By CHIOMA OBINNA

Globally, Primary Healthcare Centres, PHCs,  provide easy access to  healthcare services to people at the grassroots. But the reverse appears to be the case in  Nigeria. The nation has continued to witness a breakdown of  service delivery at PHCs leading to unnecessary congestion at the secondary and tertiary healthcare centres.

Special Adviser to the Lagos State Governor on Public Health, Dr. Yewande Adesina, spoke to Good Health Weekly, on the State’s revitalisation of PHCs with special focus on 57, 24-hour Comprehensive Flagship PHCs.

She argues that a strong PHC system is central to improving the health of all and reducing inequalities among different groups as well as redirecting Nigerians back to the basics of the healthcare system. Excerpts:

Healthcare System

In Lagos, there  is one Tertiary health facility, 26 General Hospitals, eight Maternal and Child Centres, MCCs and 277 Primary Healthcare Centres, PHCs.  These three interface. Nobody goes to secondary school without attending primary school and that is the sense of how health should be seen in any system.   When the primary level cannot handle the condition we refer to the secondary level. If the secondary level cannot handle the case it is referred to the tertiary level.  The referral should be bi-directional, meaning once we refer from primary to secondary and they have done their investigations and completed the treatment, they are supposed to send back to the primary level.

Culture

But achieving this has become a real problem in the system. We realize that our people have developed a culture of skipping the primary level and going to the secondary. The demand for excellence services has really kept the government on its toes, so we need to reorientate our people to the significance of going to the primary level first.  One other thing that we realized is that because the secondary facility is the first point of call for a lot of people it is over- stretched and overly inundated with cases that can be managed  on a routine bases in the primary health centres.

Government came up a blueprint of the revitalization of the primary health centres. It is a template we are now using to work on the PHCs.  The revitalization programme is essentially to create 24-hour primary healthcare services within the local government and council development area.   Out of the 277 PHCs, we are targeting to have 57 flagship comprehensive 24 – hour PHCs that will hoist the flag of excellence and improvement in our primary healthcare. Then, the other PHCs will now feed into the flagships and the flagship will feed into the secondary and tertiary facilities.  We intend to complete 20 flagships this year and already five have been completed. By next year, we will complete the remaining.

Essence of revitalisation

First, it is to redirect patients to the PHCs.  We are looking at redirecting the patients to the PHCs without being intrusive or breaking the  confidence in the system.  To address this, we intend to allow patients come into the General Hospitals like any other day. The community will now take over their cases. They will  screen out what we call ‘cold cases’ – like I want to check my blood pressure, I have a rash, etc., things that are routine services, we will now redirect these cases through the community health department clinic which will be run by the medical officers of the PHCs.

So it gains two things,  patients becomes familiar with doctors of the PHCs inside the General Hospitals, they will have more confidence when they go into the PHCs because they now see them as one.  While at the community health department clinic of the General Hospital, we will offer one – on–one counseling and education on the need for patients to visit the PHC first and also on their proper use.

We will also refer them back to the PHCs component of the hospital  that is close to them and that same doctor that  they  saw there will now become their primary care provider at the PHC so that the General Hospitals will focus on what they are called to.

For instance, the MCCs are not meant for every pregnant woman unless if it is a high risk pregnancy.  They are supposed to be emergency referral centres like when the patient is in labour and it got into a difficult position they can quickly transport them to the MCCs for further intervention. But we are having challenges because the beds are full with normal deliveries that should have happened in the Primary centres.

Scaling up

We have moved away from  traditional PHC system which focuses mostly on immunization and antenatal care and preventive screening things.  To help the secondary facilities we have added non communicable disease including cancers such as breasts, cervical prostate, and colon cancer.   Our flagship is rearranged for convenience of flow.  Before, when you go into  any PHC everybody is seated in one hall and it is rowdy but now the flagship are designed that all maternal cases have their own area. There is a pattern, orderliness in how we are providing services now.

Drug Revolving Fund

When we say free health nothing is actually free, somebody has paid for that medicine somewhere and that somebody is mostly tax payers.   Lagos state has about 70 percent informal sector and about 30 percent  paying for what 20 million people will be utilizing for free healthcare. We are offering free health care for preventive health.  But once you are diagnosed with a life time ailmentssuch as diabetes and hypertension, you have to pay. We have decided to subsidize the drugs to be cheaper than at the secondary healthcare system.

There is huge challenge on the financial allocation of funds and the state drug revolving fund basically allows us to reinvest whatever proceeds we get from selling the drugs. For instance, if the drug is N1.00,  70 percent goes back into purchasing more drugs and the remaining 30 percent goes into the free health scheme.

Facilities

Each area is equipped with newer furniture, labour and delivery facilities are replaced with a more modern mechanized type.  We have added a laboratory to every flagship PHC.  They do what  we call point of care, to support NCDs clinic.

We have the ability to do blood sugar, Haemoglobin  which is essential to diabetes care; urine for protein, kidney amongst others.    Our partners donated what we call point of care machine , we can now do haematology in the PHCs.

This is all in the bid to bring these services to the door step of the grassroots.   We will be relieving the general hospitals of the burden and being able to address the community’s challenge. I think is a win-win situation for the government and the citizens of Lagos State.