Ask what ails primary healthcare in Nigeria and the answer comes quickly: money. The budgets are too small, the releases too slow, the facilities too few. All of that is true, and none of it is the whole truth.
The gap between the announcement and the patient
Follow one approved budget line to its end. Funds are appropriated. A policy is announced. Commodities are procured and dispatched. On paper, the system has performed. But at the ward health center, where a mother brings a child for immunization, the vaccine is out of stock, or the health worker posted there is absent, or the register that should have flagged the child was never kept. The care does not happen. And because nobody’s job was to verify completion, the failure leaves almost no trace.
That is under-delivery, and it is a different disease from underfunding. Underfunding is cured with money. Under-delivery is cured with accountability: named owners, delivery chains that are managed link by link, and verification by someone other than the person who did the work.
What a community should be able to ask
A community does not need another announcement. It needs to be able to ask three questions of its health center and get answers: What care was due here? What care was completed? Who answers for the difference?
My new book, The Primary Healthcare Delivery Compact, builds a delivery model around exactly those questions, with seven functions, Locate, Rank, Engage, Assign, Complete, Verify, and Improve, drawn from Nigeria’s own evidence base. Nigeria deserves a primary care system judged by verified care, and its communities deserve the standing to judge it.
The book is on the Publications page: axiompreventivehealthsystems.com/publications