Primary Health Care (PHC) is the bedrock of the health system in Nigeria. It is not just about small clinics in rural villages; it is an approach to health that makes care universally accessible to individuals and families in their communities. Established globally by the Alma-Ata Declaration of 1978, PHC aims to bring healthcare as close as possible to where people live and work. It relies on practical, scientifically sound, and socially acceptable methods that communities can afford. By focusing on equity, PHC ensures that even the most vulnerable populations, such as pregnant women in remote settlements, receive essential health services without facing financial hardship.
To achieve health for all, PHC breaks down health delivery into distinct essential elements. According to the WHO and adapted for Nigerian health policies, these elements cover the most common health needs of a community.
Maternal and child health (MCH) forms the core of primary healthcare delivery in Nigeria, given our high maternal and infant mortality rates. Midwives working at the primary level provide continuous care that spans from pregnancy confirmation through childbirth and the postnatal period. Services include routine antenatal care to monitor fetal growth and maternal blood pressure, administration of intermittent preventive treatment for malaria during pregnancy (IPTp), tetanus toxoid vaccination, and skilled birth attendance. Postnatal care focuses on monitoring the baby's growth, promoting exclusive breastfeeding, and checking for postpartum hemorrhage in the mother.
Controlling infectious diseases is vital for community survival. Immunization remains one of the most cost-effective public health interventions available in primary care. Midwives and community health workers administer vaccines against vaccine-preventable diseases such as polio, measles, tuberculosis, and yellow fever through routine immunization schedules and outreach campaigns. Beyond vaccination, disease control involves active surveillance, contact tracing, and health education on how to prevent vector-borne illnesses like malaria through the proper use of insecticide-treated nets.
Primary Health Care cannot succeed if the community remains a passive recipient of services. Community participation means local people are involved in planning, implementing, and maintaining their health programs through village health committees. When community members take ownership, health initiatives last longer. Furthermore, health is influenced by factors outside the clinic walls, such as agriculture, education, and housing. Intersectoral collaboration brings together different government ministries and non-governmental organizations to address the root causes of ill health, such as poverty, poor road networks, and lack of formal education.
Midwives are often the frontline pillars of primary healthcare in Nigeria, especially in rural primary health centers. Their responsibilities extend far beyond attending normal deliveries. A PHC midwife acts as a clinician, educator, counselor, and community leader. They provide antenatal and postnatal care, manage normal labor, immunize children, treat minor ailments, and supervise community health extension workers. By building trust with families and traditional leaders, midwives bridge the gap between formal medical services and local cultural practices, ensuring mothers and babies survive and thrive.