Appraising Ganduje’s Approach To Effective Primary Health Care System In Kano

By Maryam Hassan Ibrahim

Primary health care was officially launched in 1978 at a World Health Organization (WHO)/UNICEF conference in Alma-Ata, in the former Soviet Union, at which some 150 governments were represented.

The Alma-Ata Declaration defined PHC as follows: Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

It was documented that, in 1960, there was no strong focus on health systems development, policymakers and political actors made efforts to establish and expand health-care infrastructures with more emphasis placed on curative medicine rather than preventive medicine and from 1975 to 1980, health system development was initiated with PHC as the cornerstone.

It was then, the National Basic Health Services Scheme (NBHSS) was developed based on a PHC approach. Unfortunately, the NBHSS program could not achieve its goals due to implementation challenges; hence, PHC services were not delivered across Nigeria.

It was in 1985 that, Professor Olikoye Ransome-Kuti was appointed the Minister of Health. Professor Ransome-Kuti adopted PHC in 52 local government areas in Nigeria as models based on Alma Ata Declaration of 1978. Similarly, Nigeria’s first comprehensive national health policy based on PHC was launched in 1988. From 1986 to 1990, Professor Olikoye Ransome-Kuti expanded PHC to all local governments, achieved universal child immunization of over 80%, and devolved responsibility for PHC to local government areas.

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The ultimate goal of primary health care is better health for all. WHO identified key elements to achieving that goal: reducing exclusion and social disparities in health, organizing health services around people’s needs.

The primary care physician has a number of functions which includes the provision of continuous and comprehensive care, a reference to specialists and/or hospital services and to coordinate health services for the patient among other things.

It was based on the importance of PHC services that Kano state government held the PHC Summit with the theme- PRIMARY HEALTHCARE SYSTEM…THE JOURNEY SO FAR, and the Subtheme: Primary Healthcare Under One Roof (Prospects and Challenges).

It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

The Alma-Ata Declaration identified 10 activities as the basic elements of PHC (Table 1); as can be seen, general practice is only one component of this. The Declaration contains important socio-political implications that address not only treating disease but also ensuring fair access to a positive state of well-being for all citizens.

In a communiqué issued at the end of the summit, It was observed that payment of salaries of PHC Staff is still undertaken by Ministry of Local Government, hence Kano State Government has committed to;  Complete movement of staff salaries from the Ministry of Local Government to the State Primary Health Care Management Board by the end of March 2020.

It was also observed that the state has committed to soon embark on renovation, upgrading and in some places, construction of healthcare facilities with a view to achieving the goal of one functional PHC per ward.

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The executive governor of Kano State Dr Abdullahi Umar Ganduje had during the summit announced that the State has awarded a contract for the construction and Equipping of 400-bed capacity specialized hospitals in all the newly established emirate councils in order to improve access to quality and affordable healthcare delivery services.

The governor further revealed that, based on population growth in Kano State, the State Government has observed gaps in human resource for health and therefore it will continually recruit competent manpower in various PHCs in the state in addition to over 900 Health staff recently recruited.

The governor also revealed that within the next one month, Kano State Government will recruit and deploy one medical officer each to all the 44 LGA councils of the State with a view to improving the delivery of Primary Healthcare Services.

In an effort to improve the quality of Data on Routine Immunization exercise, at the community level, that involves community leaders and health workers with the Primary Health Care facility, governor Abdullahi Umar Ganduje was recently at Sani Marshall PHC, in Kura local government and witnessed RI Reconciliation meeting.

At the meeting that took place at the premises of the facility, the Village Head of Azore, Alhaji Garba Labaran,  along with his Wards Heads met with PHC staff and compared notes from their registers that they register newborn children and children under One year.

The Reconciliation of Data meeting took place in the presence of representatives from World Health Organisation (WHO), UNICEF, Bill Melinda and Gates Foundation and Clinton Health Access Initiative (CHAI), who appreciated the strategy and the commitment shown by both parties, traditional leaders and health workers.

At the practical demonstration of interrogating already accepted data by both parties, Wards Heads from 11 places under Azore Village, reconciled their records by comparing what they have at hand. Some of the Wards are that of Rinji, Tafasa, Kuri, among others.

Also, at a point, the records that did not reconcile with that of the PHC facility workers proved to be as a result of family relocation, from one Ward to another or from that local government to another. That differences (only 2) were easily detected and reconciled, there and then. That shows the strength of the quality of that Data.

