The establishment of Ondo State Primary Health Care Development Commission, whose bill was signed into law in October 2012, has brought qualitative health care delivery to the state.
Following the take-off of the commission, primary health care (PHC) has been restored by the state administration under Governor Rotimi Akeredolu.
The commission operates under the state Ministry of Health with the mandate to develop PHC policy and support LGAs to implement it.
The commission has the goals to control preventable diseases, improve access to basic health services, improve quality of care, strengthen the institution, and develop a high-performing and empowered health workforce among others.
Speaking with Sunday Vanguard on how far the commission has impacted on the lives of the people under the state administration, it’s Executive Secretary, Dr Francis Akanbienu, said, “PHC is as old as mankind and, you know, the first delivery that was taken was not done in any big hospital but taken at home by people who provided midwifery services.
“But PHC has evolved over the years and various countries and international organizations realised that over 70 percent of the population of any country reside at the level of the community.
“This means that for you to provide PHC for the large number of people, you must take health care services to them and such people live in hard to reach areas where there are no good roads and social amenities, while the other 30 percent in the cities enjoy better resources like hospitals.
“But Primary Health Care does not get attention in terms of human resources, infrastructure and finance”.
According to him, that is why in 1978, a United Nations conference held in Russia came up with the concept of PHC.
“There are some principles and one of such principles is the equitable distribution of heath resources to enable government reach this disadvantaged majority”, he said.
Akanbienu continued, “The other principle is using health promotion ahead of preventive approach. In essence, if you’re able to prevent diseases, it is cheaper in terms of resources allocation because it is more expensive to treat than to prevent.
“Another principle is inter-sectorial collaboration. For instance, the health system does not have facilities to provide water because this is the responsibility of water resources and when talking about food and nutrition, which is a core component of human health care, we need the ministry of agriculture. Also when you want to provide information to the public, we need the ministry of information and orientation.
“The other principle is what is called appropriate technology. You cannot deliver PHC without using the technology that is locally acceptable in terms of culture, religion among other factors.
“The faith principle has to do with full community participation. PHC believes you cannot plan for a community if you don’t know what the people want.
“So, whatever you’re doing you must involve the community.
“These are the five principles”.
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On the establishment of additional PHC across Ondo by the Akeredolu administration, the Executive Secretary said, “We had over 576 functional health centres in the state and few ones have just been added to make about 604.
“Last year, the state government procured life saving equipment to help in the delivery of babies. Most of the PHC facilities now have equipment that can be used to detect if a new born baby has enough oxygen.
“In other words, the services people get at Mother and Child Hospitals are almost the same with those they have at our PHCs but the ones that require greater skills are referred to General Hospitals or the newly designated Mother and Child Hospitals.
“Government is working to make sure that our PHCs have the same standard as what we have in Ondo and Akure Mother and Child Hospitals”.
Akanbiemu dismissed the claim that accessing PHC is costlier than what obtains at the state level.
“In majority of our health centres, the services are cheaper though there may be isolated cases where services are costly.
“Even some services are free but some people will always break the law. Recently, government advised us to ensure accountability in our health centres, and, for the first time, the agency, with the support of the ministry of internal revenue, produced security receipts which we distributed to health centres across the state.
“Health care for pregnant women and children is free but for any group that is outside free health care service, receipts are now available and this also ensures that nobody is charged above what is obtainable at the PHC level”.
He said that the confidence of the residents of Ondo in PHC has attracted them to the centres despite the existence of many traditional birth attendants (TBA) in the rural communities
“As of 2012, the people who delivered through PHC attendance were less than 60 but today we have over 70. This survey was not done by us and this means that delivery is more at our facilities”, he said.
“In 2017 when I took over, the survey that was done by UNICEF and other partners showed that our immunisation coverage was around 66 percent but as at today, we are about 79 percent.
“So, we work on evidence and from the national survey, you find that utilisation of those health facilities is increasing.
“The number of delivery is increasing because people don’t pay for that service as well as treatment for children under five years”.
On the activities of TBAs, Akanbiemu said, “Nothing has changed, the policy is still in place, but we are building on the policy and you will agree with me that the activities of the TBAs have dropped.
“We don’t base our recommendations on speculations and referral remains one of the strong principles of our PHC system and the Nigeria State Health Investment Project, NSHIP, has also been helping.
“So TBAs are encouraged to refer and at appropriate time we are thinking of calling them again to a stakeholders meeting to reemphasize this concept that they must continue to partner us in terms of providing quality health care”.
Speaking on the training and retaining of health personnel in the health sector, the Executive Secretary said, “We do a lot of training and in the last two months health workers have been on one form of training or the other”.
On what the people of the state should expect on PHC in years to come, he said, “We are meeting with Governor Akeredolu very soon to make sure that the state retains its position as the leader in the health sector.
“The governor is working to ensure that we have at least 90 doctors at the PHC level to add to the about 30 that are already there. This is going to be unprecedented in the history of Nigeria.
“I am sure that in the next couple of months, people will stop going to General Hospitals for cases that are not supposed to go there”.
On the impact of NSHIP in Ondo, Akanbiemu said, “Most of the successes we are recording in the health system in the state, NSHIP has contributed immensely.
“NSHIP ensures that community is part of whatever health facilities do. The chairman of the health committee is from the community and the committee accounts for everything it does to ensure that health services are jointly done by the facilities and the community members”.
The Executive Secretary, while speaking on how to cushion the effect of the NSHIP now that it is about to wind up in the state, said, “Ondo has suddenly come up with sustainability plan and this was discussed recently in Akure where stakeholders agreed that we have to come up immediately. Contributory Health Scheme is another area government has considered to take over all the principles and gains of NSHIP.
“Basic health fund on which the state government is working in the couple of weeks would also get full attention to sustain whatever gain NSHIP has made.
“And from the basic health fund and the contributor health insurance scheme, the government is also going to increase funding to PHC system while the local government system is equally supportive.
“All local government chairmen have been contributing to the sustainability of PHC system when NSHIP exits in 2020”.