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2020: Functional PHCs could yield dramatic turnaround in health indices

Dr. Francis Faduyile is the president of the Nigeria Medical Association (NMA). In this interview with APPOLONIA ADEYEMI, he discusses initiatives to achieve progress in the health sector in the new year

 

Looking at the challenges of the health sector in 2019, what are your projections on the way forward in 2020?

 

ºWe believe that if the federal and state governments are interested in improving health in a geometric way, they need to put more money in that sector but most importantly is our ability to judicious use the money budgeted for health and be able to have access to the meagre amount that was budgeted. Most times we have far less than 50 per cent of the meagre amount allocated to health. We hope that we shall have improvement in the release of funding for health this year.

National Health Insurance Scheme (NHIS)

 

On the side of the National Health Insurance Scheme (NHIS), we expect a dramatic turn around. We are positive that the current executive secretary of the NHIS should be able to bring new reforms that will increase the number of people who will enrol in the scheme. Once that is done, it is certain that it will improve the health of those who are covered. We also expect improved funding that to take care of the generality of the people.

 

Primary Healthcare Centres (PHCs)

 

On the issues of the Primary Healthcare Centres (PHCs), we hope that the governments, especially the governors will have a re-think about this very important level of healthcare.

 

What are the specifics that will bring expected turnaround in PHCs

 

–All of them will dovetail into finance because the most important thing is to have physician-laid PHCs. We need all the PHCs in this country to have at least one medical personnel who should manage the centre. Also, we should have other complements of staff: the nurses, community health officers, the community health extension workers (CHEWS), both junior and senior, to get them more into employment so that we can have functional PHCs. Many of the PHCs are in dilapidated state. We expect that the government will put money to refurbish them and make them habitable for people to stay and be treated.

 

If we decide for a year to focus on the PHCs with the attendant duties they are supposed to take care of, I can tell you that the health indices in this country will have a dramatic positive jump.

 

How will you assess the rehabilitation of PHCs, which the administration of President Muhammadu Buhari has undertaken more than four years ago?

 

It is very difficult to assess it because the PHCs are not within the purview of federal government and if the federal government is doing it as it is, I doubt if it will have the necessary impact that is expected.

 

The state governments and the local governments needed to put more emphasis at those region, but had largely left it unattended to and that is the dilemma we have. One of the major things about PHC is for us to have what is called community participation. People in the community must be able to cue into the vision and the direction of that PHCs.

 

Unfortunately, if you are improving it from somewhere that is far away and you are not bringing the community people into the vision, many times, it is going to be disastrous. You may be building and some of them will go to pilfer some of the things you are using to build.

 

You may be putting things there and they don’t just understand what those things are there for. So, we really need governments in the different states and local governments to do a lot of advocacy and social mobilisation and these are intangible things that will make those PHCs work effectively.

 

What is current situation of cancer care in the country and how can it be re-jigged to bring succour for patients?

 

The governments of this country has no policy about the treatment of cancer patients and it is really unfortunate. The most important aspect of cancer care is prevention and I can tell you that there is no single government policy on prevention of cancer in this country. For example, we are supposed to have a policy on mandatory pap smear; that is cervical cancer screening for our women in the reproductive age group (15 to 49 years).

 

There is none of that in place. We are supposed to have a mandatory mammogram; that is, checking the breast of our women who are 25 years and above from time to time. We don’t have that policy. We are supposed to have a policy, which will check for colorectal carcinoma in this country; we don’t have that policy. Similarly, when we are talking  about the treatment of cancer, we want to start from diagnosis. I can tell you that most of the equipment that we have as well as the manpower are not enough for cancer diagnosis. We need the government to look into that.

Even talking about cancer treatment is another kettle of fish and I can tell you there is nothing that we can say that we have that can take care of the number of patients who are suffering from cancer in this country. So, I may not be able to say we have good news for cancer patients because the country is still, by and large sleeping and not looking in that direction.

 

Way forward in cancer care

 

The way forward in cancer care is for us to harken on the government to see how we can have a policy. It is when we develop that policy that it will drive the implementation on the ways in which we want to take care of our cancer patients. Today, I doubt if we have policies and if we have policies, I know they are not being implemented and I think that is the first place we need to work on.

 

Cancer Registries in this country are important integral part in driving the policy. In all these things, we need government super interest in directing the outlook towards the prevention and treatment of cancers.

 

What can be done about disease surveillance to control numerous diseases that are re-surging such as Lassa fever, measles, etc.?

 

Some of these zoonotic infections may be very difficult to eradicate totally, but we should continue to contain them. Since the discovery of Lassa fever in 1969, it comes up in the dry season towards December and January.

 

What we just need to do is to have more education for the people to know the implication of whatever we eat, how we interact with the bush and how we should take care of our foods. However, better information, hygiene and behaviour change can go a long way to help.

 

 

 

Measles

 

Fortunately, measles has a vaccine that can prevent children from having measles. We need to improve on our immunisation or vaccination. It is another way of looking at the policy of the government if the government is interested in implementing the policy, it will be able to mop up all the cases of measles.

 

Polio

 

For polio, we need to congratulate the Federal Government for being able to eradicate the wild polio virus, but the underlying thing we need to work on in this country is to improve our immunisation level and that is tied to the PHCs. However, in as much as we have PHCs that are inefficient, we may not be able to prevent all these re-infections and the new infections that are coming up. The most difficult aspect of tackling these disease outbreaks is for the governors to demonstrate the political will that will make the PHCs effective.

 

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