Martin Akpan, Medical doctor, prolific writer and Chairman, Akwa Ibom State Primary Healthcare Board, in a no-holds-barred parley, bared his heart on some issues to mark his two years in office.

What is the importance of primary healthcare to the citizenry?

The importance of primary health cannot be overemphasized. In the first place, it is the first point of contact of the patient with the national health system. Secondly, it is health at the doorsteps of the people in Akwa Ibom State. We have a whopping 446 health centers scattered across the state. There is no community you don’t find a primary health facility. Primary healthcare occupies the base of the health pyramid and covers about 80 percent of a person’s health needs during their lifetime. This makes it the mother of healthcare.

Can you elaborate more on this?

The World Health Organization (WHO) defines Primary Healthcare as essential healthcare that is based on scientifically sound and socially acceptable methods and technology made accessible to individuals and families in a community with their full participation and at an affordable cost. It covers promotive, preventive, curative, rehabilitative and supportive or palliative care. The focus is basically on preventing illness and promoting health using a multiplicity of channels or ways like health education, nutrition, safe water and sanitation, maternal and child health, family planning, immunization, prevention and control of endemic diseases and treatment of common ailments. The declaration of Alma-Ata which was adopted at the International Conference on Primary Health Care held in Alma-Ata (now Almaty), Kazakhstan in September 1978, identified primary healthcare as the key to the attainment of the goals of ’Health for All’. In other words, it’s the key to achieving the much-trumpeted Universal Health Coverage.

When was the Akwa Ibom State Primary Healthcare Development Agency (AKSPHCDA) established? How operative is it?

The Agency is relatively young, having come into existence barely two years ago. For a long time, we were yearning for the Agency in the state, but it never came. It took the vision and the can-do spirit of His Excellency, Mr. Udom Emmanuel for us to have the Agency. Let me at this juncture seize this opportune moment to commend His Excellency for the umpteenth time for this all-important achievement. His proactive and pragmatic approach to governance remains unassailable. Because ours was late in coming, we are doing everything within our power and competence to catch up with other states that had started before us. And I bet you, soon we shall not only catch up with them, but we shall also overtake them by the grace of God.

After two years what is the journey like?

The journey so far has been both exciting and challenging. It’s particularly exciting for me because the Primary Healthcare family is where I’d always wanted to be. As a kid in primary school, in those days, I had the opportunity of experiencing life first hand in a primary healthcare setting because of my elder sister (a passionate and compassionate community nurse) with whom I lived. I knew many things about health and health centers that most of my peers didn’t at the time. So you could imagine my excitement when, many years after, I was given the opportunity to add value to that sector, courtesy of His Excellency, Governor Udom Emmanuel.

On the other hand, the assignment is challenging because ours is the pioneer Board of the Agency, and that imposes on us a huge responsibility. The expectations of the public are phenomenally high. As pioneers, we are expected to lay a solid foundation upon which a thriving primary health sector can stand. We are expected to set standards in all areas of operation as well as provide the roadmap and policy direction. Thank God, when the vision is right, every other thing is right.

Building on the clear vision of His Excellency, and with an amazing team spirit within the board, we have laid a solid foundation for a thriving primary healthcare sector in the state. Our headquarters at 29 Wellington Bassey Way is a reference point in the country in terms of location, organization, working environment, and personnel orientation, among others. We have forged a robust partnership with critical stakeholders in the health sector including the National Primary Healthcare Development Agency, Federal and State Ministries of Health, other state agencies as well as development partners. And the result has been quite rewarding.

For instance, no sooner had we taken off that the National Primary Healthcare Development Agency (NPHCDA) dispatched a team to our state to give orientation training to our Board Members and management team. A couple of months ago, we trained over 3000 health workers in the state on Covid-19 in collaboration with our National office. Apart from these, we have enjoyed a robust synergy with a number of development partners including Planned Parenthood Federation of Nigeria (PPFN) and SHOPS Plus (a USAID-funded program) in the provision of family planning services in the state, just as ANRiN/World Bank intervention has provided succor to children and pregnant women in the area of nutritional services. A lot has happened within the short period of our existence. And much more will happen in the days ahead.

To ensure proper coordination of our programs and uptake of services at the grassroots level, we have successfully inaugurated Local Government Health Authorities in the 31 local government areas of the state. The formation of Ward Development Committees or their reactivation (where they already existed) is ongoing in the various communities. All these have become necessary because primary healthcare demands strong community engagement to guarantee success. Also receiving premium attention are some key policy documents such as operational guidelines, regulations, annual and strategic plans to entrench and streamline policies, procedures and protocols for a seamless operation.

Is the Agency experiencing challenges?

As a young Agency, there are challenges. And that’s natural. Any new or young enterprise is bound to experience some teething problems, and ours is not an exception. The mother of all our challenges is the Basic Healthcare Provision Fund – a Federal Government of Nigeria lifeline to the primary healthcare sector, which our state is yet to access. As a young quango, we are in a hurry to break even, hence the need to access the fund. The state government alone cannot fund the massive reform that we envision for the sector. The problems of the sector are humongous- ranging from infrastructural decay to a yawning manpower deficit to paucity of functional equipment, drugs and consumables occasioned by years of neglect preceding this administration. All these translate to money ….a lot of money. Hence the need to access the Fund. But you don’t get it on a platter.

