Advancing primary health care in Nigeria

In recent decades, considerable progress has been made in improving the health outcomes of women, children, and adolescents. However, these advancements have encountered significant challenges and obstacles. The unfinished agenda of preventable mortality among these vulnerable groups persists, while shifting epidemiological patterns demand increased attention to non-communicable diseases.

The critical periods of pregnancy and the first two decades of life offer a unique opportunity to foster healthy growth, mitigate health-related risks, and promote overall well-being throughout the lifespan. Realizing the demographic dividends of improved survival hinges on empowering women, children, and adolescents to thrive, thereby enhancing human capital and reducing disparities for current and future generations.

In the aftermath of the 2023 UN General Assembly, a high-level meeting dedicated to universal health coverage, member states are poised to recommit to achieving universal health coverage and the Sustainable Development Goals by 2030. The Director-General of the World Health Organization (WHO) has advocated for a paradigm shift towards primary health care as a foundational pillar of this endeavour.

This approach comprises three fundamental elements: integrated health services with a primary care focus, community engagement and empowerment, and multi-sectoral policies and actions that address the broader determinants of health.

Within this context, we illuminate the implications of implementing a transformative primary health care approach for the health and nutrition of women, children, and adolescents. This perspective is endorsed by the Strategic and Technical Advisory Group of Experts for maternal, newborn, child, and adolescent health and nutrition, a body that provides counsel to the WHO Director-General.

Both the transformation of primary health care and the global strategy for women’s, children’s, and adolescents’ health necessitate a shift towards preventive, promotive, and protective roles within healthcare services, coupled with community involvement and cross-sector collaboration. The strategy’s “survive, thrive, and transform” agenda mandates health system enhancements and multi-sectoral interventions in health, education, finance, social protection, water and sanitation, agriculture, nutrition, law, justice, and more.

Furthermore, it emphasizes the importance of disease prevention and the promotion of overall well-being. A continuum of care, commencing with the health of prospective parents before conception and extending through all stages of a new-born’s, child’s, and adolescent’s life, is at the core of this strategy. It also underscores the significance of family and community support systems. Successful implementation hinges on evidence-based intervention packages and essential public health functions that have a lifelong impact on individuals and populations. 

The transition from vertical programmes and illness-centered care to a preventive, promotive, and life-course approach necessitates expanding and enhancing investment in community-based healthcare models, including basic health services. Such systems can not only deliver universal basic health services but also address the determinants intertwined with poor health outcomes, stemming from political, social, cultural, economic, environmental, and health system factors.

Empowering individuals and communities to take charge of their own health necessitates improving health literacy and extending community participation in health governance, advocacy, service delivery, self-care, and home-based care. Investments in accessible, effective, and quality community-based health services for maternal, child, and adolescent health, nutrition, mental health, and the management of both communicable and non-communicable diseases and injury risk reduction are expected to yield substantial returns across the life course.

A more integrated, community-centered, and multi-sectoral model of primary health care will be characterized by functional primary health care networks. These networks encompass organizations dedicated to delivering comprehensive and integrated health services to defined populations, with accountability for coverage, care quality, and health outcomes. To establish such service delivery models, laws and policies must mandate workforce development for essential public health functions and life-course interventions.

This at the heart of the Right to Health project implemented by the Centre for Social Justice under the Strengthening Civic Advocacy and Local Engagement programme of the United States Agency for International Development (USAID-SCALE). The project’s goal is to contribute to improvements in the realization of the right to health in Nigeria through enhancing respect for extant laws and policies, reforming laws and policies as well as mainstreaming transparency and accountability in public health sector expenditure.

This advocacy also necessitates reforms in human resource and financial management systems to ensure adequate investment in community-based health services. This entails governments, international agencies, the private sector, local governments, and non-governmental organizations acknowledging and overcoming barriers linked to an overemphasis on vertical programming and illness-centered care, along with insufficient investment in workforce capabilities for life-course interventions and community-based services.

Supporting the transformation of primary health care for women, children, and adolescents demands a commitment to values and investments in systems, services, workforce development, and community engagement. Key drivers include translating values of quality, equity, gender responsiveness, and accountability into tangible systems and processes that prioritize community needs and voices in health policy, planning, and service delivery.

As the 2023 UN high-level meeting on universal health coverage gets underway, we call upon political leaders and health partners to prioritize women’s, children’s, and adolescents’ health across the life course within the framework of primary health care transformation. This entails shifting mind-sets, reforming laws, policies, resource allocation, and governance processes to align with prevention and care models. The urgency of this primary health care transformation cannot be overstated, as it holds the potential to ensure access to essential health interventions and exert a lifelong impact on the health and well-being of future generations.

Okeke writes from the Centre for Social Justice (CSJ) Nigeria