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Rh “Rhetoric! Realism! Results!!! Health Care in Nigeria.”. Adetokunbo O. Lucas, MD. Outline. Primart Care Primary Health Care (PHC) Realism: - PHC in Nigeria Resukts Rhetoric. Primary Care. Pre-Alma Ata Stand alone - poor linkage to other tiers

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Rh rhetoric realism results health care in nigeria
Rh“Rhetoric! Realism! Results!!!Health Care in Nigeria.”

Adetokunbo O. Lucas, MD


Outline

  • Primart Care

  • Primary Health Care (PHC)

  • Realism: - PHC in Nigeria

  • Resukts

  • Rhetoric


Primary care
Primary Care

Pre-Alma Ata

  • Stand alone - poor linkage to other tiers

  • Top down – minimal community involvement

  • Inequitable allocation & access

  • Arbitrary, non-scientific

No "NAFDAC" number


Basic Health Services Primary Care Level

CURATIVE

SERVICES

HEALTH

EDUCATION

HEALTH

STATISTICS

MATERNAL &

CHILD HEALTH

ENVIRONMENTAL

HEALTH



Alma ata declaration 1978
Alma Ata Declaration 1978 6–12,

Primary health care is essential health care based on practical, scientifically sound & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation, & at a cost that the community & country can afford to maintain at every stage of their development in the spirit of self‑reliance & self‑determination.


Alma Ata Declaration 1978 6–12,

  • Primary health care is:

  • essential health care

  • based on practical, scientifically sound &

  • socially acceptable methods & technology

  • made universally accessible to individuals & families in the community

  • through their full participation, &

  • at a cost that the community & country can afford to maintain at every stage of their development in the spirit of self‑reliance & self‑determination.


7 pillars of phc
7 Pillars of PHC 6–12,

  • Foundation of the health system

  • Focus on priorities

  • Equity

  • Science/Evidence based

  • Culture sensitivity/social relevance

  • Community participation

  • Sustainability & self-reliance

"NAFDAC" number


#1 Foundation 6–12,


1 foundation contd
#1 Foundation (contd.) 6–12,

…should be sustained by integrated, functional & mutually‑supportive referral systems, leading to the progressive improvement of comprehensive health care for all, & giving priority to those most in need;…."


Strengthening Referral System 6–12,

TERTIARY

SUPPORT SUPERVISION

REFERRAL

SECONDARY

PRIMARY


2 equity and social justice
#2 Equity and social justice 6–12,

.....made universally accessible to individuals & families in the community.


3 science evidence based
#3 Science/Evidence Based 6–12,

"…is based on the application of the relevant results of social, biomedical and health services research and public health experience;…"


4 priorities
#4 Priorities 6–12,

“addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly. "


5 culture sensitivity social relevance
#5 Culture sensitivity/ 6–12, Social relevance

  • …socially acceptable methods & technology;

  • ….reflects & evolves from the economic conditions & socio-cultural & political characteristics of the country & its communities.


6 community participation
#6 Community Participation 6–12,

  • The people have the right & duty to participate individually & collectively in the planning & implementation of their health care.

  • ..requires & promotes maximum community & individual self‑reliance & participation in the planning, organization, operation & control of primary health care…….


7 sustainability self reliance
#7 Sustainability & self-reliance 6–12,

......at a cost that the community & the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination."



Committee on national health policy
Committee on National Health Policy 6–12,

Chairman: Adetokunbo O. Lucas

Members

Professor Umaru Shehu – Eminent academic

Chief Lambo, President, Association of Traditional Healers

Etc.


Committee on national health policy1
Committee on National Health Policy 6–12,

  • Recommended a health system based on PHC

  • Linked to National Development Goals

  • Report – 1984

  • Several Ministers of Health ignored report

  • No formal action until 1988

Professor Olikoye Ransome-Kuti

National Health Policy - 1988


Second national development plan
Second National Development Plan 6–12,

  • A free and democratic society

  • A just and egalitarian society

  • A united, strong & self-reliant nation

  • A great and dynamic economy

  • A land of bright & full opportunities for all citizens

    Professor O. Aboyade


Realism
Realism 6–12,


1 integrated health system
#1 Integrated Health System 6–12,

  • Fragmented services

  • Poor co-ordination among 3 tuers of government

  • The most critical component of PHC (Primary Care) is assigned to the weakest, poorest and least stable governments


2 equity
#2 Equity 6–12,

  • Equity & social justice

  • Universal coverage with basic health services

  • Conditioned by national resources


3 science evidence base
#3 Science/Evidence Base 6–12,

  • Promote ESSEMTIAL NATIONAL HEALTH RESEARCH

  • Objective assessment of needs and opportunities

  • Science based decision ,making at every level of the health services


4 priorities1
#4 Priorities 6–12,

Selection of interventions on the basis of:

  • Burden of disease

  • Cost

  • Cost effectiveness


5 cukture sensitivity
#5 Cukture Sensitivity 6–12,

  • Listening to the people

  • Adapting interventions in relation to beliefs & preferences

  • Advocacy and education to encourage bedt choices

#


6 community participation1
#6 Community Participation 6–12,

Full partnership

  • Planning strategies/projects

  • Delivery of services

  • Monitoring

  • Evaluation

  • Contributions in cash & kind


7 financing health services
#7 Financing health services 6–12,

  • Affordable

  • Sustainable

  • Allocation based on agreed priorities

  • Balance between primary care and other services


RESULTS 6–12,


Health statistics nigeria

Health Statistics: Nigeria 6–12,

Consistently poor performance

Limited progress

`


Ghana 113 6–12,

Cameroun 164

Nigeria 187

Angola 181

Kenya 140





Where do we go from here1
Where do we go from here? olds

  • Advocacy - key stakeholders

  • Strengthening health care units

  • Optimising referral system

  • Training managers

  • Financing

  • Accommodating culture



From olds

Primary Care

Conclusion

To

Primary Health Care


Primary Health Care olds

  • Health system

  • Priorities

  • Equity

  • Evidence based

  • Culture

  • Participation

  • Sustainability

PRIMARY CARE


Honouring his memory
Honouring His Memory olds

Make

PHC

Real in

Nigeria


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