Lack of Compliance to Minimum Requirements by Primary Healthcare Centres (PHC) in Nigeria

• Only 20 per cent of the 34,000 PHCs in Nigeria are function;

• Only 57 per cent of Nigeria’s PHCs can boast of five hours of electricity supply;

• Despite regulations and provisions for infrastructure, staffing, and efficient service delivery, inefficiency still pervades Nigeria’s health sector;

• Government must prioritise compliance with standards in healthcare delivery in the country.

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A picture of 34,173 Primary Healthcare Centres catering for a population of over 200 million is pretty bad. But what if we told you that of that sum, only 6000 were functional? Or that only 57% of the sum can boast of five hours of electricity; that’s not even one-quarter of a day! The Good Governance Team with support from the Heinrich Böll Stiftung unearthed these findings in a report.  The recent document highlights the poor state of infrastructure, human resources, and service provision at PHCs across the country.

The report also noted how the government, over the years, established various guidelines and regulations to provide for a baseline for healthcare provision in the country. Some of these include the National Health Act (2014), National Human Resources for Health Policy (2015), National Health Policy (2016), Second National Strategic Health Development Plan (2018 – 2022), Ward Minimum Health Care Package (2007), National Primary Health Care Development Agency [Cap N69] (2004).

For example, the Ward Minimum Healthcare Package of 2007 prescribes a set of minimum standards for health infrastructure, personnel, drugs, and other medical consumables. Part of the stipulated standards provides for hierarchical distribution of health facilities by population. According to the document, each population of 500 people requires a health post. A Primary Health Clinic is required for every population between 2,000 and 5,000 people. And a population between 10,000 and 20,000 is entitled to a Primary Healthcare Centre. Together with these standards are fundamental details such as adequate land area, provision for a clean water source, provision for electricity, and even residential apartments for staff.

The derelict nature of Nigeria’s healthcare

Despite these legislations, the reality is different. Nigeria’s healthcare system still features derelict infrastructure, a pressured workforce, and a poor overall quality of care. What’s more, only 20 per cent of the PHCs are considered functional. In some cases, lack of electricity often results in early closure of healthcare facilities, and a consequent inability to run night shifts. Lack of efficient water supply systems results in compromising water quality during treatment of patients. Further, the poor state of infrastructure exposes both patients and caregivers to physical and security risks.

It is important that the government ensures compliance with standards in healthcare delivery in the country. They should also make conscious efforts in providing necessary funding to deliver standard health facilities across the country. Also important is the ratio of facility to population as highlighted by the preceding legislations. Adequate staffing of health facilities as well as improved quality of service should also be made a priority. Beyond these, the government should also provide clean energy/ electricity alternatives for health facilities in legislation and in practice. These and more will improve the functionality of health facilities in the country.