The stats are dire: 918 primary healthcare centres (PHCs) are closed in 32 states. On the other hand, cholera cases are up: some 88, 000 cases nationwide, reaping no less than 3, 200 deaths. The deaths would have been preventable if we had better municipal services in healthcare delivery, the provision of potable water and cleaner environment.

It’s a sensational collapse of primary healthcare that should worry everyone. It’s time, therefore, for the Federal Government to restate and reinstate the primacy of primary health, as base for a vigorous healthcare delivery system, before climbing up the reference ladder to secondary and tertiary hospitals.

The primacy of primary health was one of the few glittering legacies of the military government of Gen. Ibrahim Babangida, which the irrepressible Prof. Olikoye Ransome-Kuti (God bless his soul!) clinically drove, as Health minister. Over the years, however, that focus is all but gone.

It’s time — and urgently too — to return to that policy. Though that won’t be easy, it’s a task that must be done, if the majority of Nigerians, flung across the country’s vast territory, must access basic treatment.

Indeed, from the Federal Ministry of Health’s own Health Facilities Registry, which a report of The Punch analyzed, the statistics are depressing: 918 PHCs had closed down — 81 permanently; 837 undergoing repairs, even if their reopening dates are not certain. That means no conventional healthcare access for citizens in those localities, many of them far-flung rural areas.

To be sure, insecurity accounted for many of the PHCs closing down. Boko Haram-ravaged Borno State, for instance, accounted for 220 out of the 918 nationwide. Another 170 have been shut in Adamawa State, also exposed to Boko Haram violence, even if it’s not Boko Haram’s epicentre as Borno.

Even then, the spread of PHC closures in the other 30 states are sobering: Abia (one), Akwa Ibom (two), Bauchi (two), Benue (16), Cross Rivers (8), Delta (9), Ebonyi (one), Edo (seven), Ekiti (five), Enugu (four), Gombe (five), Imo (two) and Jigawa (two).

Others are Kaduna (45), Kano (10), Katsina (42), Kebbi (35), Kogi (23), Kwara (23), Nasarawa (22), Niger (39), Ogun (19), Osun (35), Oyo (30), Ondo (one), Plateau (12), Sokoto (five), Taraba (49), Yobe (67) and Zamfara (two).

While states like Kaduna, Katsina, Niger and Kebbi could adduce their high closure rates to spikes in banditry plaguing their rural areas (though Zamfara’s low number of two goes against this trend), the high closure rates in the three South West states of Ogun, Osun and Oyo are rather worrisome, since their security challenge is not as dire as the northern states’.

Beyond insecurity, however, the PHC collapse appears a natural result from state governors’ subversion of the local government system, for fleeting executive gains. PHCs are integral parts of municipal, suburb and rural services, for which local governments are constitutionally primed to discharge.

But with governors sitting on local government funds and the victims too feeble to do anything about it, the gradual killing of PHCs appears the direct result. This is a trend the Federal Government should use its bully pulpit to halt, for the sake of millions of compatriots out there, now denied their constitutional rights to these essential services.

Let’s have a national consensus to empower and strengthen the local governments. On that strength, we can proceed to structure, and effectively run PHCs. Even if the federalist argument carries the day that local governments should be the exclusive business of states — and it should — there should be a national health policy that makes local governments the drivers of PHCs.

Giving the local governments their due, subject to robust and effective constitutional oversight, would further strengthen their hands in providing health and environmental services: providing running water, clearing drains, disposing refuse, etc. If all of these are effectively done, cholera, diarrhea, malaria and other water-borne and environmentally transmitted killer-diseases would be greatly impaired.

Doing that would dovetail nicely into local governments running robust PHCs, as the base of the healthcare system. Proceeding from the dictum of “prevention is better than cure”, the local governments will evolve a healthcare structure that checkmates basic illnesses and relieves, of avoidable pressure, the secondary and tertiary ladder of the healthcare system.

From the survey, it’s heart-warming that Lagos is one of the few states (four out of 36), which has experienced no PHC shutdown. Even then, the state — like most others — needs to spruce up its PHC facilities, to build better public confidence. Many a time, not a few patients that could be conveniently treated at PHCs head for general hospitals.

Parallel to this renewed PHC attention, the National Primary Healthcare Development Agency should, in concert with states and local governments, mount a deliberate, intensive and consistent mass enlightenment blitz, educating the populace on health tips for disease-avoidance; and the great benefits of visiting PHCs in their locale, should they face health challenges.

Nigerians crave a robust healthcare system. But that would be a grand mirage without a robust PHC system at its base.

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