Despite the cholera outbreak in Nigeria which has affected more than 100,000 people and claimed the lives of over 3,000 Nigerians in 2021, no fewer than 918 primary health care centres across 32 states in the country have remained closed, aggravating the challenges of the poor people who use the facilities.
Experts have maintained that the outbreak is not unconnected to poor hygiene practices, lack of water facilities and inadequate medical intervention.
It was gathered that 81 of these centres have been closed permanently, while 837 are shut temporarily. Out of the 32 states, crisis-ravaged North-East Borno State has the highest number of closed health centres, accounting for 220 out of the total. It is followed closely by Adamawa with 170 PHCs.
Other states include Katsina, Kebbi, Kwara, Nasarawa, Taraba, Yobe, Kaduna, Ekiti, Niger, Ogun, Osun, and Oyo.
Primary Health Centres are the first point of contact to keep people well and improve their quality of life.
According to the World Health Organisation, primary health care is the provision of basic essential health services, including preventive, curative, and rehabilitative care. In Nigeria, about 30,000 PHCs are spread across 9,565 wards in 774 Local Government Areas. With most of them under the control of LG authorities, many are in rural and low-income communities and are the first line of defence for such communities.
But the continuous closure of these facilities illustrates the ingrained insensitivity and failure of Nigeria’s public health sector, both at the national and sub-national levels.
The development is emblematic of a much bigger problem: the weakness of the LGs. The LG tier of government has been grossly underfunded by the states, which see them as mere appendages and routinely divert their allocations. This has undermined their effectiveness and hampered service delivery. For instance, the primary schools, which are mainly under the LG control, have been left derelict, ditto for the roads. So emasculated have they become that in some states like Lagos, revenue-yielding LG functions like regulation of outdoor advertising and waste disposal have been hijacked by the state. Thus handicapped, LGs can barely operate PHCs. Consequently, universal health coverage in Nigeria stands at a paltry five per cent.
At the United Nations high-level universal health coverage meeting in 2019, Nigeria, along with other countries, committed to strengthening primary health care.
The WHO had recommended that every country allocates an additional 1.0 per cent of GDP to primary health care from government and external funding sources but this has been a pipe dream for Nigeria despite the promulgation of the National Health Act.
According to the Act, about 1.0 per cent of the Consolidated Revenue Fund should go into the Basic Health Care Provision Fund along with contributions from donor agencies. The fund is mainly for primary health care. Sadly, the Act has failed to make any impact as the Federal Government continues to blame states for failing to provide the needed counterpart funding.
The Minister of Labour and Employment, Chris Ngige, says only about three states have been able to access the fund due to the challenge of counterpart funding.
Though other pressing matters compete for government funding, health care is a social investment, a right that should not be toyed with.
The Sustainable Development Goal III regarding good health and well-being, which Nigeria has pledged to, targets a reduction of maternal mortality, ending all preventable deaths under five years of age, fighting communicable diseases, ensuring reduction of mortality from non-communicable diseases, granting universal access to sexual and reproductive care, family planning and education; and achieving universal health coverage among others.