Abstract
Since 1978’s Alma-Ata Declaration on Primary Health Care (PHC) with the popular slogan “Health for All by the Year 2000” and subsequently the Millennium Development Goals (MDGs) of the Year 2000, Nigeria has made 3 major attempts to establish a sustainable PHC system and some of the reasons for failure of the first two have been identified. Even though there is some degree of general improvement, compared to other countries in the world, Nigeria’s indices in spite of international aids have remained poor {Neonatal Mortality Rate (40/000), Under-five Mortality Rate (157/000) and Maternal Mortality Ratio (545/100000). The aim of this descriptive, interventional study is to highlight positive steps taken by governments to re-establish and revitalise PHC, especially by empowering communities, the challenges, and lessons learned as potentials for improvement of a universal, qualitative PHC system in Nigeria. The Health Reform Laws and Strategic Development Plans emphasize commitment to the promotion and protection of the health of the people as an essential service for sustained socio-economic development and better quality of life. Community structures (Local Government Health Authorities–LGHAs, Ward Health Committees– WHCs and Health Facility Management Teams) backed by the law were either newly established or reconstituted and empowered. The study describes measures taken to strengthen the weak foundation of the PHC system in Lagos State (the study’s index state), the outputs, outcomes and potential impacts. The challenges and lessons learned from dealing with them can be projected for improved national coverage
Highlights
The Alma Ata Declaration of 1978 [1] expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world
The aim of this study is to highlight the challenges and lessons learned from the implementation of the National/State Health Reform Laws as potential for improved qualitative and universal Primary Health Care (PHC) coverage in Nigeria
The challenges are still basically inadequate financing of health, non-engagement of trained manpower, inadequate and poor distribution of available human resource, and inadequate community mobilization resulting in sustainability problems
Summary
The Alma Ata Declaration of 1978 [1] expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. PHC has been identified as the key to attaining this as part of development in the spirit of social justice. It relies, at local and referral levels, on health workers, including physicians, nurses, midwives and community workers as applicable, as well as traditional practitioners as needed. There have been 3 major attempts at PHC implementation in Nigeria. The first attempt (1975-1983) was by the Federal Ministry of Health through the Basic Health Services Implementation Agency
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