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The Declaration of Alma-Ata on Primary Health Care, which continues to be a key text in the history of global health, was published in 1978 during a meeting of world leaders, representatives of international organizations, and representatives of the health sector in Alma-Ata, Kazakhstan. This declaration stipulated a standard of public commitment to providing everyone with affordable, community-based health care and served as the precursor of the Global Strategy of Health for All by the Year 2000 that was pursued by WHO and its partners for the rest of the 20th century. It also informed the United Nations’ Sustainable Development Goal (SDG) 3: "Ensure healthy lives and promote well-being for all at all ages" by 2030.

The WHO report, ‘A Vision for Primary Health Care in the 21st Century,’ identified that 30 years after the Alma-Ata Conference, the world health report of 2008 created a new opportunity for the reinvigoration of primary health care. However, in the following years, health development assistance has become more disease-focused, and an opportunity to work across sectors, across programmes, and for community involvement in healthcare decision-making has been lost. The resultant effect of this is that the accountability and reach of the primary care system – a core component of primary health care – remains weak in many countries, along with the poor quality of care and inadequate staffing.

Many countries across the world – Nigeria inclusive – are still grappling with what has been described as the unfinished agenda of the Millennium Development Goals (MDGs), addressing the burden of communicable, maternal, neonatal, and childhood disease, and malnutrition. However, globally there has been a dramatic shift in the patterns of disease, as a result of population ageing and unhealthy environments contributing to unhealthy lifestyles (including unhealthy food, lack of physical activity, use of tobacco, etc.).

Across all countries, the proportion of disability-adjusted life years lost to non-communicable diseases (NCDs) grew from 44% to 61% between 1990 and 2016, with the fastest rises noted in low- and middle-income countries. The coexistence of multiple (often chronic) conditions in a single individual presents a particular challenge, not only because of the significant burden it imposes on the individual concerned but also because of the relative lack of evidence available to guide their complex management. Addressing these increasingly complex health needs calls for a multi-sectoral approach that integrates health-promoting and disease-preventing policies, solutions that are responsive to communities, and health services that are people-focused – in short, primary health care (PHC).

For context, between 2019 and 2021, a consortium that includes ONE Campaign, National Advocates for Health, Nigeria Health Watch, and the Public and Private Development Centre, assessed the state of primary healthcare delivery in Nigeria and found that in the areas of immunisation, nutrition, and maternal health, only 19 of the 36 states and the Federal Capital Territory (FCT) achieved a score of 56% and above. The highest-performing state, the FCT, achieved a score of 68%. Only 11 of the 36 states and the FCT have at least one operational PHC in each ward, although they all claimed to have the required number of PHCs per ward.

The fact that 26 states in Nigeria do not have at least one functional PHC per political ward is a huge challenge and a powerful reminder that while local and state governments are ultimately responsible for ensuring that basic healthcare is delivered as efficiently as possible, this is not a burden they can carry alone. There is a need for private actors to play their part in channelling resources into building or revitalising PHCs if we are to realise the dream of a healthy and prosperous nation.

Hence, in 2020, when Aigboje Aig-Imoukhuede – former CEO, Access Bank Plc and Chairman, Coronation Capital – planted the seed of the Adopt A Healthcare Facility Programme (ADHFP), it quickly became apparent that the initiative would grow to become one of the most impactful in the Nigerian health sector.

Introduced under the umbrella of the Private Sector Health Alliance of Nigeria (PSHAN), the primary goal of ADHFP is to establish PHCs across Nigeria’s 774 Local Government Areas and apply market-based reforms to provide affordable quality healthcare to the poor and vulnerable. The ADHFP is driven by the belief that the African continent will continue to carry the burden of high disease mortality long after the rest of the world has overcome such challenges unless key stakeholders across public and private sectors collaboratively address the poor state of healthcare systems at the primary level.

Individuals and corporates like Herbert Wigwe, the Group Chief Executive Officer of Access Corporation are leading the charge to improve health outcomes in Nigeria. Wigwe has adopted 23 PHCs across all the Local Government Areas in Rivers; Aliko Dangote has committed to adopting 44 PHCs in Kano; Aig-Aigboje Imoukhuede is adopting 23 PHCs across all the LGAs in Edo, and Jim Ovia is adopting 25 PHCs across all the LGAs in Delta. These recent adoptions, combined with the collective contributions of members of PSHAN, have enabled the Alliance to scale its impact and achieve a combined number of 181 PHCs adopted thus far.

The ADHFP is important to sustaining the socio-economic health of the country. There is no greater sense of corporate and collective responsibility than giving Nigerians a chance at a good life and a promising future. “I am excited to witness the first phases of this remarkable initiative and hope that other members of the Nigerian corporate community can once again come together to create lasting change to the health sector, one PHC at a time,” Wigwe commented at the launch of the initiative.

By serving on the board of organisations like PSHAN, Access Bank and other like-minded corporate institutions are striving for a Nigeria where everyone has equitable access to quality and affordable healthcare and wellness.

Access Bank’s commitment to healthcare, however, goes beyond the ADHFP. Through its contributions to initiatives like the "Malaria To Zero" campaign, the bank sought to leverage private sector financing and other resources in the fight against the deadly malaria disease, which accounts for an estimated 207,000 deaths annually.

Seeking to address the worrying fact that Nigeria currently has the third largest HIV epidemic statistics in the world, Access Bank as Co-Chair of Nigerian Business Coalition Against AIDS (NiBUCAA), earlier in the year joined other public and private stakeholders to launch a $100 million HIV trust fund targeted at ensuring mobilisation of resources towards the eradication of AIDS in Nigeria, starting with the prevention of mother-to-child transmission of the virus.

The WHO has noted that achieving the targets for primary health care would require an additional global investment of around $200 to $370 billion a year for a more comprehensive package of health services. Such targets as reducing maternal, neonatal, and child mortality; ensuring universal access to sexual and reproductive health services; strengthening the prevention and treatment of substance abuse; and preventing and treating NCDs, will rely on multi-sectoral policies and actions that promote health and well-being. Achieving the targets will also require integrated health services that prioritise primary care and public health functions, and empowered people and communities.

While it has been established that no collective governmental strategy will be enough to achieve these targets, sustainability-driven Access Corporation has assured it would play its part to ensure private stakeholders are mobilised to contribute their quota. The Corporation’s efforts also aim at achieving its vision of a world where there is equitable access to quality and affordable healthcare for all.

Omobolanle Victor-Laniyan is Head, Group Sustainability, Access Corporation.