Health system has improved in Ondo State
Dr Francis Akanbiemu is the Executive Secretary, Ondo State Primary Health Care Development Agency. In this interview with KEMI OLATUNDE, he spoke about issues relating to Primary Health Care (PHC) and the health system generally. Excerpts:
What is the concept of PHC?
PHC is as old as the existence of mankind. It has evolved over the years and various countries, organisations realize that over 70% of the population of any country reside at the level of the community and that means that for you to provide healthcare services to that large number, you must take healthcare services closer to them. You must know that 70 per cent lives in the area with no good road, social amenities isn’t enough etc while the 30 per cent reside in source concentrated area.
The PHC centres which are expected to take care of the 70 per cent are under funded in terms of human resources, infrastructure, finance etc. It was observed that there were so much unmet needs in those area that caters for the larger majority of the people and that was why in 1978, a conference in Alma ata in Russia was held and members of United Nation countries committed to improving the health of those majority and they came up with this concept of PHC with certain principles.
One of the principles is the equity distribution of health resources and to do that, you reach the disadvantaged majority.
The other principle is using health promotion or health preventive approach. It is observed that if you are able to prevent diseases, it is cheaper in terms of resources allocation, in terms of expenditure to prevent diseases. It is more expensive to treat than to prevent.
Another principle is inter-sectorals collaboration, which is collaboration with other sector to ensure health services are properly given to these people.
Principle of appropriate technology is another one which involves the provision of health services for everybody through proper health assessment. You must look for equipment which can be managed in areas without light etc. You cannot deliver PHC without using the technology which is locally acceptable in terms of culture, religion etc.
The fifth one is full community participation. You can’t plan for people you don’t know what they want. You must ensure that you involve the community in all you do. They should tell you what they want. Within the above fire principles, there are components too.
In Ondo State, with over 70% of the people living in the rural communities, how many PHC centres do we have in the state?
We have over 576 functional health centres. In fact, as at now, few ones have been added to it. We actually have 604 but of those ones we have functional health centres in the 576 and in terms of meeting up with the above principles, Ondo State government is consciously working to address them.
In terms of infrastructure, the state has gone far. With the intervention of Nigeria State Health Investment Project (NSHIP) which is a World Bank funded health intervention project, a lot of infrastructural developments have taken place. Many facilities now have solar power system to provide light for them.
Ondo State government has expanded the initial Mother and Child hospital to seven in all the senatorial districts of the state.
The concept is that once a woman or an under 5 child requires service which will be given at the Mother and Child hospital level will be such would not rush to Akure or Ondo for that service.
At the PHC, the health strengthening system that the Federal Government has embarked on is to make the services that are available at the health cenres. If you remember, last year, Ondo State government provides some life saving equipment to save baby breath such that if a baby is delivered with birth aphasia (inability to breath) the health centres now have equipment to detect the oxygen circulation to know if the child’s brain has enough oxygen.
Not only that, recently, another 300 health centres were provided with basic equipment like ambu bags, suction machine etc. It is only in Ondo State the government has been able to provide penguin suction device in 300 health centres. All these are facilities you see at the Mother and Child hospital but no matter how equipped the PHC centre is, there is this linkage between the traditional PHC system and the Mother and Child hospitals in those seven areas such that any case beyond the capacity of the health centres, a referral system is there. There are levels of the services obtained at the Mother and Child hospitals, at the PHC centres, but the ones that require better skills are referred to the General Hospitals, the newly designated Mother and Child hospitals or other tertiary health institutions.
Government is ensuring that the new additions have the same standard with the initial Mother and Child both in Akure and Ondo.
Some people are of the opinion that accessing health at the PHC is more expensive to what obtains in the second health facilities. How do you react to this?
I don’t think that is true because in our health centres, we always have isolated cases of those who are perpetual law breakers but in majority of our health centres, health is cheaper. Delivery in our health centres is free but like I said, a lot of people will always break laws.
Recently, the government advised us to ensure that we provide accountability in the management of the health centres and that was why for the first time, the agency with support from the State Board of Internal Revenue (BIR), produced security receipt which has been distributed to all the health centres such that for the age group outside the free health care services, receipt are now available. It will also ensure that nobody charge anything above what obtains at the PHC level.
What is the patronage level of government health facilities?
Patronage has increased. As at 2012, the people that were delivered by skilled birth attendants was less than 60% but as at today by national survey, we are already over 70%. Delivery now is more at our facilities.
For immunization coverage, in 2017, the multi indictor survey done by UNICEF and other partners, shown that our coverage was around 66% but as at today, we are over 79%, that has been a tremendous improvement.
In terms of antenatal untilisation, it has actually increased. From available survey, it has been observed that utilization in those facilities has actually increased.
The number of delivery has also increased as it is now free. Due to free services, people have been patronising the PHC especially with improvement in the quality of health care delivery. With the effort of government, we will achieve more tremendous improvement in the health system.
Is the polity of the referral case by Traditional Birth Attendants (ABAs) still effective?
The policy is still in place. We are building on policies. You will agree with me that delivery at TBAs has actually dropped. As at today, referral is still one of the strong principles of our PHC system and NSHIP has also be very helpful as people and facilities still get rewarded by referral; not only referral from the TBAs even referral from the health centre to higher level. The TBAs are still encouraged to refer. At the appropriate time, we will hold a stakeholders meeting with them, so as, to re-emphasised the concept of partnership with government in terms of providing quality health care to our people.
What is the take of government in the area of personnel’s training in the health sector?
A lot of training exercises have been on since last year in terms of data management, quality of care, helping baby to breath etc. We have engaged our staff in their capacity across the agencies to ensure that they are able to respond to emergency and routine cases.
What are you doing to improve the system?
We are working on improving the system. Ondo State is always known to be the leader in the health system. As at today, Ondo State Governor, Arakunrin Ouwarotimi Akeredolu is working on ensuring to have 90 doctors at the PHC to add to the existing one. We are going to inject another set of health workers apart from doctors and nurses into the PHC.
I am sure that in the next couple of months, people will stop going to the General Hospitals for cases that are not meant to be handled there. We are clutching the health centres such that doctors will be available to manage people as people will have confidence if they have health system with adequate doctors on ground.
What is the relationship between the agency and NSHIP?
NSHIP is one of the programmes under the agency. Most of the success in the health system in the state, NSHIP has contributed greatly to it. NSHIP has the autonomy to use the fund given to them to ensure quality healthcare services, train staff, community participation etc. The pricing of health care services is done by the facility and community members.
With the various contribution of NSHIP in the state, how do you hope to sustain it after its expiration next year?
The state has come up with a sustainability plan. The contributory Health Scheme is another area which the government consider in fully taking up all the principles of NSHIP.
Ondo State will fully key into the Basic Health Provision Fund and it will be used to sustain the gains of NSHIP.
Government is also increasing fund to the PHC system. Local government have been very supportive and contributing to the sustainability of NSHIP in 2020.