The power of primary health care

Every country has a national anthem and all countries have a national flag. A few countries have a national pledge and even fewer have a national tree. Canada has gone a step further and put the maple leaf at the center of its national flag. Some countries have gone much further and have placed entire trees on their national flags. These are countries like Haiti, Equatorial Guinea, Lebanon, Fiji and Belize. It’s no wonder that Canada has glorified the maple tree. The North American nation is the world’s largest supplier of the sweet syrup from the maple tree making it responsible for three-quarters of its global production.

Like many countries, Nigeria has not adopted a national tree. Many of our revered playwrights have written or referenced the Iroko tree in their poetries and stories. Such is the greatness of the Iroko tree that when a person is great, he can be described as a man/woman of timber and caliber. When a person of laudable, rare phenomenal, larger-than-life achievements passes on, s/he is likened to an Iroko tree that has fallen. The Iroko tree is one of the sturdiest trees and can live up to 500 years. Although it has a scientific name, it is called by one of its African names- Iroko- even in Western nations. The Iroko tree is resistant to insect invasion. Every part of the tree is useful. It is a durable and die-hard material that does not need any chemical treatment to be preserved. In communities where it is found, the Iroko can be used in furniture and in construction. It has numerous medicinal uses. Its processing also serves as a source of employment for the community.

The 7th of April was marked as the World Health Day and the theme was “building a fairer, healthier world.” The power behind a fairer, healthier world is Primary Health Care (PHC). Oftentimes, the power of PHC is under rated and people under use it or do not even make use of it at all. Such people are shortchanging themselves. And it could be that the community would have wanted to use it but the PHC center is ill-equipped. Then the people are being short changed. It is like having an Iroko tree in your backyard and going in search of a mahogany tree several kilometers away. Cuba is one of the few countries that has successfully implemented the PHC programme. A Primary Health Care Center should have amenities that can treat common diseases and offer immunizations against preventable diseases. It should have durable infrastructure that is economically, socially, geographically and culturally accessible to the community. If the PHC center staff cannot speak the local language and the patients cannot speak the official English language that the staff speak, then it is not culturally accessible. If the cost of transportation to get to the center is not affordable or the fee at the center is prohibitive for the consumers, then it is not economically accessible. Primary Health Care is actually giving power to different communities to chart their own health trajectories provided the governments have provided the PHC with human, financial and material resources.

In 2001, when Nigeria hosted the African heads of state under the auspices of the African Union (AU) the African leaders pledged to commit 15 percent of their annual budgets to improving their health sector. Twelve years after the 2001 meeting, African heads once again met in Nigeria to review their pledge commitments to health budgeting. Since 2001, Nigeria has not gone higher than six percent in its annual budget. In 2012, Nigeria allocated 5.95 percent of its annual budget to health. In 2020, our budgetary allocation for health was 4.16 percent! Medical tourism is obviously not included in our budgetary allocation but it is estimated that the amount spent on traveling abroad for medical treatments is more than our budgetary allocation for health. In 2020-2021, South Africa allocated 12.6 percent of its yearly budget to health. The population of 67.7 million people is about a quarter of Nigeria’s 200 million inhabitants.

An Iroko tree can never thrive in a desert even though it is an Iroko tree. Having a PHC center without the accompanying financial, material and human resources is like having an Iroko tree in a desert. The power of the PHC cannot be unleashed when the resources are not there; when the resources are not provided.

In Primary Health Care, it is important for the human resources to be part of that community especially when it comes to issues of trust like in getting the community vaccinated or in emergencies. Apart from having the medical officer of health, the community nurse midwife and the community health extension worker, the village health worker or volunteer health worker (VHW) has a vital role to play in this pandemic. The village/ voluntary health work is a member of the community. S/he lives in that community.

In some communities in the USA, when women were reluctant to get tested for breast cancers and other reproductive health cancers, it was the VHW that was able to convince them to get tested. These volunteers did not just stop at persuading them, they counselled and continued to follow up especially in cases that cancers were confirmed and surgery was needed. The VHWs also bust some myths associated with the causes of cancers. A lot of people in the community believed that their cancers were a judgment for their “evil” work and so people with cancers were often alienated in the communities. However, over time, with the help of the VHWs, more and more women voluntarily went for their reproductive health cancer screening examinations and those who had cancers were no longer seen as evil people who had received judgement through cancer diagnosis.

The power in PHC is that it gives the community, ownership over their own health. They get to participate in decisions relating to their communal health. They see one of their own that they can trust in navigating them through the health system. Primary Health Care is supposed to be the first contact that the patient has with the health care provider in his/her community. It is important that that contact must be within the community of abode and the health service available must be trust worthy to the patient. Teaching hospitals and secondary health care centers are not supposed to be the first contact we have with the health service provider. When we go to secondary and tertiary health centers for essential care that is available at the PHC, we tend to clog the process for genuine cases that need secondary or tertiary care.

Primary Health Care is an ideal model of the type of health service every community should have. It was adopted at the declaration of the International Conference on Primary Health Care held in Alma Ata, Kazakhstan in 1978. The health inequalities that existed then prompted the development of PHC. Although PHC has made some inroads in many communities around the world since then, the present pandemic has exacerbated these inequalities. The attempts at global vaccination is a case in point. Globally, the pandemic has claimed almost 3 million lives and infected more than 137 million people. In low income countries, 1 in 500 people have been vaccinated while 1 in 5 people have been vaccinated in high income countries. About 680 million vaccine doses have been administered worldwide but poor nations have only received about 0.1 percent of the total number of doses administered. In Africa, less than 2 percent of its 1.3 billion population has been vaccinated.

While many countries were unable to procure even a singular vaccine type, some countries like Canada has been able to secure enough doses of different vaccine types to vaccinate its population five time over. Inequalities existed before the pandemic but has been exacerbated by the unequal distribution of vaccines.

Primary Health Care is the rudimentary key to unlocking people’s resistance and hesitancy to vaccination. The beauty in PHC is that the people that work or volunteer at the PHC centers are members of the community and are therefore known to the enclave. If a foreigner enters a community and tells the people to take vaccines or tries to convince them in the existence of a coronavirus, they would not believe him/her. Similarly, if anyone outside the community, visits that community even if s/he’s a doctor and tries to convince them to imbibe a progressive health behavior, they would not believe such people. Rather, they would look at these outsiders suspiciously. A foreigner in this article is someone who is not part of the community and s/he does not live or work in the community. S/he may not know the nuances in that community. That foreigner might be highly knowledgeable and experienced in the treatment of diseases but as long as s/he is a foreigner to that community, s/he would be looked upon with suspicion.

However, if a village or voluntary health worker that resides in that community takes the vaccine and later tries to convince them to also take it, s/he would have a greater chance of success than if someone they consider as an outsider who they do not trust and who they do not know on a personal level tries to convince them to take the vaccine.

In this present dispensation, just like the Iroko tree is durable and has many uses, the PHC is a powerful tool that has been under-utilized for too long. We need to harness the power behind the PHC at this time more than at any other time. We have undervalued the power of PHC for too long and that has not been in in our favour. Primary Health Care is integral to solving the impediments to debunking conspiracy theories, sensitization and vaccination.

It is like an Iroko tree that some countries have embraced wholeheartedly and reaped the benefits. We too can embrace our PHC given the right climate.

Obilade, an associate professor of public health is of College of Health Sciences, Nile University, Abuja.