Without Health We Have Nothing 1

Gabriel Oke

By Gabriel Oke

The role of Primary Healthcare in Nigeria: a way forward

The problem: Dr Ifeanyi Nsofor answers questions on HPHR Fellow Gabriel Oke's vlog series

Spectrum of Primary Health Care

Primary healthcare (PHC) is the foundation of the healthcare system: it is a level at which non-emergency, preventative health issues should be managed or resolved. The first level of contact of individuals, families and communities with the national health system is the primary health centre, so communities must be able to afford the cost of healthcare at these centres to avoid more serious and expensive tertiary healthcare in hospitals. Thus, it is also important that a country can afford to maintain primary health centres at every stage of development.


PHC is also the level at which health promotion and education efforts are undertaken, and where patients in need of more specialized services are connected with secondary care. Primary healthcare was established essentially to bring health closer to the people, in the community, and through their full participation.


Primary healthcare is meant to provide services to the majority of people based on need, without geographical, social or financial barriers.

Today.ng: A primary healthcare in Gombe State, Nigeria

Currently, the state of the PHC system in Nigeria is shocking: only about 20% of the 30,000 PHC facilities across Nigeria  are fully functional. The rest of the PHC facilities cannot provide essential primary healthcare services. Centres face problems including: poor staffing, poor distribution of health workers, poor quality of health care services, poor condition of infrastructure and lack of supply of essential drugs.


The inability of PHC centres to provide basic medical services to the Nigerian population has increased the influx of patients to secondary and tertiary healthcare facilities. This has led to long queues in these hospitals and worse patient experiences. The Nigerian government spends less than 4% of its budget on healthcare,  and instead, the country depends on donors and NGOs to finance its health projects. Response and management of diseases are left in the hands of foreign partners.


Also, the increasing brain drain and deficient sizes of the health workforce has put a major strain on the PHC system, with the existing workforce preferring employment in the secondary and tertiary healthcare systems, thus leaving the PHC systems underequipped.

The Health Foundation: What do we need for good health?

A way forward: Recommendations

The Ministry of Health should collaborate with other relevant government departments to:

  1. Fix and complete all primary healthcare centres littered across the landscape in Nigeria. Care should be taken to make each functional for the population in that area.
  2. Increase budgetary allocation for health in Nigeria to improve financing of health centres, including for healthcare workers’ salaries.
  3. Allocate adequate, well-trained healthcare providers to PHC centres throughout Nigeria.
  4. Improve healthcare education at community and household levels to debunk myths surrounding the quality of health services at PHC facilities.

These 4 steps should improve the perception of PHC services, quality of services, and patient experience with PHC centres. Thus, people will be encouraged to visit PHC centres as a first step.


In addition, the government overall should:

  1. Secure more commitment from political leaders for implementation of policies, strategies, regulatory frameworks, and financial commitments.
  2. Establish adequate supervision, monitoring and evaluation of programmes to ensure that wastage, abuse and misappropriation of funds are avoided.

These recommendations refer to changes needed both within the health sector and beyond, domestically and with foreign collaborators.

You can follow Dr Ifeanyi’s Thought leadership posts here: https://www.ifeanyinsofor.com


1. Ifeanyi Nsofor: Without Health, we have nothing (TedxOguiRoad, 2018). Available at: https://www.youtube.com/watch?v=u4r_0TLTBQw

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