State of Primary Health Care Spending in Nigeria (2001-2014)

By Joshua Olufemi and Deji Adekunle

There is temptation to believe that primary health care is thriving in Nigeria if the National Primary Health Care Development Agency, NPHCDA’s data that N32.7 billion has been spent between 2001 and 2014 on construction of 687 Primary Healthcare Centres in something to go by.

View the interactive infographics below (Click on each State to see the spending)

The top five states that has accessed these funding for revamping primary health care between 2001 and 2014 are Kano, Jigawa, Delta, Gombe and Borno. Kano had the highest with N6.3 billion, followed by Jigawa which got N2.2 billion and Delta that had N1.65 billion. Gombe, which is the fourth had N1.4billion while Borno got N1.1billion. Other states that followed suit in the top ten ranking as shown below are Ogun, Bauchi, Cross River, Katsina and Anambra. It is unclear why these states got more than the other states.

The philosophy of primary healthcare in Nigeria is to reduce the weight of healthcare delivery on secondary and tertiary hospitals for communities. It is also to ensure family health workers support the continuum of healthcare services at the grassroots.

Ironically, a recent World Health Organization, WHO report stated that every single day Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age thus accounting for 10% of global estimates of maternal deaths. Albeit, 70 percent of under-5 deaths in Nigeria are avoidable, research has shown

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The current Minister of Health in Nigeria stated his intention to strengthen existing primary health care facilities by renovating and equipping at least 10,000 primary healthcare facilities in the country. However, current data from the Nigeria Millennium Development Goals Information System (NMIS) revealed that only 50 percent of the needed (5,423) government owned primary health care centers (PHCs) exist, their present conditions are nothing to write home about.

Investigation by PREMIUM TIMES reporter and procurement monitors from Public and Private Development Centre (PPDC) has revealed that there is little or no value for the investment across the country. The awarded contracts for the construction of PHCs in Kaduna, Nasarawa and Abuja environs showed the terrible state of primary health care in Nigeria.

For instance, PPDC’s monitoring assessment of 29 primary health centres in Lere and Kubau Local Government Areas of Kaduna State, in October 2015, revealed “95% of the clinics do not have staff quarters. Most walls of the clinic are broken, ceiling sheets falling off and some of them need new structures e.g. Kuli Health Centre.” The roads leading to some of these clinics are not accessible; more staff are needed in some of the clinics to enable them carry out their assigned duties effectively; and most PHCs do not have equipment for their diagnosis, most of which is obsolete and need replacement.

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Critics of the sector have complained about the shortage of basic equipment and where available, the equipment is obsolete or not procured according to needs and technical specifications stipulated in the tender documents. There are also disturbing cases of unavailability of essential drugs & consumables coupled with cases where health workers administer fake and substandard drugs.

Similar reports from Karu and Keffi Local Government Areas of Nasarawa State, revealed that none of the Karu and Keffi PHCs have provision for treatment of tuberculosis and dental cases. There was no van or ambulance; no emergency number in the PHCs; and a few had a pharmacy section, some indicated by government also did not exist (Angwan Jaba) while one was packing up due to low patronage (Barkin kogi). Other issues were most PHCs had shortage of staff; poor facilities (some without toilets); no access roads and absence of sign posts for direction. Most of the PHCs in the distant villages need to be rebuilt.

Also, poor community members are subjected to extreme out-of-pocket spending. It is worrisome to believe the Nigerian health sector has received close to 2.5 trillion Naira budgetary allocation since the year 2000 even though 95 percent of Nigeria’s total spending on health services comes from individuals who pay upfront without insurance against the desirable 20 percent standard set for a nation’s out-of-pocket spending.

Data Source: Public and Private Development Centre.