44 years after the alma-ata declaration; the state of primary health centres in Nigeria

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THE ALMA-ATA CONFERENECE
6th- 12th of September, 1978 was when the conference was held in Almaty, Kazakhstan which expressed the need for urgent action by all government, health and development workers and the world community to protect and promote the health of all people. The main theme of the conference was “how to bring about an improvement in the general health of the people of the world, especially those in rural areas”. Primary Health Care was therefore chosen as a key strategy to achieve the goal and the year 2000 was accepted as the target year to achieve this goal, the declaration emerged as a major milestone of the twentieth century in the field of public health as it identifies Primary Health Care as the Key to the attainment of the goal of health for all around the globe. It was the first international declaration underlining the importance of Primary Health Care, which has been accepted by member countries of WHO as a key to achieving the goal HEALTH FOR ALL.

WHAT PRIMARY HEALTH CARE SHOULD LOOK LIKE.
The declaration defined Primary Health Care ” as an essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community 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, from this definition my interpretation is that Primary Health Care should be scientifically based and whatever method that would be used in the delivery process of health care should be acceptable by the members of the community hence the need for community participation at every level of development and also the government should ensure they persuade the community members enough to be willing participate and contribute to it also, the should be organised I a way that they would be able to afford it’s need for developmentmeaning it should not be necessarily big. Since there were different countries during the conference and they all have their socio- cultural beliefs which should be considered in the organisation of Primary Health Care to ensure acceptance, countries were saddled with the responsibility of composing what Primary Health care will be in their country but the keywords in the definition must be considered and it must be affordable for the poor.
During the conference Primary Health Care was said to be the first level of contact of individuals, the family and the community with the National Health System, bringing health care as close as possible to where people live and work, and constitute the first element of the continuing Health care process, in other words Primary Health Care Centres should be the first place an individual or family visits when in need of medical attention and when it cannot be handled such person is referred to a Secondary Health Care which in Nigeria’ ‘s case is the General Hospital”s, this is advised so as to reduce the crowd at the Secondary and Tertiary level of Health care delivery system and also to relieve them of some minor duties that can be handled by the Primary Health Centres. There is hardly a community in Nigeria that doesn’t have a Primary Health Centre, so as to bring Health care close to the people and also the cost of Health care at the Primary Health Centres are usually cheap.
Components of PHC’s
At inception Primary Health care had 8 components however two was later added, hence any health service such as Nigeria based Primary Health Care should include all aspects which include;
1. Health education
2. Promotion of food supply and adequate nutrition
3. Adequate supply of safe water and basic sanitation
4. Maternal and child health care including family planning
5. Immunizations against communicable diseases especially childhood diseases
6. Appropriate treatment of common diseases and injuries
7. Provision of essential drugs and supplies
8. Prevention of locally endemic diseases
9. Provision of mental health services
10. Provision of dental health services.

Primary Health Centre should have the following sections;
1. Treatment room
2. Laboratory
3. Counselling service
4. Labour room
5. Pharmacy
6. Reception
7. Immunizations room
8. Family planning .
9. Dentist office
All this sections doesn’t have to be big it could just be rooms with several demarcation. Only few Health centres meet this standard and of all have visited, the only Health centre that meet this standard is Ipaja/ Ayobo Health centre.
PROBLEMS OF PRIMARY HEALTH CENTRE IN NIGERIA
1. Inadequate staff
2. Lack of financial support
3. Lack of basic amenities such as laboratories, medical instruments
4. Lack of administrative skill by some of the personnel
5. Lack of community participation
6. Lack of maintenance culture.
7. Inadequate on-the-job training of health workers.
SUGGESTIONS
1. Employment of adequate and competent staff.
2. Local governments should be given financial autonomy so that the can properly finance the Primary Health centres.
3. Some of the health workers that head various Primary Health Centres that do not have administrative skill hence the Health centre is not properly managed.
4. Provision of adequate amenities by the government, Private-Public Partnership could be introduced to reduce the financial burden on the government.
5. The community members should be included at every stage of its development, in some places some community members are not aware that there is a Primary Health Centre in their area and this would not help the situation as the Health Centre will not be able to function properly that’s even if it functions at all.
6. Maintenance culture should be imbibed in the health worker as sometimes even the few amenities they have are not properly maintained.
7. Some of the health workers do not have up- to- date knowledge on health issues and this is very serious as have experienced this times without number and if care is not taken, wrong health information will continue to circulate especially among the uneducated citizens.

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Godwin Okafor is a Financial Journalist, Internet Social Entrepreneur and Founder of Naija247news Media Limited. He has over 16 years experience in financial journalism. His experience cuts across traditional and digital media. He started his journalism career at Business Day, Nigeria and founded Naija247news Media in 2010. Godwin holds a Bachelors degree in Industrial Relations and Personnel Management from the Lagos State University, Ojo, Lagos. He is an alumni of Lagos Business School and a Fellow of the University of Pennsylvania (Wharton Seminar for Business Journalists). Over the years, he has won a number of journalism awards. Godwin is the chairman of Emmerich Resources Limited, the publisher of Naija247news.

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