Institutional Profile of PHC Facilities in Nigeria and its Implication for PMTCT Scale-Up and Decentralization of HIV and AIDS Services: Nasarawa State as a Case Study

Abstract

Part of the national strategic plans for improved coverage and uptake of HIV and AIDS services in Nigeria include decentralization and scale up of HIV and AIDS services with focus on the country’s PHC system. There is however the need to determine the system’s readiness, capacity and capability as a domain for attaining this twin goal. This is critical to ensure the sustenance of quality of ensuing services. Nasarawa State, the case study in this review, is one of the states with a higher-than-thenational HIV sero-prevalence rate. Like in many of the states in the country, it desires to achieve an increased coverage and uptake of HIV and AIDS services through its scale up and decentralization plan. Towards this, it carried out a state-led statewide assessment of its PHC facilities in 2013. A review of assessment reports of 287 PHC facilities in Nasarawa State with focus on infrastructural profile, accessibility throughout the year, operating time (days and hours) of the facilities, human resources for health, services being provided and availability of basic laboratory services was carried out to determine the status of the facilities. With the exception for of family planning services in 54% of the Primary Health Care centres, adequate space for laboratory, pharmacy and HIV counseling services was found in less than 50% of the facilities. Ongoing HIV counseling and testing, DOTS and basic laboratory services were found in less than 50% of the facilities. Widespread paucity of skilled manpower such as physicians and nursing and midwifery staff was observed, being respectively available in 1% and 4% of the sites, with more than 80% of the manpower being of lower skilled health care providers. The study indicates gaps in the capacity of the PHC system, an example of what the state of PHC is in many states in Nigeria, indicating the need for pre-implementation system strengthening to ensure the accommodation of decentralization and scale up process. To address them would require judicious input of resources for health system strengthening that would enhance its capacity to provide quality HIV and AIDS services.

Key words: PHC, HIV and AIDS, Decentralization and Scale Up