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Amending the NPHCDA Act


By Ibanga Jo Inyang

SIR: Primary Health Care (PHC) is the official health care system adopted by the federal government to provide essential health services to entire population in both urban and rural settings. It was in this context that the National Primary Health Care Development Agency (NPHCDA) was established by an Act in 1992 to fulfil the stewardship role, based on the recommendation of a high-level WHO consultative/review team which described Nigeria’s endeavour at developing a PHC system during the period 1985-1992 as follows:

“Nigeria has embarked on an innovative and courageous process of seeking to establish an equitable health care system through its local government area (LGA) focused approach to PHC implementation. The LGA approach offers greater prospect for placing resources and knowledge closer to the people for fully integrating health care delivery and for empowering communities to analyse their problems, set priorities and seek solutions based on available resources. Nigeria is one of the countries to implement this approach nationwide. The process is still evolving and new lessons are being learned all the time”.

The House of Representatives’ call for memoranda toward the Act amendment undertaking lists 27 corporate stakeholder entities. I assume these listed entities’ submissions will be largely nuanced to their operational landscapes and lines of special interest and engagement in the health sector. My hunch is that most of their contributions on the “way forward”, will thrust or revolve around increased funding, and probably not emphasizing efficiency or ownership by stakeholders at various socio-political levels. But the amendment exercise will also require a holistic mindset, not a compartmentalized one, to yield optimal output.

To enhance holistic dividend, it might be of advantage if the House includes in its checklist of variables to assess, vis a vis NPHCDA, a reflection on the Ten Essential Public Health Services (a matrix offered by the American Public Health Functions Steering Committee), as well as the 7 Health Systems Building Blocks (formulated by the WHO). Consideration of these two pertinent templates will complement the meso-structural and operational articles specified in the six parts of the current Act, and additions that may birth in the amended Act.

The current Covid-19 pandemic has brought to bold relief the fault-lines in our health system and behavioural inclination. We now know that token community participation does not yield the same pragmatic advantages as community engagement, which can be defined as the process of working collaboratively with relevant stakeholders to address health-related issues that concern them. The principles of community engagement stress the validity of community views, collation of community experience and validation through appropriate scientific measurement. Community engagement reaches beyond those who passively use offered services. Its implementation can empower communities, involve them in decision making, ensure that their perspectives, attitudes and values are respected, and makes it easier to encourage ownership of innovations or intervention to fulfill felt needs.

Furthermore, it facilitates the process of finding out what people need and what they get and relate this to the service offered; so that they get to live the solutions because they participated in determining those solutions.

The paradigm emphasizing community engagement will be increasingly important as we may have to face emerging health and social challenges, including the transition to heavier burden of chronic and non-communicable diseases and its demand for long-term on-going continuum of personalized care that needs starting from first line health services to referral needs facilities.  The effective solutions for reducing health problems that impede human well-being may require both epidemiological and social elements of interface between care provider and user.  But note that just multiplying number of so-called community-based health workers may widen geographic accessibility without bringing about effective care and service to complement what rural community members can do for themselves, including correct self-perceived risk recognition, and logical action. Thus, capacity building is paramount.

Can the NPHCDA deploy their historical memory and lessons learned during the polio eradication pathway, if they have such asset, to achieve accelerated suppression of Covid-19?  Has hHHFSDSDNPHCDA the capacity and vocational passion to build community voice into planning and preparedness for and response to non-communicable health challenges and a pandemic?  Given the present working approach of the NPHCDA, it would be easier for rural community dwellers in Nigeria to get heard by Bill Gates and the US president for response to their PHC needs, than to get NPHCDA attention.

The NPHCDA Act amendment exercise should include analysis beyond rationalization for increase in funding.


  •  Ibanga Jo Inyang,

Uyo, Akwa Ibom State.

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