At the meeting, governor Ganduje assured that his administration would work tirelessly to make sure that the development of primary health care delivery system remains moving up and up, saying that, “This strategy is superb and very encouraging.”

To also show his satisfaction of the strategy he said, “I will be sending my Commissioners to similar Reconciliation Meetings across the state. For them to also monitor and be conversant with the process to appreciate the work we are doing. This will also encourage the actors. I mean the community leaders and the health workers.”

He appreciated the authentication of the Data collected, as a strategy for improving the quality of the Data in the registers of community leaders and the PHC health workers, “…I am also calling on our people to be supportive of this.’’

He reminded that the authentication process, Reconciliation meetings are absolutely necessary and important. Emphasizing that, “With this, we are telling our development partners that we are up and doing in this process. And we are also showing them that our efforts in this and other areas have come to stay.”

The representative of WHO, Dr Bashir Abba commended the governor for what his administration is doing to make sure that healthy population thrives in the state. “We all come to understand that universal health coverage is the fastest, easiest and more accessible in improving our health,” he said.

Dr Abba reveals that the WHO would be in Kano to ascertain the total eradication of the Polio, as the absence is recorded for over two years now, adding that, “Kano is doing very well and we are all appreciating that.”

The representative of Bill Melinda and Gates Foundation,  Harolyne J. Appia appreciated that the visit to Kura showed them how local communities are linked to the Primary Health Care delivery system, “This also shows your commitment in this area Your Excellency,” she commended.

She appreciated the financial management, data quality, community engagement among others, that she observed, were given all the necessary attention from Ganduje administration, insisting that “We are calling for a continuous commitment as shown by the leadership of Dr Abdullahi Umar Ganduje. We are all determined to continue supporting you.”

Dr Hashimu Abubakar who represented Clinton Health Access Initiative (CHAI) also commended the effort of the state government for taking along with her communities in the primary health care delivery system.

“We also appreciate the Monthly meeting between the government and the local communities. We will continue to work and in hand with your government in the primary health care system, so as to improve the health of the population,” he encouraged.

In his remarks the Commissioner of Health, Dr Aminu Ibrahim Tsanyawa disclosed that the PHC facility is attended by over 300 people. Adding that “All the Ward Heads and are doing their best in this area. That is why we are recording these feats.”

“It is through the engagement of our community leaders that we find it very easy to detect those children that are vaccinated and those that were not vaccinated. So the immunization of our newborn is taken good care of,” he said.

It was said at the meeting that over 10,000 books, that serve as Manuals were distributed to the community leaders for easy understanding of the exercise.

However, during the 2019 End of Year Review of the state Health System Strengthening Program, that brings together governor Abdullahi Umar Ganduje of Kano state, with his team, Gates and Dangote Foundations, with the Minister of Health and Executive Secretary of the National Primary Health Care Development Agency (NPHCDA), at Africa House, Government House, Kano, via teleconference.

It was vividly clear that Kano state government has displayed commitment and high-level political will in strengthening institutions and implementing, to a greater extent, the signed Tripartite Agreement between the state and Bill and Melinda Gates and Dangote Foundations in the healthcare service delivery system.

The governor also assured all the partners that all the feats achieved would be sustained with all vigour and clear understanding of societal demands, highlighting that, “.For the year 2020 the state would scale up existing referrals network service between primary health care centres to secondary health facilities, by June 2020 and would implement resolutions of 2020 Primary Health Care Summit with emphasis on rationalization of the minimum service package investment plan,” he said.

He also revealed that some of the state’s priorities for the year 2020 is to optimize Reach-Every-Ward (REW) micro-plan to incorporate other PHC services beyond RI by February 2020, develop plan to fill identified statewide human resource for health gap, by March 2020, to achieve Kano state’s Polio Free Certification, by June 2020, among others.

It was also reported that in their separate remarks Minister of Health Dr Osagie Ehanire, Co-Chair, Bill and Melinda Gates Foundation, Mr Bill Gates, (who was represented) Chairman Dangote Foundation, Aliko Dangote and Executive Secretary of the National Primary Health Care Development Agency (NPHCDA) Dr Faisal Shuaib, all commended the effort and commitment of Governor Ganduje in keeping faith to all sections of the MoU.

Maryam Hassan Ibrahim, Health Development Advisor writes from Malali, in Kaduna.