Though the Primary Health Care centres (PHCs) in Nigeria are poorly financed, there are key interventions they can bring to the fight against the COVID-19 pandemic. The governments and NCDC must not disconnect from with these hubs which are the primary point of care under the Primary Health Care Under One Roof (PHCUOR) National Policy.
Essentially, there are four immediate needs for the PHCs. They are the closest behaviour change sensitization outlets and they are the grassroots channel to engage traditional and faith-based gatekeepers. Above all, they must continue to administer routine immunisation and remain the rounded framework to coordinate the 774,000 new sanitation officers mooted by the Federal government.
To date, the Nigerian government’s laudable response to COVID-19 has failed to chart a clear role for the Primary Health Care (PHC) level of the health system. It would seem that the PHC facilities have been under-emphasized and relegated to the background in the scheme of things.
The Partnership for Advocacy in Child and Family Health at Scale (PACaH@Scale) coalition in its Brief, recognised that infectious disease control requires highly specialized interventions, and that could mandate facilities removed from communities. Nevertheless, there is an important role for PHCs in infectious disease prevention. Therefore, the fight against COVID-19 should not be one which trades off PHCs against a specialized and central command system of service delivery, the Coalition insisted.
The Partnership for Advocacy in Child and Family Health at Scale (PACaH@Scale) is a coalition of 24 Nigerian Civil Society organizations working on issues of access to health in Nigeria. In response to the ongoing policy intervention of the government to curb COVID-19 outbreak in Nigeria, the Coalition has put forward a 4-point agenda.
The agenda, as highlighted below, makes recommendations to policymakers and stakeholders in health management on how the PHC system can serve as an asset to strengthen national and state governments’ fight against COVID-19.
- The Government of Nigeria and the National Centre for Disease Control (NCDC) in particular, should pivot and leverage PHCs as centres for community-based training and sensitization engagements on handwashing and behaviour change communication on social distancing for local communities, especially in rural geographies.
Under the PHCUOR National Policy, the PHC health system has already been entrusted key social and behavioural change communication roles in areas of nutrition, polio and routine immunization as well as prevention of diarrhoea and pneumonia of infants and children. In regions with limited access to the internet where videos of hand-washing can be demonstrated, PHC staff are well placed to demonstrate proper handwashing and social distancing protocols. - Across Nigeria’s 36 states and in the FCT, PHCs are struggling to respond to the demands of the National and State Primary Health Development Agencies to continue providing services. Experiences from the Ebola outbreak in West and Central Africa provide the evidence base for not disrupting PHC services during an epidemic outbreak and no doubt underpin the expectation of the National and State PHCDAs.
The enlightenment campaign of the National Primary Health Care Development Agency (NPHCDA) to reassure all Nigerians that PHC services will continue must be seen in this light. PHCs struggling to provide services for a mass clientele during this hot season or routine immunization services are in dire need of clear guidelines of how to remain active while not inadvertently spreading COVID-19.
As the hot season approaches many states are coordinating Meningitis vaccinations programs within the PHC system; routine immunization has not stopped; women are giving birth; and research is being conducted in states with where new Vaccine-Derived Polio Virus type 2 (cVDPV2), cases have emerged.
While PHCs are providing ongoing public health services a strategic opportunity is being missed to incorporate COVID-19 protocols in their ongoing services. Therefore, if PHC services are to remain undisrupted, critical questions must be asked about whether state governments have provided enough Personal Protective Equipment (PPE) to staff and whether they have received updates in handwashing protocols? - Nigerian civil society community have been grumbling their under-presentation in National and State governments COVID-19 situation rooms and coordination points. They ask – “where are the Market Women Associations? Where are the health professional associations? Where is the Guild of Nigerian Actors? Where are representatives of Nigeria’s numerous religious and traditional leaders councils in these coordinating agencies and situational rooms?
Maybe if they sat in situation rooms our Imams and Pastors would not continue to curate their flock for religious worship and our Actors and Actresses will realize the seriousness of COVID-19 and lend their voice to the campaign.
While we agree that Infectious Disease health professionals must take the lead in testing and treatment; and that Epidemiologist is vanguards for contact tracing, there is also an important role for civil society groups to mobilize communities for behavioural change to prevent the spread of the virus.
The PHC level provides an effective opportunity to engage civil society groups, including traditional and faith leaders and their communities of faith at the local level. Traditional and Religious leaders served as gatekeepers, key influencers and guiding voices to most Nigerian communities.
PHC centres can and should be positioned to serve as the NPHCDA/SPHCDA and the NCDC agents for interfacing with the Traditional/Religious leaders with regularity to support the process of community engagement, contact tracing and subsequently, referrals and reporting back to the NCDC.
Despite their well-known limitations, one critical success factor of PHC centres all over Nigeria is that they have well-established lines of coordination with community-based associations, traditional and faith leaders on issues related to disease outbreaks, to complaints of poor service, to social welfare for indigent patients.
This asset can and must be pivoted and leveraged in the fight against COVID-19. - Government’s initiative to recruit 774,000 new sanitation officers in the fight against COVID-19 is commendable and has great potential for readdressing falling sanitation and hygiene standards in our overcrowded and infrastructure-overburdened urban, periurban and rural centres.
For hand-washing to be effective in the fight against COVID-19 there must be water. For water to be usable; it must be clean. For the 774,000 new sanitation officers to fulfil their role, they must be anchored within a PHC system.
Within the PHC system, their knowledge and skills will be stepped-down and reinforced. Water, Sanitation, Hygiene and Health are all interlinked and should not be separated in the fight against COVID 19.
Government is already on the right track in recognizing this linkage with the proposal to engage 774,000 Female and Male Sanitation Officers.
PACFaH@Scale Health CSOs stand by these recommendations and poised ready to provide support.