By Caesar Keluro
COVID19 has shown the critical importance of quality primary health care in the creation of effective and responsive health systems. Rising inequality, poverty, climate change impact and the emergence of complex patient conditions, coupled with fiscal pressures have brought into bold relief the critical importance of a resilient health care infrastructure. As the critical role of primary health care has become even clearer, it is worthy to mention the laudable Adopt-A-Health Facility Programme (ADHFP) initiative.
ADHFP was conceptualized by Mr. Aigboje Aig-Imoukhuede and the Private Sector Health Alliance of Nigeria (PSHAN) with the primary aim of delivering, at least, one global standard Primary Healthcare Centre (PHC) in each of the 774 Local Government Areas (LGAs) in Nigeria. Technological progress and new ways of delivering services is transforming primary health care systems. It is critical we integrate laudable initiatives like ADHFP with digitalization so we can deliver resilient health systems.
Previously, primary health care was designed to deliver on preventive care, healthcare that focuses on disease treatment, often targeting one illness at a time. Research revealed that such an approach has evolved by integrating digital technologies needed to realise the required efficiency gains. With digitalization and digital platforms, we can go beyond treating infectious diseases, and address: nutrition, addiction, mental health and healthy ageing.
We believe that an efficient primary health care system needs to leverage all the functionalities offered by digital technologies to support health outcomes and health-related activities. Key objectives shaping digital technologies include: improved efficiency, productivity and quality of care. Digital health adoption in primary healthcare is being led by these countries with the highest levels of implementation in Denmark, Estonia, Finland, Spain, Sweden and the United Kingdom.
Some Areas of digital health applications
For example, EHR systems are generating clinical reminders to help physicians track preventive and ongoing care services for patients with chronic diseases. This medical support tool has helped with improved workflow, policy, communication and cultural practices; it is a key recommendation for safe patient care in primary health care settings. Also, Telemedicine/Teleconsultations are one of the most used telemedicine interventions in primary health care, notably to improve access to care for people living in underserved areas like rural Nigeria. ePrescription programmes have been associated with a reduction in prescribing of potentially inappropriate medications and efficiency gains have been found for prescribers and dispensers.
Impressively, home monitoring, ePatient portals and self-management applications have become strategic levers to improving care quality and the delivery of people-centred primary health care. Furthermore, digital applications in the areas of diabetes, depression, and anxiety have improved the management of chronic diseases, through greater patient’s awareness of their condition, helping them to make health-related decisions.
Also, with the help of clinical algorithms, we could bring external and patient-derived data into the clinical decision-making process, leading to personalised predictions of disease status and generate more appropriate treatment, thereby increasing the efficiency of primary health service delivery. United States with Kaiser Permanente and HealthConnect, are utilizing this to understand relationships between multiple behavioural factors to enable the assessment of opportunities and risks associated with a particular set of conditions. Experts said this could be used to flag patients at risk of avoidable hospital (re)admission, or to conduct specific targeted preventive actions towards disadvantaged or high-risk populations.
A Digital-boost for Primary Health Care
In transforming Nigeria’s PHC, we are faced with access to reliable electricity and network connectivity, which is improving, pegged in sub-Saharan Africa, at 57 per cent of the population. Both can be addressed by renewable energy solutions and novel mobile broadband access. ADHFP riding on the strength of robust health information infrastructures is essential to transforming Nigeria’s PHC.
It will form the fulcrum of a people-centred primary health care based on quality teams and networks, both a matter of striving for better health outcomes and an economic necessity. A rich information system is a prerequisite to achieving a good understanding of how, where or why inappropriate and poor primary health care quality exists in Nigeria. It will help us to collect data on clinical performance and efficiency at Local Government Area PHC level; local PHC can compare themselves to their peers and access tools for performance improvement. It will help us strengthen health information infrastructures and promote effective use of such data.
ADHFP Community Quality Scheme
In driving ADHFP, it is important we embed a pan-Nigeria PHC Community Quality Scheme. This scheme should reward PHC/Community pharmacies or care centres for delivering quality based on these criteria: clinical effectiveness, patient safety and patient experience. At the core of ADHFP should be measurement metrics like PREMs and PROMs. PREMs is Patient-reported experience measures (PREMs). This captures the patient’s view on health service delivery (e.g. communication with nurses and doctors, staff responsiveness, discharge and care co-ordination); while PROMs: Patient-reported outcome measures (PROMs) would help us provide the patient’s perspective on their health status (e.g. symptom burden, side effects, mental health and social functioning).
The success of ADHFP will depend on significant co-ordination between primary health care, specialists and hospitals. Integration and co-ordination of care requires a good flow of information and consistency of decisions across the different levels of care in our health system, including primary health care settings, specialist settings and hospitals. The consequences of an uncoordinated ADHFP/PHC would lead to repeated information or diagnostic tests, conflicting instructions, broken transitions between providers with even dire health outcomes.
In all, COVID-19 pandemic outbreak has reinforced the need for us to be able to track, analyse, and share data quickly and effectively. There should be careful oversight and regulation of digital services in order to maximise benefits and avoid harm. This pandemic has stimulated many innovative practices at global, national and local level. It is important that ADHFP’s founders incorporate such innovations with a view to promoting their wider adoption as health systems as we move into the pandemic recovery phase and beyond. Also, it will be amazing to see how we integrate existing healthcare start-up innovations into ADHFP, drive interoperability, and deliver improved healthcare outcomes for millions of Nigerians.