By Dr. Femi Ogunyemi

In the simplest of terms Nigerian health services are organised along three tiers of Governments as follows: Primary healthcare – Health Centers at local government, ward and community level; Secondary healthcare – General and state hospitals; Tertiary care – Federal teaching and specialist hospitals. Primary health care is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

Much has been spent and continues to be spent on PHC. Yet, our health statistics have plummeted over the last three decades. For example : Maternal Mortality rate (MMR) Despite our excellent obstetricians, skilled birth attendants and community health workers, Nigeria is amongst the world’s worst. A pregnant woman developing complications at the PHC level will be sent to a SHC facility. There, bleeding, infection and anaesthesia-related problems remain the biggest killers. Many believe we should not just pour funds into PHC (prenatal care, health education etc) and ignore the PERIOPERATIVE inadequacies at SHC facilities.

From a 2000 publication the ratio of PUBLIC secondary healthcare facilities to teaching and specialist hospitals (tertiary care) was 16:1. If you add the PRIVATE secondary facilities the ratio becomes 71:1. Assuming the ratio remains the same today, it is clear that a SUBSTANTIAL amount of Nigeria’s healthcare lies in the grasp of SECONDARY healthcare services.

PROBLEMS in Secondary Healthcare Services

(1) LEGISLATION. Due to lack of legislation, all the stakeholders involved in providing the Secondary Health Service have not been performing their roles & responsibilities according to policy guidelines. (2) STRUCTURES •Most of the buildings are dilapidated, Uneven distribution of facilities Inadequate maintenance culture. Abandoned projects. Lack of optimal use of facilities

(3) EQUIPMENT • There is acute shortage of basic equipment; • Most of the equipment are

obsolete; and not procured according to needs and technical specifications, • Poor maintenance culture.

(4) DRUGS & SUPPLIES • unavailability of adequate essential drugs & consumables; • Inadequate funds; • Fake and sub-standard drugs; • Poor management of the DRF system.

(5) HUMAN RESOURCES • shortage of skilled staff • lack of continuing education (capacity building) • poor motivation/incentives • wrong distribution

(6) BASIC AMENITIES (UTILITIES) • Basic amenities are lacking in most of the facilities, especially in the rural areas. “(7) FUNDING • Poor funding of SHC • The untimely & irregular release of funds makes planning difficult. • Non-implementation of Budget

(8) MANAGEMENT • Lack of managerial skills for Health Professionals; • Limited available Health Human Resource is ineffective and inefficient for service delivery • Culture of corruption and self –interest in management.

(9) HEALTH MANAGEMENT INFORMATION SYSTEM • Poor data collection; • Inadequate planning

Where data is available it is not used in planning & decision making at the Hospitals • Lack of reliable data returns from facilities to SMOH.

(10) COMMUNITY PARTICIPATION AND OWNERSHIP • Lack of involvement of host communities in the establishment and running of facilities • Lack of awareness, commitment, enlightenment and knowledge on the part of the Communities and those involved in the management of facilities.

(11) PRIVATE SECTOR PARTICIPATION • Inadequate involvement of private sector participation in SHC delivery.

(12) REFERRAL SYSTEM • Poor & uncoordinated referral system • Lack of feed back mechanism in the referral system.

I have a confession to make about the brilliant points listed above :

They are not mine! They are quoted verbatim from an FMOH’s 2005 document “Strategies for Strengthening Secondary Healthcare Services (SHC) Delivery Service” on ilo.org.

In developed health systems the disparities in standards between tertiary and secondary facilities is negligible. Not so in Nigeria. Human and material resources, and funding, differ greatly in both types of facilities.

If this anomaly is addressed with commitment and vigour, our health indices will immediately improve. The solutions already lie in that 2005 FMOH document.

Do you agree Lassa is being handled brilliantly by our Minister? As for our NASS Health Chairmen…….did you watch the remarkable insight displayed by our Distinguished Doctor during his TV interview? And have you heard the encouraging words from our Honorable Representative?

We now have square pegs in square holes handling our health matters in the executive and legislature. It is time to face secondary healthcare in Nigeria….squarely.