By Nurse Sikpi, Linus.
WHAT IS THE PRIMARY HEALTH CARE SYSTEM?
The Primary Health Care System is the closest to the people among the 3-tiered health care levels. The fundamental premise of primary health care (PHC) is that all people, everywhere, have the right to achieve the highest level of health. Furthermore, scaling up primary health care interventions across low – and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030 (WHO, 2025). The World Health organization posits that Universal Health Coverage can only be possible when everyone, everywhere can access the health services they need.
In Nigeria, the government at the federal, state, and Local Area levels had pushed several programs to see to the output of quality healthcare through Primary Health Care Under One Roof (PHCUOR). Nevertheless, the number of nurses and midwives engaged in this sector is grossly insufficient to meet the health needs of the Nigerian population. Meanwhile, the document on the minimum standards for a Primary Health Centre in Nigeria prescribes that at least 4 Nurses/Midwives must be active as staff of each Primary Health Centre and at least 2 Nurses/Midwives for Primary Health Clinics respectively.
These standards, when complied with, is the panacea for all the challenges of the primary health care system and improve the health indices of the Nigerian health system.
THE ALMA-ATA DECLARATION:
The alma-ata declaration came into being on 12th September, 1978 at Alma-Ata, USSR during the international conference on Primary Health Care. The conference expressed the need for urgent action by all Governments, all health and development workers (including Nurses, Doctors, Pharmacists, Medlab scientists, etc) and the world community to protect and promote the health of all the people of the world.
Ten (10) declarations on primary health were made of which Declaration Six (VI) was adopted to as “Primary health care is 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 selfreliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.”
MATERNAL AND UNDER-5 MORTALITY SURGE:
The situation of the Nigeria Primary Health Care System has been grappling with poor public health indices despite the huge amounts spent on the sector. Maternal mortality rate of 1047 per 100,000 (WHO, 2023) live births and under-5 mortality rate of 114 deaths per 1,000 live births (WHO, 2020). These deaths are caused mostly by curable and preventable conditions should there be the needed Nurses and Midwives in all 30,000 Primary health facilities in Nigeria. This situation exposes Nigerians in labour seeking health services to be delivered in the PHCs by non-professionals who do not fall into the Skill Birth Attendant (SBA) Criteria by the World Health Organization.
The World Health organization has defined to be “an accredited health professional, such as a midwife, doctor, or nurse, who is educated and trained to manage normal pregnancies and childbirth, as well as identify, manage, and refer complications in women and newborns”.
This defined SBAs as a trained Nurse, Midwife, or Medical Doctor, and No one else (WHO, 2016).
Regrettably, in Nigeria, according to a study by the National Primary Health Care Development Agency (NPHCDA), less than 8% of health staff in PHCs across Nigeria are Nurse and Midwives and 90% of deliveries were taken by non-SBAs; hence leading to the high maternal mortality rates (MMR) Nationwide.
This identified gap can only be corrected by employing Nurses and Midwives to man PHCs for improved and professional health services to the Nigerian masses.
THE NURSES/MIDWIVES AND PRIMARY HEALTH SECTOR:
Despite the undisputable knowledge that Nigeria Nurse and Midwives are best fit for the transformation of the Primary Health Sector, intra-professional politics and lack of will by Government had limited the recommendation and employment of Nurses and Midwives to work in the primary facilities even with the thousands of Nurses and Midwives graduated and rolled out from training institutions, licensed and ready to practice and transform the health care system of Nigeria.
For instance, Rivers State has 364 Primary Health Care facilities with just 183 Nurses and Midwives as staff working in these facilities, a gap of over 1,300 nurses and midwives in accordance with the NPHCDA document on minimum standards for PHCs which stipulates that 4 nurses/midwives should be the minimum staff in the . Similarly, Cross River State has 944 public Primary Health facilities with 100 nurses and midwives with a gap of over 3,900.
Similarly, in Kano State, there are about 1,200 PHC facilities with just 500 – 600 nurses and midwives (and majority are adhoc staff), leaving a gap of more than 4,000.
This is the situation across all the States and Federal Capital Territory of the Federation of Nigeria and these gaps need to be filled for a result-driven primary healthcare sector to be achieved.
CONCLUSION:
Nigeria Primary Health Care system needs to be given keen attention, especially to populate the facilities with Nurses and midwives which is the missing piece to solve the puzzle of improving the health index of the Nigerian health system.
The Primary Health Care sector of Nigeria needs at least 120,000 nurses and midwives according to the NPHCDA standards for results. Nurses and midwives are trained to professionally identify, treat, and refer all health conditions, especially with higher proficiency in management diseases common to the Nigerian space.
Nursing training encompasses preventive and curative approach, including key proficiency in assessment, diagnosis, and treatment of medical and surgical conditions with evidence-based interventions, holistically managing these conditions to increase client’s recovery speed.
Nurses are equipped with Primary Health Care expertise in community diagnosis and mobilization, among others, in the improvement of community and public health. Nigeria must arise to critically engage nurses and midwives for results.
