A PHC-based health system is an overarching approach to the organization of health systems designed to improve population health and maximize equity. Such an approach makes the right to health a guiding principle of the health system, with the health system structures and functions oriented towards achieving equity in health and social solidarity, based on a core set of principles and elements. Primary health care can also act as the basis of the healthcare system by establishing fundamental policies, programs and priorities that respond to the population health needs. In Nigeria, a notion of primary health care is seen as a defined set of services, which are in accordance with local needs, and it is an entry point into the health care system.1 the services at that level alone are not sufficient to adequately cater for the more complex health needs of the populace. Thus health care systems should work in an integrated manner through the development of mechanisms that coordinate care across the entire spectrum of services, including referral systems.
With this background in mind we can conveniently say the history and development of health systems in Nigeria can be classified in accordance with the historical evolution of the nation into; Pre colonial period, Colonial and post colonial era. The health care system in the pre colonial period was both a combination of the orthodox and the modern which was tailored towards serving the need of the missionaries and the slave traders , the modern system was able to serve them with basic services comparable to their level of development , in the colonial period the first national development plan called the 10 years national development plan and social welfare (1946-1956) was a modest ,realistic, practicable and adequate plan considering the era in which it was proposed , it provided a plan for the provision of more hospitals , more personnel ,especially doctors and perhaps it is this its therapeutic and infrastructure based orientation and disposition that has persisted up till today leading to neglect of preventive services by our policy makers
Nigeria as a nation became independent in October 1960 and an automatic member of WHO in 1963 it became a full member of UN after assuming a republican status, but from then on politicization of the policy makers took place, 3 as they became more pre occupied with political matters neglecting other issues of governance, so the first national development plan 1962-1968 could not be implemented, the second national development plan 1970-1974 was more of an attempt to rehabilitate economic activities in the war torn areas, judging from its national objectives which were to ensure just, strong and self reliant nation.
The third national development plan 1975-1980 highlighted serious concerns for rural development with a need to reduce disparities between regions and localities and a fall out of this process is the basic health service scheme, whose major strengths are
Delegation of responsibilities to non physicians in order to augment the deficiencies of doctors.
Location of training centres in environments similar to where trainees will serve. Use of home based care records to increase patient’s participation in health care.
The Basic health service scheme failed at the end due to the neglect of more important principles of PHC like community participation and intersectoral collaboration.4,74
Primary health care is defined as essential health care that is based on 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 can afford to maintain at every stage of their development in the spirit of self reliance and self determination.1
It is supposed to be the first level of care for individuals and families with the national health systems and it should at least be able to provide the following components.80
Immunization against the major communicable diseases
Prevention and control of locally endemic diseases and epidemics
Maternal and child health including family planning
Environmental sanitation including adequate water supply and hygiene
Health education on the prevailing health problems and the methods of controlling them
Adequate nutrition through promotion of food supply and proper nutrition
Provision of essential drugs
Appropriate treatment of common diseases and injuries
Recently mental and dental care as well as primary eye care has been included as other components of primary health care. The basic principles of the PHC system are essential health care, community participation, equity, appropriate technology and intersectoral collaboration.
Due to the palpable demand for a grass root based health care system , the WHO in conjunction with UNICEF organized the Alma Ata conference in Kazakhastan (USSR) in 1978, The conference was a scientific movement of professionals, institutions, governments, civil society organizations, researchers and grass roots organizations that undertook to tackle the politically, socially and economically unacceptable health inequalities in all countries, the declaration was clear about the values of social justice, right to health for all, community participation and solidarity, with the overall aim of the attainment of a level of health that will ensure a socially and economically productive life for all by the year 2000.5
A part from the basic health service scheme which failed due to the circumstances enunciated above, a second attempt at implementing PHC was done in 1980 and 1985 , during this period the government began the implementation of the various programmes of PHC in pieces without any attempt to integrate them and without any clearly mapped out plan and objectives, this led to the fragmentation of services with both the states and federal governments pursuing different objectives agreeable to them and to donor agencies interested in some of the programmes.
A deliberate attempt to adapt and nationalize the entire components of the PHC system started in 1986 in 52 pilot LGAS, which culminated in the adaption of the national health policy by the armed forces ruling council in 1987 and launched in 1988.6,7 The goal of the national health policy is the attainment of a level of health care that will enable Nigerians live and achieve socially and economically productive lives, through the emergence and institutionalization of a comprehensive primary health care system ,that is promotive, protective ,restorative and rehabilitative.7 By 1990 the federal government has extended the PHC system coverage to all the LGAs of the country.8
The major progress achieved so far under the PHC system include the rolling out and the entrenchment of the Bamako Initiative in 1988, the complete demarcation of the roles and responsibilities of the three tiers of government , the introduction of the referral system as well as the establishment of schools of health technologies to provide available and affordable critical manpower gaps in the sectors , the institutionalization of the concept of ward and village development committees as well as some degree of intersectoral collaboration, others are the establishment of the national primary health care development agency that will support government in monitoring PHC plan and implementation and provide continuous technical assistance to the government in PHC implementation in 1992.