Opinion
Mobilising Community Participation To Strengthen PHC Delivery
Community participation is a cornerstone of effective primary healthcare delivery. By actively involving communities in health planning and implementation, we can create more responsive and sustainable healthcare systems that truly meet the needs of the people. The Alma-Ata Declaration, adopted in 1978 at the International Conference on Primary Health Care (PHC) in Alma-Ata (now Almaty, Kazakhstan), was a landmark global health policy that emphasised Primary Health Care as the key to achieving “Health for All” by the year 2000. Key highlights of the declaration are:
· recognises health as a fundamental human right,
· defined Primary Health Care (PHC) as essential, community-based, and universally accessible healthcare,
· stressed importance of intersectoral collaboration, including education, agriculture, and social services, in achieving health goals,
· called for government action, international cooperation, and community participation in strengthening PHC.
The 1978 declaration underscored that health care should be accessible, affordable, and involve the community in planning and implementation.
Specifically, VII.5 of the declaration states that “primary health care requires and promotes maximum community and individual self-reliance and participation in the planning, organisation, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate.” This.” Thisately aims to create more effective, sustainable, and culturally appropriate health care delivery systems.
The World Health Organisation (WHO) defines community participation “as a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change.” In Nigeria, the Nigerian National Health Policy and the Sustainable Community Engagement Strategy highlight the importance of community participation in PHC delivery. These documents outline strategies that support communities in health planning, management, and monitoring.
Over the years, the Nigerian government has continued to design impactful community programmes aimed at strengthening primary health-care delivery in the country. Examples of these include:
· The Community Health Workers (CHWs) Program (1978 – present): This initiative was introduced to bridge the gap in healthcare provision, particularly in rural and underserved areas. Community Health Workers (CHWs) were trained to provide basic health services, conduct health education and immunisations, and help manage common diseases, including malaria, diarrhoea, and respiratory infections. Community engagement with CHWs has resulted in a 50 percent increase in family planning service uptake and expanded access to other primary health care services, including maternal and child health services, and chronic disease management.
· Community Influencers, Promoters, and Services (CHIPS) Program (2018 – Present): The CHIPS Programme focuses on enhancing community health participation by training community health influencers and promoters to deliver health education, promote healthy behaviours, and assist communities to access essential health services. CHIPS workers, often members of the local communities, are deployed to engage with the communities, conduct health outreaches, facilitate health campaigns, and promote family planning, immunisations, and maternal health. CHIPS agents have effectively promoted healthy behaviours and facilitated access to essential health services, leading to improved health indicators.
· COVID-19 Community Response and Health Education (2020 – 2022): In Nigeria’s response to the COVID-19 pandemic, community participation played a vital role in the public health response. Community health workers (CHWs) were mobilised to provide health education, assist in contact tracing, and distribute COVID-19 preventive materials. Local community leaders, religious groups, and influencers helped spread vital information regarding the COVID-19 pandemic, including safety measures like mask-wearing, social distancing, and hand hygiene.
· Strengthening Community Engagement and Accountability for PHC (SCEAP) Project (2021 – present): Implemented by BudgIT Foundation with support from the Bill and Melinda Gates Foundation (BMGF), this project aims to improve primary healthcare delivery through community-led advocacy and monitoring, and empowering community actors to promote transparency and improve healthcare facilities and services.
The collaborative partnership between the community-based organisations, stakeholders, village heads/representatives, WDCs, women leaders, facility in-charges, and community members has proven instrumental in addressing healthcare challenges and enhancing service delivery. There is also an increase in service utilisation at the PHCs, which is evident in increased patient turnouts that have been observed since the start of SCEAP, with a 55 percent increase in the number of participants visiting the PHCs weekly and a 30 percent increase in the monthly visits to the facilities. Additionally, there has been a 70 percent increase in outpatient consultation and antenatal care services in most facilities.
· Ward Development Committees (WDCs) and Village Development Committees (VDCs) (2001): were created as community structures to support planning and monitoring of health care services. These community structures have facilitated community involvement in healthcare decision-making, leading to more tailored and accepted health interventions, and enhanced monitoring of health services, which has contributed to improved accountability and service delivery.
. Basic Healthcare Provision Fund (BHCPF) (2019 – present): This is a funding mechanism designed to provide financial support to primary healthcare centres across Nigeria. It aims to improve the quality and accessibility of PHC services by ensuring adequate funding for essential health services, including immunisation, maternal and child health, and disease surveillance.
The establishment of the BHCPF has enhanced accountability in fund utilisation, thereby improving the management and delivery of PHC services. The BHCPF has also improved access to basic healthcare services, especially for vulnerable groups such as women of childbearing age and children under five years of age. A study found that most patients (98.2%) were satisfied with service delivery, which influenced patient utilisation of PHC facilities.
The Aig-Imoukhuede Foundation recognises the critical roles that community structures like the CHIPS and WDCs play to ensure effective delivery of PHC to communities. As a result, we are taking clear steps to support government interventions and improve community participation for PHCs through our Adopt-a-Health Facility Programme (ADHFP), which aims to strengthen PHC systems, improve service delivery, and enhance community engagement.
These steps include:
1. Providing periodically structured training programmes to WDC members to strengthen their leadership and governance capacities.
2. Support existing structures for multi-stakeholder review and engagement meetings between WDCs, local government health authorities, and community stakeholders.
