By Victor Okeke
SIR: The COVID-19 pandemic has shed light on the critical importance of primary health care (PHC) in Nigeria and the devastating consequences of neglecting it during times of crisis. The diversion of health workers and the disruption of health systems have had far-reaching implications, leading to widespread backsliding of health services and a decline in access to essential health products. This regression has created a vicious cycle of vulnerability, particularly affecting high-risk groups.
Recognizing the significance of PHC, it is crucial to prioritize it in pandemic prevention, preparedness, response, and recovery (PPR) efforts. Before a pandemic strikes, PHC plays a crucial role in promoting health, preventing underlying conditions, and strengthening individuals’ ability to fight off infections. It builds trust in local health workers and facilities, combats misinformation, and enhances community resilience.
During a pandemic, PHC serves as the first line of defence. Health workers available through PHC are essential in identifying new cases, supporting surveillance efforts, delivering continuous care, providing risk communication tailored to specific contexts, and ensuring the availability of essential supplies. Moreover, comprehensive PHC systems can be quickly repurposed to distribute emergency countermeasures alongside essential health services, preventing the collapse of the health system.
After a pandemic, PHC plays a vital role in delivering catch-up care and addressing disruptions to preventive services. It can contribute to social and economic recovery by connecting communities to support programmes related to nutrition, housing, and finance.
Additionally, integrating emergency surveillance with routine health data at the PHC level enables the rapid identification of disease hotspots and informs future research and development efforts, ensuring that pandemic counter-measures are suitable for the communities they aim to protect.
Despite the importance of PHC, proposed reforms to the PPR architecture have largely overlooked it. This silence is concerning, given the instrumental role PHC plays in crisis management.
To address this gap, there are several key actions that Nigeria should take. First, increased investment in PHC is necessary to maintain and improve population health. Second, community-driven contingency plans should be established to ensure that PHC remains accessible and affordable throughout all stages of a crisis, including catch-up care.
Finally, PHC should be leveraged as a coordination point for integrating PPR efforts with universal health coverage, ensuring equity and comprehensive care.
PHC can serve as the linchpin for equity in PPR, and therefore, emergency response should not come at the expense of routine service delivery. Governments must develop failsafe plans for PHC, similar to crisis management plans for data and computer systems. Prioritizing PHC in national and international PPR negotiations and investments will help communities better prepare for, respond to, and recover from infectious disease threats.
This means that the country should prioritize increased investment in PHC to ensure the availability of essential health services, a well-trained workforce, and sufficient infrastructure. Adequate funding will enable the expansion and improvement of PHC facilities, ensuring they are equipped to provide quality care, diagnostics, treatment, and preventive measures.
There is also need for community engagement to foster partnerships between health care providers and local communities and empower individuals to take an active role in their own health. This includes promoting health education, preventive measures, and effective risk communication to enhance awareness and response capabilities.
Also, a robust surveillance system is critical for early detection and response to emerging health threats. Nigeria should strengthen its disease surveillance mechanisms, leveraging PHC facilities as primary reporting points. Health workers at these facilities should receive proper training to identify potential outbreaks, report cases promptly, and follow established protocols for containment.
A resilient PHC system requires uninterrupted access to essential medicines, vaccines, and medical supplies. Nigeria should strengthen its supply chains, ensuring the availability and distribution of critical resources during a pandemic. Additionally, essential health services such as routine immunizations, maternal and child health care, and chronic disease management should be maintained even during crisis situations.
It is time to recognize the critical role of PHC and ensure its integration into Nigeria’s pandemic response and recovery strategies. By doing so, we can build resilient health systems and safeguard the well-being of all Nigerians.