Challenges Facing Nigeria’s PHC System and Possible Solutions

Nigeria’s PHC System: Challenges and Practices
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Nigeria’s PHC System: Challenges and Practices
Challenges Facing Nigeria’s PHC System and Possible Solutions
Nigeria's PHC system forms a central component of the country's health system and is an integral point for every Nigerian citizen's social and economic development. It is the first point of health service contact for communities, families, and individuals, and the country's health system as a whole. Since making PHC the cornerstone of health system development in 1975, the government has shown a remarkable commitment to PHC programmes, as demonstrated by the increased budget allocations and the numerous governance reforms aimed at streamlining PHC services. The country has also succeeded in ensuring a relative abundance of PHC centers nationwide, and there is reasonable geographical access to primary health care services at the community level. However, health gains at the grassroots level have been stubbornly slow, hinting at a possible underperformance in the country's PHC system. There are several reasons why Nigeria’s PHC system has failed to deliver quality health services at the community level. Some of these include inadequate funding for healthcare infrastructure and resources such as drugs, medical equipment, and vaccines at the facility level; fragmented supply chains; insufficient government commitment; poor engagement with the private sector; and inadequate health worker performance (Aregbeshola & Khan, 2017).
One of the biggest reasons for the poor performance of Nigeria’s PHC system at the community level is limited government funding which translates to higher out-of-pocket payments by health care consumers. Even though PHC coverage is comparatively satisfactory with sufficient facility density across the country, except for some isolated pockets where PHC services are limited, most families cannot afford the cost of public PHC visits. Most of the country's rural population resides within a moderate distance of a public PHC facility, but health care services continue to remain out of their reach. For instance, the average cost of visiting a PHC center is $2.30 for child patients and $3.20 for adult patients, sometimes going up to $8.00, which is taxing on 45% of the country’s population who typically live on less than $2.00 a day, and more so on 28% of Nigerians who live on less than $1.25 a day, as per World Development Indicators (Kress et al., 2016). Part of the reason PHC services are financially inaccessible for a majority of Nigerians stems from the fact that health care worker salaries are prioritized over health care supplies and other facility operational expenses. Because of financial constraints and the large workforce of community health workers, most budgetary allocations end up paying health workers at the expense of ensuring PHC facilities are stocked with essential drugs, modern equipment or that the facilities themselves are maintained. A large number of PHC facilities are under-resourced and cannot provide the high quality of healthcare services required by families and individuals at the commun...