The healthcare system in Nigeria has the universal tri-level of care: primary, secondary and tertiary (Asuzu, 2004). All the levels of government have responsibility for their level of care and the other two in addition and accordingly provide services at all levels. However the tertiary level happens to be the only one interested in by all. The social and infrastructural problems evolving out of the poor healthcare system have been represented as an inverted health care pyramid where the primary and secondary care are depicted as neglected (Asuzu, 2004).
Health reforms have been instituted earlier in three Development Plans but none were planned or instituted well. The Third Plan (the 1970s) was more elaborate but again responsibilities were not judiciously handled at all levels (Asuzu, 2004). The drawbacks were therefore a poorly designed and delivered healthcare system: responsibilities were not shared among the three levels of government in the generation of resources, development of manpower, services for delivery and health professional manpower. There was no clear policy (Asuzu, 2004).
The National Constitution needs to be changed to include clauses for sharing of health care responsibility among the three levels of government. Legislation needs to assist in defining the limits of their primary responsibility. Primary health care is the best option for reform (Asuzu, 2004). Community health professionals need to have their roles and responsibilities defined. The referral system to the secondary health care services and hospitals needs to be well organized for maximum benefit to patients. Training and retraining are essential moves. Continuing education of the politicians and community is equally essential (Asuzu, 2004).
With the reforms, the stress on tertiary care would be reduced and secondary care enhanced. Community care would be revolutionized and established as the real basis of care. Health workers who are committed may be fully trained into professionals (Asuzu, 2004). Financial assistance for salary payments may be given by the State governments. Young doctors may be posted to the primary care areas. Dissemination of information on health, affordable health insurance and coordination of western and traditional medicines are the expected outcomes of health reforms (Asuzu, 2004).
Reproductive health programme has been improved using the referral model for integrating family planning and HIV programmes (Chabikuli et al, 2009). Males are also addressed. However the user fee policy is pulling results down. The Government needs to reconsider it and also make plans to improve primary care.
References:
Asuzu, M.C. (2004). The necessity for a health systems reform in Nigeria, Journal of Community Medicine &Primary Health Care, Vol. 16, No. 1, p. 1-3
Chabikuli, N.O., Awi, D.D., Chukwujekwu, O., Abubakar, Z., Gwrazo,U. and Ibrahim, M. et al. (2009). The use of routine monitoring and evaluation systems to referral model of family planning and HIV service integration in Nigeria. AIDS, Vol. 23, Suppl1, p. S97-S103