Nigeria still searching for right formula

Abstract

In 1990, Michael Asuzu held high hopes for the development in of a primary health care (PHC) system based on community participation, using well-trained, well-equipped and motivated community health professionals. Writing in the March 1990 issue of World health magazine, Asuzu, at the time a lecturer and consultant in the Department of Preventive and Social Medicine at the University College Hospital in Ibadan, enthused about a bottom-up grassroots PHC project in the hamlet of Elesu, 32 kilometres north of lbadan. Members of Asuzu's university department had helped villagers develop a programme to control outbreaks of waterborne guinea-worm disease and adopt other PHC measures. We expect to be able to replicate this programme in any local community ready to take charge of its needs for PHC as the Elesu community has, he said. case history shows that, when community health development workers are available and willing to go out and assist communities, it is possible for them to come forward to request and be helped to provide community-owned and self-reliant PHC programmes for themselves. Fast forward 18 years and Asuzu, now professor of Public Health and Community Medicine at the University of Ibadan, is less ebullient when discussing PHC in his country. Addressing the Nigerian Academy of Science Seminar in Abuja in May this year, Asuzu said: Nigeria has never succeeded in establishing community medical and health services for very many reasons ... some limited levels [have] been practised in Nigeria, even during the colonial days, but never fully. In June, Asuzu told the Nigerian Medical Students Association that had in the mid-1980s joined the international push for PHC after the 1978 Alma-Ata Declaration of 'health for all'. Some progress seemed to have been made with the health services between then and the mid-1990s, he said. However, the health indices have been deteriorating since then [judging] by every health system evaluation [carried out] in the country. Unfortunately, has never learnt or developed any system of authentic and full-scale community health care before Alma-Ata or after it. This explains why we have not made any success of the The world health report 2000 ranked 187 out of 191 countries for health service performance, a situation that has not changed much since then, according to Asuzu, who cites several statistics to highlight the inadequacies in Nigeria's PHC system. Annual budget allocations to health have been persistently below 5% except for the years 1998-1999 and 2002-2003 when they were at or just above this level. Infant mortality rates have been deteriorating from 85 per 1000 live births in 1982, 87 in 1990, 93 in 1991 to 100 in 2003, according to the Demographic and Health Survey, 2003. And in 2007, the Federal Ministry of Health reported 110 deaths per 1000 live births. Maternal mortality ratios are estimated at 1100 per 100 000 live births in WHO's Worm health statistics 2008. Asuzu identifies five attempts at reform over the past 70 years: * 1940s. The Nigerian Colonial Development Plan had a limited framework for a unitary health service. * 1950s. Regional governments ran independent and sometimes parallel health systems to the federal government. * 1960s. The Second National Development Plan in the post-independence era did not articulate a system with clear responsibilities for each level of government. * 1970s. The ambitious Third National Development Plan had the Basic Health Services Scheme as its focus, but again failed to share responsibilities between the governments for resource generation, manpower development, health professional deployment and service delivery. * 1980s. Following the Declaration of Alma-Ata, there were serious attempts at health system reform, based on the principles of PHC resulting in the National Health Policy in 1988. …