There are requirements to meet, some of which include: Establishment of the State Social Health Insurance Scheme, a baseline survey of our primary health facilities and successful migration of health workers and programs to the Agency.

What do I mean by migration? Before the advent of the Agency, PHC programs like immunization, family planning and nutrition were domiciled in the Ministry of Health. But now, with the introduction of the Federal Government policy of Primary Healthcare Under One Roof, these programs are expected to be moved to the Agency alongside the relevant personnel. Besides, primary healthcare personnel who are presently under the Local Government Service Commission are to be migrated to the Agency. The good news is that these and other challenges are receiving favourable attention from the highest level of government and hopefully they will be surmounted soon.

The Basic Healthcare Provision Fund will ensure predictable funding to the Agency while reducing overdependence on the lean resources of the state government.

What is the Agency’s projection in the next two years?

I envision an Agency that will be rated among the best in the country. I see a primary health sector that’s bubbling with life –fully revitalized with standard infrastructure, functional equipment and skilled, motivated workforce. A sector where clients would walk into a facility and be promptly attended to in a polite, humane manner. I see primary health facilities that are truly client-friendly. Where there’ll be a complete u-turn of our pregnant women from prayer houses to the health centers. Pray, let the prayer houses concentrate on conducting their deliverance and leave delivery of our babies in the hands of qualified midwives in the health centers. We want to restore people’s confidence in the system; confidence that had been badly eroded through years of poor staff attitude, unhealthy working environment, bureaucratic bottlenecks and other encumbrances. We want to leave the sector much better than we met it- a primary healthcare sector that will be truly healthy in all its ramifications. Our effort in the past two years was focused essentially on laying a solid foundation for a thriving primary healthcare in the state. And of course, you and I know the vital importance of the foundation in a building construction. Every other thing depends on it. So if you fail to get it right, the whole project is doomed as the succeeding edifice is bound to collapse like a pack of cards. That’s why we took time on the foundation. Unfortunately, no matter what you put into the foundation in terms of time, effort, money and material, you don’t receive commensurate commendation as everything is buried in the ground. People only commend you for what they see…and that is the superstructure that adorns the landscape. And so having successfully laid a solid foundation, we want to spend the next two years building a model primary healthcare superstructure for the people of Akwa Ibom State. We owe our people that onerous duty. And we are going to do that through the full implementation of the WARD HEALTH SYSTEM.

This system, which is the current national strategic thrust for delivery of PHC services in Nigeria, requires that at least one primary health center be made functional in each political ward to serve as an upward referral facility in that ward. That means for our State, at least 368 out of the existing 446 health centers should be up and running in the 368 political wards of the State, in the first instance. It’s certainly a huge intervention, but it’s doable. Because, having spent the last five years injecting life into the secondary health sector, it’s not difficult to infer that for a holistic landing, primary healthcare is top in the completion agenda of His Excellency and so will receive premium attention. This, to my mind, is the heartbeat of His Excellency at the moment. And this is clearly evident in his body language.

What is your assessment of the Governor in the last five years on the saddle?

First of all, let’s agree that we have a good leader in the person of Governor Udom Emmanuel. There’s no iota of doubt that he means well for our dear State. And he wants the best for this state. Several indicators speak to this. As I said earlier, one thing that gets me so enamored of this unique personality is his proactive and pragmatic approach to governance. His achievements in the past five years or so are clearly phenomenal. In the aviation sector, for instance, he has left indelible footprints. Today, as we speak, Akwa Ibom boasts of one of the best airlines in the country. His stride in the investment/industrial sector is also remarkable. He is not called Mr. Industrialization for nothing. Look at the plethora of turn-key projects His Excellency has attracted to the state – from the syringe Manufacturing factory, King’s Flour Mill and Electric Metering factory in Onna to the Coconut Oil factory in Mkpat Enin, not to talk of the soon-to-be-completed Plywood Manufacturing Company and Ibom Deep Seaport which are instant game-changers. Definitely, there’s a quiet revolution going on in the state. It’s just amazing.

Then we come to the sector I’m most familiar with – health. A man who gives you health has given you the best asset on earth. In Akwa Ibom State today, Deacon Udom Emmanuel is that man. The giant strides in the secondary health sector speak volumes of his unflinching commitment to healthcare. From Etinan to Ituk Mbang, Iquita Oron, Eket, Ikot Okoro and Onna, our general hospitals that were hitherto in limbo are today not only wearing a new look but are also fitted with modern state-of-the-art equipment. The one in my local government area – Ikono General Hospital, which had literally assumed a ghost town status, is today bubbling with life with topnotch infrastructure and equipment. It has gone down in history as the first digitalized hospital in the state. I can go on and on. Ironically despite the plethora of projects in all parts of the state, the Governor does not make noise about them. He is a quiet achiever, and that’s what makes him unique.

Primary Healthcare is The Mother of Healthcare – Dr. Martin Akpan, Chairman AKSPHCDA

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