ASSESSMENT OF PRIMARY HEALTH CARE SERVICE DELIVERY: A CASE STUDY OF BOSSO PRIMARY HEALTH CENTRE

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Primary Health Care (PHC) is considered the core of a well-functioning health system and the most effective and equitable way to provide communities, especially in low and middle income countries (LMICs), with essential health services. The Declaration of Alma-Ata (1978) established the universal concept of primary health care as a universal health care practice that is accessible to community members and families at an affordable cost. The delivery of PHC in Nigeria remains a huge challenge and continues to hinder the achievement of universal health coverage and health outcomes in Nigeria, decades since this historic statement of purpose.

In Nigeria, National Primary Health Care Development Agency (NPHCDA) is the supervisor of the development and delivery of PHC services in all the 36 states of the federation. Yet, the PHC system has been confronting some problems in all these areas such as inadequate funding, inadequate human resources, poor infrastructure, inconsistent drug supply, and poor governance (Ajisegiri et al., 2022). Based on available data, just one out of the estimated 30,000 PHC centres in Nigeria is operational, and most cannot provide essential healthcare services because of the critical shortage of staff, equipment distribution and infrastructure (Adeleke et al., 2023). The above systemic weaknesses are the most pronounced in North Central geopolitical zone of the country with the Bosso LGAs of Niger State in the zone.

Bosso Primary Health Centre (PHC) in the community of Bosso in Niger State, Nigeria provides the main access point to basic health services to thousands of people in many settlements in the state's LGA. The centre offers a variety of services such as maternal and child health, immunisation, outpatient consultation, family planning and health promotion activities. As with many PHC facilities in Nigeria, Bosso PHC has had many challenges with resources, leading to poor service quality and community use. Significantly, the effects of the Basic Health Care Provision Fund (BHCPF) have started tackling some these challenges as facilities in the LGA are now receiving funding that has led to the acquisition of infrastructure, procurement of necessary equipment and better provision of maternal health services (Nigeria Health Watch, 2022).

The Nigerian government has acknowledged the need to revitalise the PHC system, and as of 2024, more than 260 billion Naira have been made available, with BHCPF and International Development Association funding, with over 120,000 frontline healthcare workers being retrained (Adeleke et al., 2024). The National Health Insurance Authority (NHIA) Act, 2022, also renews the policy guidance to bolster PHC as a foundation for UHC. Despite the commitments in those policies, there is a lack of evidence at the level of the service delivery actors, namely the specific PHC settings such as Bosso PHC, where case studies and empirical assessments are very important in order to devise evidence-based policies.

This study thus aims to carry out a detailed evaluation of PHC service delivery by taking into account various aspects of PHC delivery including availability, accessibility, quality and utilisation of PHC services at Bosso PHC in Bosso LGA, Niger State. The results will hopefully yield actionable evidence that will be used to support changes at the facility level, as well as planning at the LGA level and state health policy.

1.2 Statement of the Problem

Although Nigeria has made over 40-year long-term investment in the development of PHC, quality PHC services are still largely lacking at the grassroots level. Chronic underfunding, shortage of essential medicines and consumables, dilapidated infrastructure, human resource deficits and poor governance mechanisms constitute Nigeria's characteristics of the PHC system (Ogundeji et al., 2023). Such structural issues make it difficult to provide and use services and to achieve optimal health for vulnerable groups, such as pregnant women, children under five years and the elderly.

The empirical evidence of the extent of the minimum standards of services delivered by Bosso PHC in the local population relying on it, is lacking, though a large population lives in the catchment, but primarily residing in dozens of settlements. Bancroft Baker has mentioned anecdotal evidences of low-level motivation of staff, inconsistent supply of drugs, insufficient diagnostic services and poor community outreach. In addition, the funding from BHCPF has been channelled into PHC facilities in the LGA, but there is no systematic evaluation of the impact of these resources on services delivery outcome at Bosso PHC.

This policy to practice the reality are a serious issue at the facility level. This is because a lack of evidence-based assessment means that health managers and policymakers are unable to identify the most serious gaps in service delivery, prioritise the allocation of resources or design interventions which address these gaps. This study aims to address this void by giving facility based systematic assessment of the delivery of the PHC services at Bosso Primary Health Centre.

