Primary Health Care (PHC), according to the Alma-Ata declaration, was aimed at addressing the main health problems in the community, providing promotive, curative, and rehabilitative services. PHC is a shift towards the front-line of day-to-day activities carried out within the community. It was expected to correct the limitations of previous Governmental health strategies by bringing health care to the door post of community members. It was generally adopted as the cornerstone and guideline for implementation of subsequent reforms and policy instruments aimed at achieving health for all Nigerians.

Primary Health Care/Fifth Development Plan

Following prevailing weaknesses and deficiencies in Health care delivery and policies, In August 1987, the federal government launched its Primary Health Care plan (PHC), which President Ibrahim Babangida announced as the cornerstone of health policy with the following objectives:

·Accelerated health care personnel development

·Improved collection and monitoring of health data

·Ensured availability of essential drugs in all areas of the country

·Implementation of an Expanded Programme on Immunization (EPI).

·Improved nutrition throughout the country.

·Promotion of health awareness

·Development of a national family health program

·Widespread promotion of oral rehydration therapy for treatment of diarrheal disease in infants and children.

It would be recalled that Primary health care was adopted as a corner stone for achieving health for all following Alma-Ata declaration in 1978. Implementation of PHC programs was intended to take place mainly through collaboration between the Ministry of Health and participating local government councils, which received direct grants from the federal government.

The adoption of Primary Health care as the cornerstone of achieving health objectives of the fifth development plan of late 80s and early 90s led to the development of National Health policies in 1988 and 1998.

This policy document has Primary health care (PHC) as its cornerstone.

It also accorded Priority to underserved and high risk groups.

It emphasized on effective management through better planning, budgeting and control. Increased funding and cost recovery including insurance.

Reduction in capital development. Improvement of efficiency and utilization through better support drugs.

Increased inter and non-governmental cooperation and community support

It gave more roles to the local Government in management of health services with focus on primary health care elements.

It also encouraged Intermediate level manpower planning.

Inspection of private services.

The National health philosophy was founded on the underlying principle of social justice and equity while the national health care delivery system is built on the basis of the three tier responsibilities, which are of the Federal, State and Local governments.

Despite these, the following problems continues to persist: inadequate coverage, proportionally high investment in curative to the detriment of preventive services, Inadequate skill to properly manage and coordinate health formulation, planning, monitoring implementation and evaluation Poor maintenance and servicing of health equipment and facilities, Poor management of health statistics.

Health System Reform /National Health Bill

Following the lack of effective stewardship role of government, fragmented health service delivery, inadequate and inefficient financing, weak health infrastructure, mal-distribution of health work force and poor coordination amongst key players, the Health Systems Reform (HSR) was implemented between 2004-2007. The HSR was one of the social sector reforms undertaken by the Obasanjo administration, with the National Economic Empowerment Development Strategy (NEEDS) providing the overall national development framework.

The NEEDS health policy strategy includes:

·Strengthening local government capacity in public health management

·Refurbishing of primary health care facilities and making them operational

·Redefinition of the role and responsibilities of federal ministry of health and other federal public health services to Nigerians.

·Establishment of National Blood transfusion system

·Creation of the enabling environment for local manufacturing of about 70% of Nigerian needs for essential drugs/supplies antiretroviral drugs and reagents.

·Provision of minimum package of health services to all Nigerians as an integral part of the poverty reduction strategy.

The Health system reform specifically has a mission statement meant to undertake a government-led comprehensive health sector aimed at strengthening the national health system to enable it deliver effective, efficient, qualitative and affordable health services and thereby improve the health status of Nigerians as health sector‘s contribution to breaking the vicious circle of ill-health, poverty and under-development.

It has the following strategic thrusts:

· Improve the performance of the stewardship role of government

·Strengthen the national health system and improve its management

·Improve availability of health resources and their management

·Improve the access (including physical and financial) to quality health services

·Reduce the disease burden attributable to priority health problems

·Promote effective public-private partnership in health

·Increase consumer’s awareness of their health rights and health obligations.

Though the reform has made some achievements in some of its priority focus, it is yet to be implemented in several sectors.

However it is an ongoing process that requires time to fully take effects. One important development that has emerged in the course of ongoing reform was the development of the National Health bill.

The Bill has seven parts:

·Responsibility for health and eligibility for health services and establishment of national health system

·Health establishments and technologies

·Rights and obligations of users and healthcare personnel

·National health research and information system

·Human resources for health

·Control of use of blood, blood products, tissue and gametes in humans

·Regulations and miscellaneous provisions

Generally, the Bill if signed by President Jonathan will clearly define the various roles and functions to be played by the three tiers of government on health related issues. Once enacted, the bill is expected to help Nigeria achieve universal health service, guarantee improvement in the health sector, regulate healthcare practice, and promote professionalism among healthcare givers. The bill is also expected to set standards in health care services rendered across Nigeria and also help eliminate medical quacks in the system. It seeks among others, the enablement to provide one per cent of Nigeria‘s consolidated revenue fund for the development of primary health care. The various states across Nigeria through this fund are expected to improve on primary health care services in their states. The bill also covers provision of health care insurance for Nigerians especially the less privileged. It will provide guidelines in the development, promotion and formulation of national health policy, among others. Currently the bill even though signed by the senate on 19th February, 2014 is yet to be signed by the president due to perceived controversies and disagreements among interest groups especially healthcare professionals.

The National Strategic Health Development Plan (or NSHDP) (2010-2015)

The National Strategic Health Development Plan (or NSHDP) – reflects shared aspiration to strengthen the national health system and to vastly improve the health status of Nigerians. The Plan is the overarching reference health development document for all actors towards delivery on a shared Results Framework, to which each and everyone will be held accountable for achieving the goals and targets as contained in the Results Framework.

It has the following eight strategic priority areas:

• Leadership and Governance for Health.

• Health Service Delivery.

• Human Resources for Health.

• Financing for Health

• National Health Management Information System.

• Partnerships for Health.

• Community Participation and Ownership.

• Research for Health.

The plan is to serve as a guide towards meeting the aspirations of the health component of the National Vision 20:2020 to achieve better health in Nigeria.

The determination of the Nigerian government to improve the national health care services was reflected in the official launching of Primary Health care as a corner stone for achieving health for all Nigerians in consistence with Alma Ata declaration of 1978.Since this launching, several other reforms, policies and health plans have been developed for the purpose realizing health for all. Though some achievements have been made, Nigeria still seems to be far from her health objectives.