Hospitals, hospitals, hospitals – but can they conquer malaria?

Nigeria Health Watch calls our attention to numerous news headlines highlighting hospital construction …

… and makes the observation that, “While all these are important to some extent … no building has ever saved a life. However … it is convenient for politicians to brag about these.”

Although hospital emergency/casualty wards are often used for treatment of severe malaria, it is at the primary health care (PHC) level where the main attacks against malaria take place.  What role do buildings play in the PHC process?

When PHC was getting off the ground as official health policy in Nigeria in the late 1970s, the effort had three main components – infrastructure, personnel and community.  Infrastructure for the local government (district) level consisted of a web of facilities ranging from comprehensive health centers and health centers to health clinics and health posts. Personnel needs for PHC were to be met by new cadres of staff whose titles, though varying over time, all contained the word ‘community’ – community health officers, community health assistants, community health supervisors, community health extension workers.

These new cadres of staff, while linked to or based in the facilities, were expected to work in and with community members. The formation of village, district, ward and other levels of health and development committees that included both a representative selection of community members and leaders as well as health workers and staff from other sectors, formalized, in theory, the link between the front line staff and the community.

Many new PHC health facilities were built over the past 30 years, especially in the more rural and underserved sections of Nigeria’s 774 local governments. These new buildings alone did not guarantee services.  For example, several new PHC structures in the more remote rural areas of Oyo State mainly provided shelter for goats and sheep for their first 10-15 years.

Eventually as more trainees graduated from the community health worker courses, there were attempts to staff the facilities, as few professional nurses would not work there.  Ultimately local governments found that these community health workers were in fact a cheaper substitutes for nurses, pharmacists and other professionals, and thus, the community side of their work was often not fully realized.

With the advent of major malaria financing in Nigeria from the Global Fund, DfID, USAID, the World Bank and some NGOs, it may be possible to see the PHC system spring to life and ensure that the combination of facilities, personnel and community actually deliver malaria treatment and prevention services at the grassroots as hoped for 30 years ago.

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