1.3 Research Questions

This study is guided by the following research questions:

1. What is the availability of essential PHC services at Bosso Primary Health Centre?
2. What is the quality of PHC service delivery at Bosso Primary Health Centre as perceived by health workers and clients?
3. What are the patterns of utilisation of PHC services by residents of Bosso LGA?
4. What are the barriers to effective PHC service delivery at Bosso Primary Health Centre?
5. How does current PHC service delivery at Bosso PHC compare with the national minimum service package standards?

1.4 Objectives of the Study

1.4.1 General Objective

The general objective of this study is to assess primary health care service delivery at Bosso Primary Health Centre, Bosso LGA, Niger State.

1.4.2 Specific Objectives

The specific objectives are to:

1. Assess the availability and functionality of essential PHC services at Bosso Primary Health Centre.
2. Evaluate the perceived quality of PHC service delivery among health workers and clients at Bosso PHC.
3. Determine the patterns and determinants of PHC service utilisation among residents served by Bosso PHC.
4. Identify barriers to effective PHC service delivery at Bosso Primary Health Centre.
5. Compare the service delivery profile at Bosso PHC against national minimum service package standards.

1.5 Significance of the Study

This study makes several important contributions. First, it generates evidence on the current state of PHC service delivery at Bosso PHC, which can serve as a baseline for monitoring improvements under ongoing government revitalisation efforts. Second, the findings will assist health managers at the Bosso LGA PHC Department in identifying priority areas for infrastructure investment, human resource deployment, and quality improvement. Third, by situating facility-level findings within the broader national PHC policy landscape, the study contributes to understanding implementation fidelity of Nigeria's PHC revitalisation agenda at the grassroots level.

For policymakers at the Niger State Ministry of Health and the NPHCDA, the study provides a case study that illustrates the translation of national PHC policy into facility-level outcomes, including the impact of the BHCPF. The findings will also be of value to development partners and civil society organisations engaged in PHC strengthening in the North Central zone of Nigeria. Finally, the study adds to the growing body of empirical literature on PHC service delivery assessment in Nigeria, which informs health systems research and academic discourse at the national level.

1.6 Scope of the Study

This study is geographically confined to Bosso Primary Health Centre and its catchment area within Bosso Local Government Area of Niger State, Nigeria. Thematically, the study focuses on the assessment of PHC service delivery with particular emphasis on service availability, quality, utilisation, and barriers. The study population includes health workers posted to Bosso PHC, clients attending the facility for various services, and community members within the catchment area. The study covers the current operational period, with reference to trends from 2020 to the present, coinciding with the implementation of the BHCPF interventions.

1.7 Limitations of the Study

This study is subject to several limitations. The case study design, while enabling in-depth contextual analysis, limits the generalisability of findings to other PHC facilities or LGAs. Self-reported data from health workers and clients may be subject to social desirability bias. Facility records at PHC level in Nigeria are frequently incomplete or poorly maintained, which may constrain analysis of utilisation trends. Resource and time constraints may limit the scope of data collection, particularly for community-level surveys. These limitations are acknowledged and every effort will be made to triangulate data from multiple sources to enhance the validity of findings.

1.8 Definition of Terms

Primary Health Care (PHC): The first level of contact between individuals, the family, and the community with the national health system, bringing health care as close as possible to where people live and work.

Service Delivery: The provision of health care interventions to a target population, encompassing the inputs, processes, and outputs required to meet defined health needs.

Service Availability: The existence of the required health infrastructure, human resources, essential medicines, equipment, and programmes needed to deliver health services.

Service Quality: The degree to which health services increase the likelihood of desired health outcomes, as assessed against standards of professional knowledge and community expectations.

Utilisation: The actual use of health services by eligible individuals or populations, measured in terms of attendance, coverage, or service uptake rates.

Basic Health Care Provision Fund (BHCPF): A financing mechanism established under Nigeria's National Health Act to channel funds directly to PHC facilities for improved service delivery.

Minimum Service Package (MSP): A defined set of essential health services that every PHC facility in Nigeria is expected to provide, as stipulated by the NPHCDA.

REFERENCES

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