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Nigeria Primary Health Care Policies
In August 1987, the federal government launched its
Primary
Health Care plan (PHC), which President Ibrahim Babangida
announced as the cornerstone of health policy. Intended to
affect
the entire national population, its main stated objectives
included accelerated health care personnel development;
improved
collection and monitoring of health data; ensured
availability of
essential drugs in all areas of the country;
implementation of an
Expanded Programme on Immunization (EPI); improved
nutrition
throughout the country; promotion of health awareness;
development of a national family health program; and
widespread
promotion of oral rehydration therapy for treatment of
diarrheal
disease in infants and children. Implementation of these
programs
was intended to take place mainly through collaboration
between
the Ministry of Health and participating local government
councils, which received direct grants from the federal
government.
Of these objectives, the EPI was the most concrete and
probably made the greatest progress initially. The
immunization
program focused on four major childhood diseases:
pertussis,
diphtheria, measles, and polio, and tetanus and
tuberculosis. Its
aim was to increase dramatically the proportion of
immunized
children younger than two from about 20 percent to 50
percent
initially, and to 90 percent by the end of 1990. Launched
in
March 1988, the program by August 1989 was said to have
been
established in more than 300 of 449 LGAs. Although the
program
was said to have made much progress, its goal of 90
percent
coverage was probably excessively ambitious, especially in
view
of the economic strains of structural adjustment that
permeated
the Nigerian economy throughout the late 1980s.
The government's population control program also came
partially under the PHC. By the late 1980s, the official
policy
was strongly to encourage women to have no more than four
children, which would represent a substantial reduction
from the
estimated fertility rate of almost seven children per
woman in
1987. No official sanctions were attached to the
government's
population policy, but birth control information and
contraceptive supplies were available in many health
facilities.
The federal government also sought to improve the
availability of pharmaceutical drugs. Foreign exchange had
to be
released for essential drug imports, so the government
attempted
to encourage local drug manufacture; because raw materials
for
local drug manufacture had to be imported, however, costs
were
reduced only partially. For Nigeria both to limit its
foreign
exchange expenditures and simultaneously to implement
massive
expansion in primary health care, foreign assistance would
probably be needed. Despite advances against many
infectious
diseases, Nigeria's population continued through the 1980s
to be
subject to several major diseases, some of which occurred
in
acute outbreaks causing hundreds or thousands of deaths,
while
others recurred chronically, causing large-scale infection
and
debilitation. Among the former were cerebrospinal
meningitis,
yellow fever, Lassa fever and, most recently, AIDS; the
latter
included malaria, guinea worm, schistosomiasis
(bilharzia), and
onchocerciasis (river blindness). Malnutrition and its
attendant
diseases also continued to be a refractory problem among
infants
and children in many areas, despite the nation's economic
and
agricultural advances.
Among the worst of the acute diseases was cerebrospinal
meningitis, a potentially fatal inflammation of the
membranes of
the brain and spinal cord, which can recur in periodic
epidemic
outbreaks. Northern Nigeria is one of the most heavily
populated
regions in what is considered the meningitis belt of
Africa,
stretching from Senegal to Sudan and all areas having a
long dry
season and low humidity between December and April. The
disease
plagued the northern and middle belt areas in 1986 and
1989,
generally appearing during the cool, dry harmattan season
when
people spend more time indoors, promoting contagious
spread.
Paralysis, and often death, can occur within forty-eight
hours of
the first symptoms.
In response to the outbreaks, the federal and state
governments in 1989 attempted mass immunization in the
affected
regions. Authorities pointed, however, to the difficulty
of
storing vaccines in the harsh conditions of northern
areas, many
of which also had poor roads and inadequate medical
facilities.
Beginning in November 1986 and for several months
thereafter,
a large outbreak of yellow fever occurred in scattered
areas. The
most heavily affected were the states of Oyo, Imo,
Anambra, and
Cross River in the south, Benue and Niger in the middle
belt, and
Kaduna and Sokoto in the north. There were at least
several
hundred deaths. Fourteen million doses of vaccine were
distributed with international assistance, and the
outbreak was
brought under control.
Lassa fever, a highly contagious and virulent viral
disease,
appeared periodically in the 1980s in various areas. The
disease
was first identified in 1969 in the northeast Nigerian
town of
Lassa. It is believed that rats and other rodents are
reservoirs
of the virus, and that transmission to humans can occur
through
droppings or food contamination in and around homes.
Mortality
rates can be high, and there is no known treatment.
The presence of AIDS in Nigeria was officially
confirmed in
1987, considerably later than its appearance and wide
dispersion
in much of East and Central Africa. In March 1987, the
minister
of health announced that tests of a pool of blood samples
collected from high risk groups had turned up two
confirmed cases
of AIDS, both HIV Type-1 strains. Subsequently, HIV-2, a
somewhat
less virulent strain found mainly in West Africa, was also
confirmed. In 1990 the infection rate for either virus in
Nigeria
was thought to be below 1 percent of the population.
Less dramatic than the acute infectious diseases but
often
equally destructive were a host of chronic diseases that
were
serious and widespread but only occasionally resulted in
death.
Of these the most common was malaria, including cerebral
malaria,
which can be fatal. The guinea worm parasite, which is
spread
through ingestion of contaminated water, is endemic in
many rural
areas, causing recurring illness and occasionally
permanently
crippling its victims. The World Health Organization (WHO)
in
1987 estimated that there were 3 million cases of guinea
worm in
Nigeria--about 2 percent of the world total of 140 million
cases-
-making Nigeria the nation with the highest number of
guinea worm
cases. In affected areas, guinea worm and related
complications
were estimated to be the major cause of work and school
absenteeism.
Virtually all affected states had campaigns under way
to
eradicate the disease through education and provision of
pure
drinking water supplies to rural villages. The government
has set
an ambitious target of full eradication by 1995, with
extensive
assistance from the Japanese government, Global 2000, and
numerous other international donors.
The parasitic diseases onchocerciasis and
schistosomiasis,
both associated with bodies of water, were found in parts
of
Nigeria. Onchocerciasis is caused by filarial worms
transmitted
by small black flies that typically live and breed near
rapidly
flowing water. The worms can damage the eyes and optic
nerve and
can cause blindness by young adulthood or later. In some
villages
near the Volta River tributaries where the disease is
endemic, up
to 20 percent of adults older than thirty are blind
because of
the disease. Most control efforts have focused on a dual
strategy
of treating the sufferers and trying to eliminate the
flies,
usually with insecticide sprays. The flies and the disease
are
most common in the lowland savanna areas of the middle
belt.
Schistosomiasis is caused by blood flukes, which use
freshwater snails as an intermediate host and invade
humans when
the larvae penetrate the skin of people entering a pond,
lake, or
stream in which the snails live. Most often,
schistosomiasis
results in chronic debilitation rather than acute illness.
Data as of June 1991
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