STRENGTHENING PRIMARY HEALTH CARE SYSTEMS:
A CASE STUDY OF ABUJA GLOBAL SHAPERS EMERGING LEADERS PROGRAM 2.0.

Introduction:

The World Health Organization (WHO) Alma-Ata declaration of 1978 defined Primary Health Care as “Essential healthcare based on scientifically sound and socially acceptable methods and technology, which makes Universal Health Care accessible to all individuals and families in a community. It is through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”. 

Primary Health Care is the first contact individuals, and communities have with the health care system. It is the foundation for building a sustainable future for healthcare.

In 2015, the World Innovation Summit for Health (WISH) Forum on Universal Health Coverage reported that over 1 billion people worldwide lack access to basic healthcare. The same year a WHO and World Bank Group report suggested that 400 million people do not have access to essential health services and 6% of people in low and middle-income countries are pushed further into extreme poverty because of health spending. Overall, these figures are in every way frightening. A worrying percentage of the world population remains unable to access basic health care services when they need them. Simply put, these people are unable to get assistance from well-trained health workers, access safe treatment or even get medicines and other health products without suffering financial hardship when procuring these services. On this premise, it is pertinent that in shaping the future of health, the World Economic Forum adopts a framework aimed at strengthening Primary Health Care systems.

Abuja Global Shapers ELP 2.0

The Abuja hub of the Global Shapers Community through its Emerging Leaders Program (ELP) Award in partnership with a regional non-government organization, Selfless for Africa, reaffirmed her commitment to Shaping the Future of Health by awarding its annual $3,250 grant to a group of undergraduate students who showed exceptional commitment to revamping a moribund Primary Health Center at Oke Ola Farm Settlement Agric, Ogbomosho, South-West Nigeria. This dilapidated structure is meant to serve six villages within the Local Government; but like most Primary Health Care centers in developing countries, it had lacked maintenance, financing, trained personnel, and supply of drugs and equipment. The resultant effect has been that 3,000 inhabitants of Oke Ola settlement have lacked access to standard healthcare for the past decades; and they have had to incur extra financial burden, traveling to other local governments in search for health services.

This project is holistically aimed at refurbishing the facility, providing basic treatment drugs and equipment, ensuring a return of health care workers; and ultimately improving the wellbeing of the community populace through the use of the facility. With a well-equipped and fully functional Primary Health Care Center, basic standard health services will be made available to over 3,000 people.

Objective: Advancing the role of strong Primary Health Care Systems in achieving a future where we are equipped to face the present healthcare challenges and that of generations to come.

Every effort towards shaping the future of health must as a matter of policy and necessity, provide evidence to the WHO five key elements to achieving Universal Health Coverage. The Abuja Global Shapers ELP 2.0 Project has attempted to achieve this.

