Ojeogwu, Christian Ikechukwu

The delivery of primary health care in Nigeria's rural and underserved communities largely depends on local Nigerian health institutions. Yet, their effectiveness and the quality of care they provide is under threat from a number of systemic and access-related problems. Some recent progress has been made, but it has largely been at the state level; local health institutions are still largely underfunded and are faced with a number of human and capital infrastructure challenges. With these local institutions largely under state control, and under threat from both resource and access problems, how can Nigeria expect to make progress toward either the SDGs or UHC? The paper assesses programs that promise to expand access to healthcare, including mobile health clinics, community health workers, and telemedicine. However, the paper points out uneven implementation across different regions and significant logistical challenges to all three programs. The paper also mentions sustained funding as a problem. They do see potential in telemedicine but emphasize integrating it with the two other programs mentioned above. Overall, the article does a good job of pointing out the pay-off in potential lives saved if some combination of these programs can reach people who need healthcare but can’t get to it. The paper highlights the existing problems in Nigeria's primary healthcare system can only be "overcome by a concerted, coordinated approach to investing in our communities—with the government, local communities, and the private sector all playing their parts." They call for "strategic, targeted investment" in three main areas: healthcare infrastructure, human resources (especially healthcare workers), and policies that "remove barriers to accessibility and address the quality of care provided. The paper urges an immediate reconsideration of Nigeria's strategy for the health sector. It demands that attention be focused on the local health institutions that are pivotal to the UHC vision. If these institutions are to have any chance of carrying out the mandate effectively, they need resource, training, and infrastructural gaps to be addressed. These health institutions can and should be empowered to tilt the balance toward an UHC that delivers quantity and quality of service equity across the country's vast regional distance.

Keywords: Primary Healthcare, Local Health Institutions, Universal Health Coverage, Healthcare Reform, Community Health