Improving the Functionality of Primary Healthcare Centers in Nigeria

This policy review identifies key health sector legislation, policies, regulations and guidelines. It suggests ways to infuse sustainable constant energy supply to increase the functionality of primary healthcare facilities in Nigeria.

Some of these key health legislation, policies, regulations, and guidelines reviewed in this study include the following:

• National Health Act 2014 (including Guideline for Administration, Disbursement, Monitoring and Fund Management of Basic Health Care Provision Fund)
• National Human Resources for Health Policy 2015
• National Health Policy 2016
• Second National Strategic Health Development Plan 2018 – 2022
• Ward Minimum Healthcare Package 2007 (Minimum Standards for Primary Health Care in Nigeria 2007 – 2012)
• National Primary Health Care Development Agency [Cap N69] 2004
• Protocol for the Assessment of and Accreditation of COVID-19 Isolation Facilities
• National Action Plan for Health Security 2018 – 2022
• One Health Strategic Plan 2019 – 2023

The policy review takes cognisance of the current socio-economic, technological and environmental realities such as technological breakthroughs in both the local and international energy space, issues of insecurity, the emerging public finance crisis, climate change, environmental pollution and the ongoing COVID-19 pandemic, as well as specific community factors such as ownership and gender power relations.

These factors and realities inform this policy analysis to call for the infusion and deployment of decentralised, clean, constant and sustainable energy (or a combination) in the electrification of primary health facilities across Nigeria. Such deployment should start with a holistic, multi-disciplinary, ambitious, and systemic thought process. The new National Minimum Operational Standard Guideline for PHCs in Nigeria, and the Basic Health Care Provision Fund (BHCPF) framework should make robust provision for the electrification of all or some selected PHCs to improve their functionality.

This document strongly recommends that the Federal Ministry of Health, National Primary Health Care Development Agency (NPHCDA), Federal Ministry of Power, Rural Electrification Agency (REA), together with the donor community and civil society, should facilitate the roll-out of an action plan for the sustainable electrification of 10,000 PHCs across Nigeria in line with the goal of having at least one functional PHC per ward. This should include the signing of an MoU between relevant MDAs such as the Ministry of Power (REA), and the Ministry of Health (NPHCDA); and other legislative and funding entities, i.e. State governments, financial institutions, international organisations, etc.

Furthermore, the NPHCDA and REA should ensure that the Nigerian Governors Forum (NGF) and Association of Local Government of Nigeria (ALGON) take ownership of the initiative for sustainability. The buy in of development partners such as the African Development Bank and World Bank as well as of legislative and regulatory bodies such as National and State Houses of Assembly and Nigerian Health Insurance Scheme (NHIS) need to be cultivated to guarantee short and long term funding for energising basic healthcare facilities in the country.

More importantly, renewable energy solution providers, technical partners and donors should develop a generic sustainable business plan for the electrification of PHCs with renewable energy options. Such a comprehensive plan should inform stakeholders, especially the Ministry of Health, the NPHCDA, NHIS and State governors to guide their policy decisions and commitments. This process should draw lessons from successful models in states like Kaduna, Lagos and Edo that have executed (in part) similar electrification program for PHCs facilities in their states.

Finally, PHC electrification models should stem from rich engagements with community members. This inclusive and participatory process must clearly show mutual beneficial ownership (socio-economic and direct financial gains) between community and energy solution providers. By this, the safety and security of the infrastructure is assured.