MEZIESBLOG

Anambra state has experienced some challenges to its realization of the Primary Health Care Under One Roof (PHCUOR) objectives. Some of the state-level setbacks to the health programme are the inadequate and unequal distribution of human resources.

PHCUOR is a policy implemented to integrate all PHC services under a single authority for the purpose of adding efficiency to PHC management and service delivery at both state and local government levels. Using a scorecard assessment to review performance of the PHCUOR policy in recent years, the author found that the National Primary Health Care Development Agency (NPHCDA) and its partners in the 36 States and FCT are collaborating to reduce or eliminate challenges to the full implementation of national health objectives. The apex government also established an administratively autonomous State Primary Health Care Board (SPHCB) saddled with the responsibility of overseeing PHC implementation at all levels. Additionally, relevant laws were enacted to provide legal backing and develop a Minimum Service Package (MSP) that ensures there are essential drugs, equipment and well-trained health workers available at primary health centres. Although Anambra state has achieved success in health care delivery, there are few grey areas. For example, the number of health professionals in the state are not enough for all individuals and households based on the Minimum Service Package guidelines. The human resource problem appears hopeless because partners in the health system do not want to engage in the recruitment, training and retention of qualified and experienced professionals. Research has proven that human resource management is a capital-intensive project that requires regular assessment and inputs—a reason why partners have abandoned workforce staffing to both federal and state governments.

Unfortunately, Anambra state does not have a robust funding mechanism to fully implement the PHCUOR policy. For example, sourcing for funds at the state level involves writing a memo, getting an approval, securing releases, and then the cash backing—which is the most difficult challenge. Findings show that funding is a critical aspect of healthcare. Despite the challenge, Anambra state’s ministry of health is still responsible for treating some illnesses such as Malaria, HIV, Leprosy, and TB interventions even though these are supposed to be handled by SPHCB in accordance with PHCUOR regulations.

Furthermore, research findings indicate that the quality of health care service—when compared to other drivers of health such as educational advancement, economic growth and technology adoption—is more likely to improve the overall health of developing countries at a faster rate. On this premise, Anambra state government and SMoH have designed health actions (that is, activities to improve or maintain high standards of health care delivery). But these actions occur in different, unstable political, social, cultural and institutional contexts that influence outcomes. Additionally, individuals and households seeking quality care in Anambra state face challenges from the demographic and socioeconomic makeup of the health system, including genetics and personal resources.

Cultural beliefs that favour use of alternative sources of healthcare such as traditional herbalists and spiritual healers are also a major challenge to PHC implementation in Anambra. Despite the health sensitization efforts through the media, churches, community events and face-to-face meetings with health workers, some individuals and households still consider PHC facilities as the last source of health care. This constraint to disease surveillance exposes communities to avoidable health risks. Findings show that lack of community-based approach to disease reporting as well as poor training of health workers in rural communities constrains effective disease surveillance. Regular training for the health workforce has been found to have positive results on their disease notification habits and use of ICT systems. With adequate training, health workers acquire the basic knowledge and skills they need to take certain defined lines of action that improve overall standard of performance in disease surveillance and control.

In the area of technology-driven healthcare, Anambra state lacks advanced data collection systems that enables prompt diagnosis, treatment and control of contagious diseases. Non-existence of functional public health laboratories has been a major challenge to the realization of PHCUOR objectives. Failures to control epidemics in the state were attributed to inadequate manpower resource and low adoption of advanced technologies in healthcare management. Findings show that a large number of health facilities in Anambra state do not have diagnostic support and adequate funding for logistics. Health professionals therefore face challenges from high costs of transporting patients, communicating with health providers, as well as sharing or accessing patient data on time. Disease surveillance is widely recognized as an effective strategy for controlling and preventing diseases, most especially communicable diseases, but without advanced health technologies, early interventions at the community level would remain an impossible objective.