Roles of Primary Health Care Workers

Introduction to Primary Health Care Workforce in Nigeria

Primary Health Care (PHC) serves as the bedrock of the Nigerian health system, designed to bring healthcare services as close as possible to where people live and work. The workforce is a diverse mix of professional cadres, community-level personnel, and traditional practitioners who bridge the gap between formal medicine and rural populations. Operating primarily at the grassroots or local government level, these workers tackle preventable diseases, maternal and child health challenges, and health education. Resource constraints, infrastructural deficits, and manpower shortages often characterize Nigerian PHC centers, requiring workers to demonstrate high levels of adaptability and resourcefulness.

Community Health Officers (CHOs) and Nurses

Community Health Officers (CHOs) and Public Health Nurses occupy critical supervisory and clinical roles within Nigerian Primary Health Care facilities. CHOs act as middlemen between clinical medicine and community mobilization, often heading Basic Health Care Provision Fund (BHCPF) facilities. Public Health Nurses focus heavily on disease prevention, immunization scheduling, school health programs, and home-visiting services. Together, they diagnose common ailments, prescribe standing-order medications, manage health facility staff, and coordinate outreach programs for vulnerable populations.

Midwives and Maternal Health Cadres

Midwives are the frontline defenders against maternal and neonatal mortality in Nigerian communities. Through initiatives like the Midwife Service Scheme (MSS), they have been deployed to remote health posts to provide skilled birth attendance. Their responsibilities extend far beyond labor and delivery:

• Antenatal Care: Monitoring fetal growth, screening for gestational hypertension, and administering routine prophylaxis like intermittent preventive treatment for malaria.
• Intrapartum Care: Managing normal deliveries, recognizing early signs of obstructed labor, and conducting active management of the third stage of labor.
• Postnatal Care: Assessing uterine involution, checking lochia, promoting exclusive breastfeeding, and providing family planning counseling.

Community Health Extension Workers (CHEWs and JCHEWs)

Community Health Extension Workers (CHEWs) and Junior Community Health Extension Workers (JCHEWs) form the numerical backbone of Nigerian Primary Health Care. Trained at Schools of Health Technology, they live and work directly within the communities they serve.

• Senior CHEWs: Capable of diagnosing and treating minor ailments using standing orders, conducting normal deliveries, providing family planning services, and supervising junior staff.
• JCHEWs: Focus heavily on health education, home visits, environmental sanitation monitoring, growth monitoring of children, and basic first aid.

Village Health Workers and Traditional Birth Attendants

Grassroots health delivery relies heavily on non-formal and voluntary workers who share the language and culture of rural indigenes.

• Village Health Workers (VHWs): Selected by their own communities to act as a bridge to formal clinics, promoting hygiene, distributing simple treatments like oral rehydration salts, and reporting disease outbreaks.
• Traditional Birth Attendants (TBAs): Community-respected women who traditionally assist with childbirth. Because many rural women still patronize TBAs due to cultural preferences or financial constraints, modern PHC policy focuses on training them to recognize danger signs and refer complicated labor promptly to formal health facilities.

Interprofessional Collaboration and Referral Systems

Primary Health Care is a team sport that fails when cadres work in isolation. Effective service delivery requires smooth coordination between CHEWs, midwives, nurses, and medical officers where available. When a patient's condition exceeds the scope of a PHC clinic—such as severe pre-eclampsia, birth asphyxia, or complicated malaria—a structured referral system must be activated. Nurses and CHO's must stabilize the client, document vital signs clearly, communicate with the receiving general hospital, and ensure safe transportation to prevent unnecessary deaths during transit.