Rh rhetoric realism results health care in nigeria
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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


Rh rhetoric realism results health care in nigeria

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


Rh rhetoric realism results health care in nigeria

Basic Health Services Primary Care Level

CURATIVE

SERVICES

HEALTH

EDUCATION

HEALTH

STATISTICS

MATERNAL &

CHILD HEALTH

ENVIRONMENTAL

HEALTH


Rh rhetoric realism results health care in nigeria

International Conference on Primary Health Care, September 6–12, 1978 Alma Ata, USSR


Alma ata declaration 1978

Alma Ata Declaration 1978

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.


Rh rhetoric realism results health care in nigeria

Alma Ata Declaration 1978

  • 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

  • Foundation of the health system

  • Focus on priorities

  • Equity

  • Science/Evidence based

  • Culture sensitivity/social relevance

  • Community participation

  • Sustainability & self-reliance

"NAFDAC" number


Rh rhetoric realism results health care in nigeria

#1 Foundation


1 foundation contd

#1 Foundation (contd.)

…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;…."


Rh rhetoric realism results health care in nigeria

Strengthening Referral System

TERTIARY

SUPPORT SUPERVISION

REFERRAL

SECONDARY

PRIMARY


2 equity and social justice

#2 Equity and social justice

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


3 science evidence based

#3 Science/Evidence Based

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


4 priorities

#4 Priorities

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


5 culture sensitivity social relevance

#5 Culture sensitivity/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

  • 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

......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."


Rh rhetoric realism results health care in nigeria

PHC in Nigeria


Committee on national health policy

Committee on National Health Policy

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

  • 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

  • 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


1 integrated health system

#1 Integrated Health System

  • 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

  • Equity & social justice

  • Universal coverage with basic health services

  • Conditioned by national resources


3 science evidence base

#3 Science/Evidence Base

  • 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

Selection of interventions on the basis of:

  • Burden of disease

  • Cost

  • Cost effectiveness


5 cukture sensitivity

#5 Cukture Sensitivity

  • Listening to the people

  • Adapting interventions in relation to beliefs & preferences

  • Advocacy and education to encourage bedt choices

#


6 community participation1

#6 Community Participation

Full partnership

  • Planning strategies/projects

  • Delivery of services

  • Monitoring

  • Evaluation

  • Contributions in cash & kind


7 financing health services

#7 Financing health services

  • Affordable

  • Sustainable

  • Allocation based on agreed priorities

  • Balance between primary care and other services


Rh rhetoric realism results health care in nigeria

RESULTS


Health statistics nigeria

Health Statistics: Nigeria

Consistently poor performance

Limited progress

`


Rh rhetoric realism results health care in nigeria

Ghana 113

Cameroun 164

Nigeria 187

Angola 181

Kenya 140


Rh rhetoric realism results health care in nigeria

Under-five mortality rate/1000 live births

(1990 – 2005)


Rh rhetoric realism results health care in nigeria

Diphtheria-Tetanus-Pertussis immunization among one year olds

GHANA NIGERIA


Where do we go from here

Where do we go from here?

PHC


Where do we go from here1

Where do we go from here?

  • Advocacy - key stakeholders

  • Strengthening health care units

  • Optimising referral system

  • Training managers

  • Financing

  • Accommodating culture


2 strengthening primary care

2. Strengthening Primary Care


Rh rhetoric realism results health care in nigeria

From

Primary Care

Conclusion

To

Primary Health Care


Rh rhetoric realism results health care in nigeria

Primary Health Care

  • Health system

  • Priorities

  • Equity

  • Evidence based

  • Culture

  • Participation

  • Sustainability

PRIMARY CARE


Honouring his memory

Honouring His Memory

Make

PHC

Real in

Nigeria


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