HEALTH INTERACTIVE WITH DR. AMINU MAGASHI

LGAs and Primary Health Care

Daily Trust of Tuesday, 13^th September, 2005 on page 25 carried a news story titled ‘LG constructs N 15 Million Health Center. In the story, it was mentioned that, the chairman of Shanga LGA of Kebbi State, Alh Garba Salihu mentioned that his administration has spent N 15 Million for the construction of a primary health care center at Gebbe. He mentioned that the project was designed to provide riverine communities in the areas with medical facilities and bring health care services nearer to the people. In almost another similar scenario, I vividly remember sometime last year, when I visited one Local Government Area in Northern part of Nigeria during which I had a long interactive meeting with the LGA’s chairman about the need to provide antenatal care services to his populace . Then my intention and my colleagues were to assist the LGA in addressing the high maternal mortality ratio in the LGA. His concern was to build a new primary health center that we could used for our intervention , even though we identified a dilapidated and abandoned health center which with little funding would come back to its normal shape . The chairman was very adamant and retorted that, the building we were interested in ,was built by his predecessor  and he also wanted to built his own in order to live a legacy for the poor people

While I am not trying in any way to discourage or condemn politicians in LGAs in erecting and constructing hospitals for the vulnerable people under their leadership , nevertheless we have to examine the justification and needs for erecting structures which after  living office or even at times before completing ones tenure, such places will regrettably become structures devoid of skilled  personnel, facilities, essential drugs and at worst be accommodating domestic animals.

Primary Health Care from its name, is an essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost the community and country can afford to maintain at every stage of their development in the spirit of self – reliance and self determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus and of the overall social and economic development of the community.  It 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.

For any primary health center in a rural area to meet its targets, the community where the center is cited must be involved right from conceiving the idea, design, identifying its location as well as be involved in administering and discharging its services and effective monitoring of its programme. It is only through this measure, that the center can be sustain and provide the desired services to the common man. In almost 100 percent of cases, politicians are not aware of this component and are not involving anybody from the local community when deciding to construct primary health centers. In one of the states in North-Central , during my youth service , I came across a very standard and befitting primary health center that was sponsored by an international development agency , but while erecting the building , the principles of primary health care were not adhered to , it was cited almost four kilometers away from the majority of the inhabitants of that village . Despite having good equipments, facilities and personnel, it was receiving very low turn over of patients. The community prepared to be patronizing patent medical stores close to them for any ailment; such was the poor planning and implementation.

We are concern about Primary Health Centers, because that is the first contact with the local community and most of the problems leading to high maternal and under five mortality rates are attributed to lack of or inadequate primary health care. Factors leading to high maternal and child death in our communities, which we are still grappling with, are the Three Delay Syndrome, Delay in deciding to seek for care which is related to Poverty, Ignorance and Male dominance and other Cultural Norms and Values. Even when a pregnant woman decides to go for Ante-Natal Care or when her child is sick , another risks factor of Delay in Transportation will pose a stumbling block due to distance from the affected community to the nearest  secondary health center , because in most communities , there is no single functional primary health center . When patients arrive the secondary health center, at times the problem is already complicated to either lead to death before instituting management or leads to morbidity after intervention, notable among such is Convulsion , Coma , Excessive Bleeding  and long term complications such as  V.V.F/R.V.F. Majority of the Local Governments and Districts owned health centers (Comprehensive Health Centers and Health Posts) are devoid of skilled midwives, medical doctors and facilities to respond to emergencies. All these contribute to the high maternal and under five mortality rate (Delay in Management)

Looking at the Delay in Transportation due to distance , one can see that the challenge of a local government politician is not only to build hospital , but to provide good roads for the poor people to enable them reach the centers on time to effect management . As I mentioned earlier on, in the definition of a primary health care, the component of self-reliance to ensure sustainability has to be incorporated in the planning. In essence, communities must be involved in financing the services, no matter how small that contribution may be, especially  programs such as  Drug Revolving Scheme. The strategy can be viewed through actualizing National Health Insurance Scheme (Non formal Sector).

The reader may recall that the Federal Government about two years ago had launched the Non Formal Sector of the National Health Insurance Scheme by selecting some villages across the country as pilots. A part from the selection then, which was politically and selfishly motivated, the pilot programmes  have virtually collapsed and are yet to take off in other places. That non formal health insurance scheme if implemented very well is the answer to most of the causes of high maternal and under five mortality rates. 

Coming out of this mindset of our politicians in the LGAs to only see health problems of the vulnerable people being solved through erecting structures which will invariably be later abandoned by their successors to also erect their own , there is the need for them to be empowered through trainings and seminars about the components of Millennium Development Goals especially health related goals , how to achieve them and also to understand the concept community involvement , participation and contribution in decision making , planning , designing , implementation and monitoring and evaluation in all matters related to their collective survival and development .

Dr Magashi is the Executive Director of Community Health and Research Initiative , Kano , Nigeria and can be reached at healthinteractive@hotmail.com