There is no gainsaying the fact that we need primary health care now more than ever since it is a widespread belief that prevention is better than cure. Enough of the neglect by Federal and State Ministries of Health. Both the secondary and tertiary levels of care have not reduced the disease burden on the population.
Preventive services is not given the pride of place due to belief by some health personnel that the curative services which is expensive and unaffordable by the poor citizens will lose its relevance in the medical and health fields. This is the bane of strengthening the primary health care system.
Efforts by WHO to get governments to allocate more resources to preventive services have proved abortive. Physicians who are often appointed to head the Ministries of Health have refused to change the health system towards primary healthcare. They seem not to subscribe to WHO’s estimate that better use of existing preventive measures and initiating new ones can reduce the global burden of disease by as much as 70 per cent. People keep dying of both communicable and non-communicable diseases even when it has been proven that it is only a strong primary healthcare system that can contain these diseases. Thousands of young and old people die on a yearly basis all because we have failed to accord primary healthcare great importance. Poor people have to stay sick and die because they do not have the means to get the care they need while the rich travel out of the country for medical care.
It is disheartening that governments at all levels are not making enough effort to make healthcare accessible to all its citizens. Politicians who eventually get power do not see health as a fundamental human right of the people so that they can strive for universal health coverage. The National Health Insurance Scheme established by government in 1999 is only for government employees and few other groups. A larger percentage of Nigerians are either uninsured or underinsured. All these are happening because the leaders of the health system who are supposed to know better do not want a shift in focus from the curative services to preventive services.
This misdirection of care is not peculiar to Nigeria alone as health personnel in most developing countries feel threatened by the call to change towards primary healthcare. Those of us that are concerned about the lack of access for large numbers of people are no doubt unhappy that the poor people have to sacrifice their lives.
Realistically, the advocacy for increased allocation to preventive services more than the curative services is in the interest of the poor most of whom have the least means and it is not intended to relegate curative services to the background as both prevention and cure are important in the delivery of effective health care. But the inequitable allocation of resources between curative services and primary prevention is highly detestable. The clustering of resources allocated around curative services is a deliberate attempt to undermine primary healthcare which is the only level of care that can improve health outcomes.
The time has come for primary prevention to be accorded great importance. Those that are trying to suppress its importance had better support the delivery of healthcare embedded in communities.
If the health leaders in Nigeria had strove to achieve fairness and equity in the health system, the poor people would have been better for it besides the risk of disease outbreaks would have reduced.
There would be improvement in life expectancy and reduction in child and maternal mortality. A large number of people would have access to care and emergency services.
It is the belief of this writer that Nigeria would have improved her health system if it has genuinely employed the primary healthcare approach in the control of ill-health and diseases. And it is never too late to make the health systems perform and deliver besides it is the only option we have in spite of our seemingly insufficient resources. We do not need a soothsayer to tell us this.
Enough of the sentiment and bias in the allocation of resources to curative services more than primary prevention as there is no basis for the inequitable distribution by healthcare leaders. Primary healthcare needs more attention than curative health services. Curative services are obviously concerned with treatment of conditions and symptoms while preventive services help improve the population’s health status and overall quality of life. Health leaders should not politicize this issue because the consequences are starring us all in the face.
The price for cure is expensive and unaffordable by the poor people and this has led to increased poverty and preventable deaths. If the citizens have access to healthcare and a balanced equity, cost and quality of care, the health system would have been strengthened to cope with the current health challenges.
But unfortunately, this is not happening as Nigeria still battles with the issue of which services—curative or primary care should get better attention besides it is the health professionals who are supposed to ensure that public health receive better government funding that are depriving it of the needed resources.
Clinical professionals know that the medical establishment is in danger if it does not support the adequate funding of primary care but not to the detriment of curative services. Clinical professionals should work with other healthcare professionals to improve the performance of the healthcare delivery system. The issue of inadequate health personnel still persists. Brain drain is still yet to be addressed. Despite the cries of government to the robbery of its health staffs, many doctors and nurses still emigrate to the developed world. Most health workers cannot wait for a time when the health system in Nigeria would function properly. They want a health system that will provide better health and respond to the expectations of the population. Health workers are in the medical and health fields to meet the health needs of the people but the current state of the system is not encouraging. The organization in the frontline of public health has been calling for a return to primary healthcare approaches and this level of care has proved to be capable of addressing health issues in both developed and developing countries. Primary prevention is the focus of WHO in solving public health issues rather than curative health services which is increasingly becoming overwhelmed. A United States report on climate change and its effect on human health stated that the primary healthcare in U.S is capable of containing any health issues that may arise as a result of the global phenomenon. This is to show what strengthening the primary healthcare of a nation can do in responding to the 21st century health problems. WHO has been calling the attention of all countries to the development of the primary health care. This advocacy is genuine but it is been taken with a pinch of salt in countries that really need this change in their health system towards primary healthcare.
Primary healthcare is the future as the proper health of both present and future generations depend on it. WHO’s assertion that preventive services could cut 70% of global disease is not a myth as no other organization is authorized to make such a claim. WHO is constitutionally empowered and in the frontline of improving health around the world. Different health institutions and organizations align with this estimate and are working towards the reorientation of health systems all in a bid to making the primary health care effective and improve the performance of health systems.
It is high time governments focused their spending on preventive services so that people can have access to care according to their needs and regardless of their ability to pay. This is one of the ways out of the health challenges faced by a country like Nigeria wh
ich is still developing. Industrialized nations which spent a lot on their healthcare system still record a large number of unnecessary deaths not to talk of Nigeria whose spending on health is nothing to write home about. Developing countries urgently need to strive to provide universal health care for their people. We cannot compromise this if our people must get out of poverty.
It is not within the purview of the secondary and tertiary healthcare to tackle public health problem/issues as well as leading killer diseases in developing countries and around the world. Primary healthcare is the only level of care that is suited for addressing tuberculosis, pneumonia, malaria, access to care, rapid spread of HIV/AIDS, measles, under 5 mortality, infectious disease, cardiovascular disease, acute respiratory infection, diarrhea, poliomyelitis, pertussis, diphtheria, tetanus, smoking and diabetes. Both the secondary and tertiary healthcare only help to address more complex conditions but can we afford to allow the health conditions of the citizens get worse before they can get the needed care? It is only logical that more resources be allocated to primary prevention which is not only cost-effective but has also been proved to be capable of preventing up to 70% of the disease burden. This is not to say that curative services should be neglected but the clustering of resources allocated by Ministries of Health around curative services at great cost is unacceptable. Despite the shortage of health personnel in Nigeria, many health professionals do not want the health system to change towards primary healthcare. Rather they want to be overwhelmed by the massive influx of patients—which they obviously cannot handle. Besides the hospital treatment required at this point is expensive.
The consequence of irrational investment in the different levels of care is something the curative services cannot address except primary healthcare is strengthened, improved and accorded great importance in order to address the challenges of public health. Primary healthcare will complement curative service by easing the burden on it. In fact, the importance of primary healthcare in healthcare system cannot be overemphasized.
Bolaji Aregbesola contributes from Nigeria.