  • Reduce Exclusion and Social Disparities in Health: The poorest people living in rural communities who often times are most in need of health services still remain largely unreached. With the Abuja Global Shapers example, we have attempted to tackle this issue by taking healthcare to the most disadvantaged people, rather than waiting for people to come to healthcare. If Universal Health Care must be achieved, there must be unwavering commitment to take healthcare services to every unreached locality.
  • Organizing Health Services around Peoples Needs and Expectations: Primary Health Care doesn’t necessarily mean providing the most sophisticated services to the people. It means providing what people need to live a healthy life. The aim of the ELP 2.0 project isn’t to provide state of the art facilities for robotic surgeries or STEM Cell transplant, it is to provide the essential health care needs of the people, enabling the women to have safe deliveries, providing preventive mechanisms against common infectious diseases, ensuring standard treatment regimens for everyday medical cases, as well as providing a conducive and hygienic healthcare facility. Importantly, this project clearly expresses the value of community participation in sustainable health solutions. Its grass-roots nature underlined by its implementation by indigenous locals; emphasizes the full use of local human and material resources, thus promising improved chances of self-sufficiency.
  • Integrating Health into All Sectors: Goal 3 of the United Nations Sustainable Development Goals (SDGs) “Good health and well-being for all” is just as vital as all 17 goals. There can be no meaningful legislation on Sustainable Development without embedding Health Sustainability as the bedrock of all policy formations. Just as we attempt to achieve food sufficiency, quality education, economic empowerment, infrastructural development, enhance Information and Communication Technology; we must also commit to realizing 80% health coverage globally by 2030. The fact that this project is being executed by undergraduate students is quite instructive as health outcomes have shown to be greatly influenced by education. The relationship between health and education has been established following socioecological trends and decades of research. The disparity in health status between communities with high and low education has widened, with an increased life expectancy among highly educated communities, accompanied by an increasing death rate among the least educated communities. The Abuja Global Shapers ELP 2.0 project seeks to further pursue the integration of Health into Education. An important aspect of this project features community and public health education campaigns, sensitization exercises, as well as capacity building on efficient water, sanitation and hygiene practices. 
  • Pursuing Collaborative Models of Policy Dialogue: In shaping the future of health, present and future leaders at all levels must undertake leadership reforms with a global perspective. From international organizations such as the World Economic Forum to regional and national government institutions, there must be continuous engagements to formulate strategies aimed at managing the increasing level of health risks, whilst developing a multi-stakeholder delivery system with a community-based approach, providing quality healthcare services in the most cost-effective way. Already, the rehabilitated Primary Health Care Center in Ogbomosho has been employed by the USAID as a center for supply and distribution of insecticide-treated nets to 600 women in the community. With such collaborations going beyond interventions to policy engagements, we have better chances of strengthening health systems.
  • Increasing Stakeholder Participation: Shaping the future of health goes beyond strengthening a sector or institution. It aims at producing a healthier population and improving economic and social productivity. For sustainability to be assured, all hands must be on deck. From governments to policymakers, industry experts, civil society organizations, non-governmental organizations, youth groups, and individuals; deliberations must involve the active participation of all concerned. This ELP 2.0 project clearly demonstrates multi-stakeholder participation. It is driven by non-governmental organizations, implemented by students, and ultimately will be managed and maintained by government institutions such as the State Primary Health Care Board and Ministry of Health.

Impact Assessment:

For effective impact measurement and evaluation, a few important pointers have been identified on this project.

Indicators of Achievement:

  1. Reduced Financial Burden: With indigenes having to incur travel cost of about N650 to other local governments in search of basic health services, sampled opinions have suggested that every person must have borne this cost at least once in every four months. The implication is that the community loses N1.95 million quarterly in travel cost alone, to medical tourism. These funds could have been invested in other viable economic activities.
  2. Improved Health Indices: Fewer cases of mortality from preventable infectious diseases, safe deliveries, reduced deaths from accidents, and trauma, an all-round healthier population with improved life expectancy.
  3. Education: More children will be in schools as they will be healthier, and money spent on medical services can be channeled to funding children education.
  4. Daily Walk-In Patients: The facility is projected to have clinic visit between 20 -80 patients per day. These are people who otherwise would have endured the burden of staying at home, patronizing substandard services or traveling outside their community.
  5. Improved Maternal Health: The Nigerian Urban Reproductive Health Report 2011 established that Oyo state has about 262 maternal deaths per 100,000 live births annually, with 9% still birthrate and infant mortality put at 7/1000. With this fully functional Primary Health Care center providing comprehensive antenatal and postnatal care, there’s a projected reduction in the number of maternal deaths.

In Oke Ola Farm Settlement, Agric Ogbomosho-South Local Government where the population is estimated at 3000, maternal health indices are shown in the table below.

Table 1: Maternal Health Indices

Current

Expected Annual Index

Delivery Assistance

Doctor 10%

Doctor

20%

Nurse 68%

Nurse

70%

Auxiliary Midwife 5%

Auxiliary Midwife

5%

Relative/Friend 6%

Relative/Friend

1%

TBA 4%

TBA

2%

Other 5%

Other

2%

None 2%

None

0%

   Source: NURHR 2011.

From the table above, strengthening Primary Health Care Systems is key to attaining increased professional delivery assistance in Maternal Health. There’s an expected 10% increase in the services of medical doctors, as more doctors will be willing to work with the provision of standard facilities. Cases of child deliveries by relatives and Traditional Birth Attendants are expected to reduce to 1% and 2% respectively. In the long run, no woman is expected to deliver a baby without standard medical assistance.

Conclusion:

This report will be crucial in buttressing the value of strengthening Primary Health Care systems to Shaping the Future of Health. The case study of the Abuja Global Shapers Emerging Leaders Program 2.0, showing evidence of success, has inadvertently provided an implementable model for charting a course for the future of health, led and driven by the next generation of global leaders. With empirical evidence and comprehensive quarterly impact based analysis following, the significance of sustainable Primary Healthcare systems will be fully established.