IMPROVING PUBLIC HEALTH INDICES: NEED FOR NURSES AT PRIMARY HEALTH CARE LEVEL- By Garba Abdullahi Mustapha Rn, Bnsc, MDRM

Healthcare delivery over the past three decades has witnessed a gradual yet significant shift from curative to preventive health, from a traditional hospital based care to care at the community level, from individualized care to care of a group or community.
 

Nursing as with all other health professions in Nigeria has also paid attention to the need for nursing presence at the community level with the introduction of revolutionary concepts to that effect. Typical examples include the introduction of community midwifery program and the midwifery service scheme which where both designed based on the need to increase the community or primary health care presence of nurses to enable members of the community  to adequately benefit from their broad perspective of healthcare knowledge gained through training and knowledge. It’s obvious that Nigeria’s PHCs, which should be the first contact for healthcare services, are at best comatose or at worse non-existent. This is as a result of shortage of human resources – large chunk of which should be nurses – rendering the centers into safe haven for rodents and reptiles and also hideouts for criminal elements. 

Additionally, many of such centers have tuned into practicing and molding grounds for quacks. Its common sights these days to behold PHCs without a single professionally trained or skillfully qualified health care personnel in the roll calls. Even where one is fortunate to find some, they usually abandon their responsibilities for the quacks to be having hay days irrespective of the repercussions. In an effort to salvage the situation and revive those centers into functionally efficient institutions, wide attempts were made ranging from technical, infrastructural, administrative and partnerships.

Technically, with the poor record of maternal and infant mortality the National Primary Healthcare Development Agency (NPHDA) in 2009 mobilized newly qualified, unemployed and retired midwives for the one year Midwifery Service Scheme (MSS) aimed at increasing the number of Skilled Birth Attendants at the rural areas of country. As at 2005 the maternal mortality rate, as posited by the Mamaye Initiative, was put at 74 to 1000 livebirths but dropped to 56 to 1000 by the year 2013 – a feat achieved through various initiatives and chief among was the Midwifery Service Scheme.

The introduction of the Community Midwifery Program by the Nursing and Midwifery Council of Nigeria (NMCN), though at its infancy and can’t be measured to determine its success and impact on the overall health matrix of the country, points to a remarkable feat towards reducing maternal and infant mortality through enhancing the professionalism of the midwifery practice and averting the dangers of quack practice.  The program which is run by only 5 institutions, at least for now, spread across the north western states of Sokoto, Zamfara, Kano and Katsina  and one in the north eastern state of Bauchi. Note that these are the regions with the highest number of maternal and infant mortality in Nigeria. Laudable as this initiative is, it’s grossly inadequate and unevenly spread if the aim of the program is to be achieved. More schools in different regions of the country therefore need to commence the Community Midwifery program to ensure equitable distribution and presence of skilled birth attendants in the primary healthcare sector of Nigeria.

The innovations and creativity that brought great success at the primary health care level with midwifery can be replicated with general nursing through the introduction of the Nurses’ Service Scheme (NSS) which would mobilizes and deploys newly registered, retired and unemployed nurses to the rural areas with the view to providing healthcare services at the grassroots, as was done with the Midwifery Service Scheme. This will, in essence, reduce the healthcare burden of major communicable diseases which account for a great majority of mortality and morbidity. 

Also a basic Community Nursing program can be designed and run by schools of nursing which would guarantee a more permanent presence of nurses at the community level providing both preventive and curative health services. It will also ensure ownership of primary healthcare services as those to be trained or mentored must be permanent residents of such communities. There’s also the issue of rampant negligence and misdiagnosis and or treatment carried out by quacks. The presence of nurses at the primary healthcare centers would address such through efficient service delivery.

One of the major causes of mortality of whatever nature is absence of effective referral system. Many PHCs are run and administered by large number of quacks, making it difficult for referral to be made when necessary. Many do not even know or understand what referral is and or how referral works. They remain bent on treating every ailment irrespective of their complications and sophisticated nature. Nurses presence at such centers will go a long way in checking this tragedy and reduce the unnecessary difficulty patients are being subjected too through quacks. On a final note, one major problem with Nigeria’s healthcare system generally is the absence of reliable data, if at all it’s available. I believe a good starting point are the PHCs equipped with professionally trained nurses, not quacks masquerading as nurses) especially as we have thousands of them now all over the country, of which many are unemployed). The nurses, as part of their routine duty, will record every patient and case efficiently and ensure the confidentiality of such data. Such data in return can be used in evaluating and reviewing the impact and otherwise of government policies and as yardstick for luring NGOs partnerships for modern service delivery.

The place of the nurse in healthcare is irreplaceable and indisputable as core professionals with the technical skills backed by theoretical concepts which are employed for the betterment of patients, community and the system. Healthcare system is a team comprising of various professionals and nurses are core members of the team. Having them at all levels is an asset that cannot and must not be ignored, all the time.

G.A Mustapha

Collage of Nursing and Midwifery Sciences Sokoto