‘We are determined to change the face of healthcare’
Dr Ado Muhammad
is the Executive Director of the National Primary Health Care Development Agency (NPHCDA). In this interview, he speaks on how Nigerians will benefit from the Universal Health Coverage (UHC) and how it will change the face of health care in the country. Excerpts:
How would UHC benefit your agency, and how will it affect primary health care?
UHC provides health care access for all Nigerians, without limitation of financial access or barrier. We have keyed into this. There are two aspects to universal health coverage: supply and demand side. The agency is completely responsible for supply side, and that means for every 5km radius of where any person in Nigeria resides, there should be a functional primary health care centre. This will include functionality in terms of physical infrastructure, commodities, drugs, vaccine—and the right human resource at the right time.
The availability of primary health care is strategic to us succeeding in universal health coverage. Without a functional PHC there won’t be universal health coverage. The demand side can only come after we have guaranteed geographical access.
What it means is that we have to work closely with NHIS so that when we take care of the demand side, the other aspect will be handled by the NHIS.
What about the quality of care?
It is a major aspect of UHC. Even when the supply and demand sides are handled, it is also important that the quality should be entrenched. We have what’s known as the world minimum healthcare package that defines the standard of practice, these include equipment, human resources, and services in every PHC and also ensure that these are regulated. It also speaks of expectations in terms of meeting the needs of the customers. A Nigerian does not deserve anything less than the best care provided anywhere in the world.
Would people in hard to reach areas have access to these services?
That’s why we have the 5km [radius model]. For those areas that fall outside the 5km, it is important that outreach services will also be carried out. That’s why we have community health extension workers assigned to the PHC who go out to the communities to carry out extension services, collect data and come back. We also have the practice of village health workers so that irrespective of where you reside, it is either you have access to PHC infrastructure or outreach services will be carried out to meet your health needs.
With the national health bill not yet passed to make finances available, how will this be possible?
They are complementary. The primary healthcare fund captured in the health bill will complement what we are doing. It is a movement; it is not only government that will contribute. We have other stakeholders, private sector workers who would assist.
How are efforts to eradicate polio in Nigeria coming along?
As part of our child survival strategy, we are determined to stop transmission of wild polio virus in this country. Between last year and this year, we’ve been able to reduce the burden of wild polio transmission by 57 percent. And, it might interest you to know that there are three types of wild polio virus. We have type one, type two and type three. We’ve not seen a single case of wild polio virus in this country for 13 months. We have also been able to collapse the genetic cluster and sequencing of wild polio virus from eight to two. We have also been able to reduce the sanctuaries of wild polio virus from four to two.
Before now, we had four sanctuaries of wild polio virus transmission. We had the Kano-Katsina axis; we had the Sokoto-Zamfara axis; we had the Yobe axis; and then, we had the Borno axis. Now, we have two sanctuaries: the Borno-Yobe sanctuary and the Kano sanctuary. We have also been able to confine and restrict the areas that are transmitting wild polio virus to BornoYobe and Kano.
You will recall that over the years, the North-West part of this country was major epicenter in terms of wild polio virus transmission. The whole of North-Western part of this country is now clean except for Kano. So, we’ve cleaned up the whole of North-West region, except Kano. Virtually, all other states have been cleaned up, except Borno and Yobe.
Why not Borno and Yobe states?
The reason the two states have not been cleaned up is due to insecurity. Before the State of Emergency was declared, about 17 local government areas in Borno could not be really reached. What it means is that children in the 17 local government areas could not be accessed in terms of immunizing them. But, with the State of Emergency, we have limited access to 15 of these local government areas, leaving two not accessed. We are working with the state and local government areas to ensure that for these two local government areas, we use some other public health interventions as entry point to get children vaccinated in them.
So, by and large, for polio eradication, we are beginning to see the signs that come into play when a nation is about to stop transmission. First, collapsing the genetic clustering; second, restriction in terms of scope; third, the disappearance of wild polio virus three; and, four, we have only seen two in this country this year. These are signs that manifest when polio transmission is about to stop.
And, the global community has commended the efforts of Nigeria; this climaxed with the coming of Bill Gates into this country few weeks ago. He came to commend the President for leadership in terms of child survival strategies. He also acknowledged the good efforts Nigeria is making in terms of stopping wild polio virus transmission. We are optimistic that by next year, Nigeria will exit as a polio endemic country.
Vaccine logistics is quite important, how effective is ours?
Immunization system cannot be said to be functioning if you don’t have an effective and efficient vaccine logistic in place because ultimately, what you want is that that product, vaccine, should get to Nigerian children in a safe and decent manner.
This can only happen when you have a cold-chain system that is working very well. We are working towards ensuring that we have effective vaccine supply system in place. So far, Kano and Lagos are benefitting from our first phase of intervention. You will be wondering why Kano and Lagos? The choice of Kano and Lagos is not unconnected with the fact that Kano and Lagos account for over 50 percent of the number of unimmunized children in Nigeria.
So, if you address the problem of Kano and Lagos, then, you should have addressed 50 percent of the number of unimmunized children in Nigeria. We set out a robust, realistic cold-chain improvement plan in Kano and Lagos. In partnership with states and local governments, we have been able to reach more children in Kano and Lagos. We’ve been able to provide additional cold-chain infrastructure in Kano and Lagos; we’ve been able to provide solar refrigerators in Kano and Lagos.
We intend to replicate this and expand it to other states. You will be wondering why logistic system? There is a correlation between a working logistic system and improvement in routine immunization coverage. Simple intervention in Kano and Lagos have resulted in reducing the number of unimmunized children in Kano by about 35 percent and in Lagos, we’ve been able to reduce the number of unimmunized children by about 30 percent.
We will extend the programme to other states and local government areas, nationwide. What it means is that with vaccine logistic improvement plan, we are going to ensure that for every ward in this country, there is a solar refrigerator in place. We have slightly lower than 10,000 political wards in this country, and we’ve done a vaccine cold-chain assessment, we have 6000 wards in this country that need cold chain infrastructure. So, what we are doing is to provide solar refrigerators for 6000 wards in this country. The first phase of this intervention will be between January and March in which we will be providing about 2200 solar refrigerator for 2200 wards.