention

We have seen an unending urge to launch hospitals in the name of improving access to care. Nigeria’s hospital-dominated health system overemphasizes medical interventions at the expense of public health and primary care.

Cost Constraint

Health is rarely seen as a fundamental human right by policymakers in Nigeria; hence, the inability to implement the Abuja Declaration in which African heads of state pledge to set a target of earmarking at least 15% of their annual budget to improve the health sector. Unlike our European or North American counterparts who allocate about 17.1% and 9.1 % of their GDP on health expenditures respectively, Nigeria only pushes 3.7% of its

GDP on health expenditures. If only we can have the foresight to invest more, maybe then this would translate to reduced morbidity and mortality rates, as well as give primary care a facelift. Sector Isolation

The Alma Ata Declaration( It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care) also encourages partnership and cooperation with other related sectors of the economy in the development and implementation of primary health care. Unfortunately, related sectors are also battling a series of challenges and are yet to deliver on their responsibilities to the people. A return to the Alma Ata principle would guide further development in the Primary health care system.

Primary healthcare fragmentation Problems with the implementation of Primary healthcare in Nigeria are related to the handover in the 1980s to the local government administration, which is the weakest level of government. Even with the 2011 Primary Health Care Under One Roof (PHCUOR) policy which only became a national policy a few years ago, its impact is yet to be felt on the health status and utilization of Primary Health Care in Nigeria.

Why is primary care important for the future?

Primary care has progressed from the days of the family doctor who did everything to the primary care physician (PCP) as a medical home for the patient, coordinating care with other physicians and medical providers. Where does primary care go from here?

The future of healthcare is often associated with breakthroughs in technology, patient personalization, and access.

Access

Access to primary care physicians literally helps people live longer. But there are often many barriers to the best care for patients. Location, hours of operation, insurance, etc. are all ways access can be difficult. However, innovation around access will improve the effectiveness and efficiency of primary care. The use of electronic health records (EHRs) will enable Primary Care practitioners to better coordinate care, track their patient’s medical history, and plan for an improved healthcare plan for that patient.

Technology

The average consumer will spend nearly 4 hours on a mobile device in 2020, and patients expect their health experience to evolve with their day-to-day tech experience. Hence, an imperative need

for the government to invest heavily in creating awareness and presenting patients with a technological experience at primary care facilities while delivering patient service to ensure patients feel confident using online medical records and telemedicine as a part of their health journey.

Patient Personalization

Primary Care Physicians need to know who their patients are and be able to design a health plan for them that fits their lifestyle. Patient care at the level of primary care should move from a one-size-fits-all solution, with the patient’s care team appropriately equipped to personalize a care plan based on genes, blood work, medical and weight history to find nutrition, exercise, and medication plans that work for the patient for a better long-term health outcome. These personalized services could include primary care, preventative care, Women’s and Men’s health, sports medicine, advanced diagnostics and screening, genetics and genetic

counselling, chronic conditions, medical weight loss, IV therapy, or allergy care.

Universal Health Coverage

Primary healthcare is the bedrock of any functional health insurance system. The absence of this would imply a derelict health insurance system. The future of Nigeria’s primary healthcare can only become a reality when our policymakers make it a point of responsibility to strengthen and revitalize primary healthcare (PHC) in Nigeria!