Health, they say, is

wealth and
being in good health is the centre of all human endeavours. Being in good
health is not just the absence of illness, but it entails holistic
harmony-spiritual, social, economic etc., which is primarily the responsibility
of the individual.

However, government owes it as a duty to its citizens to
ensure that affordable, accessible, adequate and sustainable healthcare
services are provided to promote good health.

In doing  this,
government must carefully and strategically plan the healthcare delivery system
in the nation.

The bedrock of strategic healthcare delivery and planning is
anchored on Primary Health Care (PHC), no wonder on September 12, 1978, 134
countries met at a conference in Alma Ata, Russia, under the auspices of World
Health Organisation (WHO), the United Nations Children’s Fund (UNICEF) and formulated
the PHC concept.

According to WHO, PHC
is an essential component of healthcare, which is based on practical
scientifically sound and socially acceptable methods and technology, made
universally accessible to individuals and families in the communities through
their full participation and at a cost which the country can afford to maintain
at every stage of their development in the spirit of self-reliance and self
determination.

Nigeria launched the National Primary Health care during the
Babangida led administration in 1988, 28 years after Nigeria became a nation
and 10 years after it was first launched.

Primary Health Care is the first level contact of the
individual and community in the national healthcare, which brings healthcare as
close as possible to the people.

The Rivers State government
in its determination to make this a reality, did not only adopt it, but
pushed it farther by undertaking  to
build 160 primary Health Centres in 160 communities of the state of this number
110 have been completed and handed over to the Rivers State Primary Healthcare
Management Board (PHCMB), according to the chairman of the Board, Professor,
Urial Etawo.

Professor Etawo stated that in addition to the 110 health
centres delivered to the Board, 200 existing health facilities being managed by
the local government councils were taken over by the state government, some of
which he said, would be upgraded to model health centres while others would be
model led into health posts for use during immunisation campaigns.

The Rivers State government went beyond the PHC scheme and
introduced free medical care scheme for children between zero to six years and
adults of 60-years and above in the first instance which presently has been
modified to Universal Free Medical Care
Scheme, open to all bona fide residents of the state. Under the scheme,
only those who can show evidence of voters
registration card and payment of social responsibility tax are eligible
to register and benefit.

Additionally, the RSPHCMB has introduced Home Based Care
(HBC) still under the Primary Health Care scheme, in which every family in the
community would be visited by a healthcare provider.

According to the chairman of the PHCMB, the advantage of HBC
is that diseases in the family can easily be identified and immunisation would
be 100 percent.

He noted that the over 300 primary health centres spread
across the state would be the focal points for the exchange of visits, adding
that, “each health centre will be in charge of 10 villages while everyone in
those 10 villages would be registered” and a record of new birth and deaths,
kept though this would require heavy funding, he observed.

If what the chairman, Rivers State Primary Health Care
Management Board, Prof. Etawo has said is anything to go by, one can say that
the health sector, since Nigeria’s Independence, 52 years ago has remarkably
improved.

In the past, the local communities never had health centres
or General Hospitals. At best what they had were sick bays and dispensaries and
the difficult cases would have to make long distances to get to a general
hospital to receive medical attention.

According to the Director, Public Health, Rivers State
Ministry of Health, Akuro Okujagu, “I don’t know what we had 52 years back, but
today, you can see the remarkable improvement. For instance, in the primary
health sector, you can see the number of facilities have increased, quality of
healthcare delivery and personnel has also improved.”

Dr Okujagu admitted that no one ever thought 30 years ago
that Rivers State would have a teaching hospital, which is now presently
located at Alakahia.

He observed that the progress might be slow but the
healthcare services are certainly better than what they were, 52 years ago.

He said: “statistically, the number though may not be too
encouraging, we are on the way forward, the health indices are getting better,
though they may not be too good but they’re certainly on the better side.”

If the health sector has improved so tremendously, why then
the exodus to India for medical attention?

Dr Okujagu said “it is just a Nigerian factor, not that most
of those cases they take to India cannot be handled here.”

He commended Nigerian medical personnel practicing outside
the shores of the country, saying “if you go to other countries where Nigerian
doctors or nurses are working, they make their mark, they’re highly respected
and most of them graduated from Nigerian medical schools.”

He expressed the hope that someday, “we will get to the
situation where no one would border to go to India.”

To further improve Nigeria’s health sector, Dr. Okujagu
said, training and retaining of healthcare providers is pivotal, adding that
since the infrastructures are now in place, modern equipment and yearly upgrade
would do the sector a lot of good.

The chairman, Rivers State Chapter of the National
Association of Perioperative Nurse of Nigeria (NAPON), Mrs Bridget Ogbannaya
also agreed that training is important if the health sector must further
improve.

On his part, Director, Environmental Health and Safety,
Rivers State Ministry of Environment, Dr Napoleon Isha Ewule feels that proper
policy implementation would place the country’s health sector at par with their
international counterpart.

For Consultant Surgeon, University of Port Harcourt Teaching
Hospital and Senior lecturer, University of Port Harcourt, Rollins Jamabo,
there has been tremendous changes over the years, particularly in the surgical
treatment of patients.

“In the past, we had only a surgeon, a nurse with or without
anesthetist with very few instruments and sutures to operate on a patient and
also we had reuseable gloves, needles and syringes and these were boiled and
reboild and re sterilised for reuse.

“Nowadays, we have disposable gloves, syringes, needles and
in fact the needles are now directly attached to the sutures such that at the
end of the usage of the sutures, they are disposed.

Furthermore, he said surgeries have been changed too, in the
past open surgery was the only way to operate on a patient but now, endoscope,
which applies minimal access is being used and “surgery was used in the
treatment of peptic ulcer but now drugs can do the job.”

Dr Jamabo regretted that the mass movement of Nigerians to
India was not orchestrated by the lack of expertise in Nigeria but that doctors
in India were offering as much as 10 per cent cost if they would refer patients
to them.

In his words, “the annoying thing about this India
expedition is that they are now paying other surrogates, if you send me one
patient, we’ll send you 10 per cent of the cost or they tell you clear cut
N150,000 is yours.

“So now, whether you want to go India or not, they’ll tell
you it’s better you go to India or better the India doctor will ring you,” he
said.

Unfortunately, he said the prognosis in India is not
encouraging at all and prays that the ‘expedition’ as he calls it, will end
soon.

He suggests increased funding, provision of equipment, drugs
and manpower as the way forward to further improve the sector.

Tonye Nria-Dappa