3. Strengthen mechanisms between communities, WDCs and PHC workers.
4. Advocatetee private sector involvement in strengthening community structures to improve PHC.
By strengthening community-based structures like the WDCs to improve primary healthcare service delivery, we envisage:
1. WDCs will be better equipped to co-design, track progress, and monitor the implementation of programme work plans, mobilise resources for community initiatives, and oversee the activities of community health workers. This will improve transparency and oversight and can lead to better outcomes at PHCs.
2. These activities will engender a culture of continuous improvement because community concerns and health priorities can be addressed promptly, improving service delivery and patient experience.
3. Trust between communities and healthcare workers will be improved, and this can lead to an increase in service utilisation.
4. Funding and resource availability for healthcare programmes is expanded as community members can advocate and raise funds for primary health programmes.
Businessday.ng
Opinion
“Let President Muhammadu Buhari Rest in Peace” – By Nasir El-Rufai
The recent launch of a book on the life and legacy of our late leader, President Muhammadu Buhari, has stirred deep emotions and renewed divisions among those who once formed his inner circle. Having followed the headlines and images from the event, I felt compelled to make a simple but urgent appeal: let us allow President Buhari to rest in peace.
A careful look at those who dominated the book launch revealed the same factional lines that existed during Buhari’s lifetime. One camp was prominently represented, while others—equally close to the late president—were excluded. This selective engagement compounded by the choice of location of the event were red flags, and raises concerns about whether Buhari’s legacy is now being shaped to serve narrow interests rather than historical truth.
More troubling was the presence of long-time critics of Buhari, some of whom now hold high office, delivering glowing, but clearly faked tributes. These are individuals who once blamed his administration for nearly every challenge facing Nigeria, but who now appear eager to revise history—perhaps to deflect responsibility for present failures.
It was also unsettling to see individuals celebrating Buhari in death who had neither his trust nor his respect in life. President Buhari was a principled man who did not easily forget personal or political disrespect, and he made his preferences clear to those around him.
I have not yet read the book, Soldier to Statesman: The Legacy of Muhammadu Buhari, and it is possible that some media reports lack context. However, many of the so-called revelations attributed to the late president appear one-sided and unfair, especially as he is no longer alive to respond. Explaining the thoughts and motivations of a complex leader through selective anecdotes risks distorting, rather than preserving, his legacy.
President Buhari was far from perfect. Many of us who supported him expected much more from his civilian presidency. However, as someone who worked closely with him in opposition political, and governance roles for over a decade, I believe much of his administration’s shortcomings stemmed from the actions and failures of a powerful inner circle—relatives, advisers, and officials who did not always share his commitment to integrity and public service.
Buhari himself remained, to the end, a man of deep faith, personal discipline, and unquestioned patriotism. Those now invoking his name for self-justification should reflect on whether they can claim the same standards.
My appeal here is simple: to all Nigerians: admirers and critics alike—let President Muhammadu Buhari rest in peace. Let history judge him fairly, without opportunism or revisionism. The truest way to honour him is not through selective storytelling, or attempting to exhibit new-found love, but by upholding the values he embodied: simplicity, integrity, humility, and service to Nigeria with all he had.
May Allah grant him eternal rest.
Nasir Ahmad El-Rufai
Cairo, Egypt
17th December, 2025
Opinion
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Opinion
Has the South-East Traded Kanu and Obi for Political Access? By Mohammed Bello Doka
When Nnamdi Kanu was handed a life sentence, expectations were clear and historic. Across Nigeria, many anticipated a decisive political reaction from the South-East: emergency meetings, coordinated resistance, forceful statements from governors, and a re-assertion of the region’s long-held grievance narrative.
What followed instead was something far more revealing — a loud, deliberate silence.
No collective pushback by South-East governors.
No political reprisal.
No price imposed on the centre.
And in that silence lies a deeper story — one that goes beyond Nnamdi Kanu alone.
For the first time in Nigeria’s political history, all five South-East governors are aligned — directly or indirectly — with President Bola Tinubu and his re-election project. This is not speculation. Public statements and political signaling from the zone confirm that the governors have closed ranks around Abuja. Some openly endorse Tinubu; others maintain strategic silence while cooperating fully with the centre. Either way, the outcome is the same: regional power has moved away from confrontation to accommodation.
This alignment explains much more than the silence after Kanu’s sentence. It also explains the quiet abandonment of Peter Obi’s presidential ambition by the same elite class that once benefited from his momentum.
For years, the South-East sustained a dual political narrative:
Nnamdi Kanu represented resistance — a symbolic struggle against marginalisation.
Peter Obi represented reform — a constitutional path back to relevance at the centre.
Today, both pillars have been set aside.
Unlike previous moments in history when South-East elites distanced themselves from regional causes out of weakness or isolation, this time is different. This retreat did not happen in defeat. It happened from a position of leverage:
The region had unprecedented national sympathy after 2023.
It commanded a powerful youth-driven political movement.
It had emotional capital across Nigeria and the diaspora.
Yet, despite this strength, the elite chose survival.
South-East governors — the true controllers of the political system — have clearly decided that confrontation carries higher costs than alignment. Federal access, security cooperation, budgetary relevance, and political protection now outweigh symbolic struggles. In plain terms, Kanu became a political risk, Obi an electoral uncertainty.
This raises unavoidable rhetorical questions.
If the South-East remains as marginalised as long argued, why was Kanu’s life sentence not treated as a regional emergency?
If injustice still defines the regional condition, why has no political consequence followed?
Or has political access softened the meaning of marginalisation itself?
Even more unsettling is what this silence suggests about the future.
Will there be consequences from the people?
Governors may control the machinery, but history shows that South-East grassroots sentiment does not always move in sync with elite calculations. Suppressed anger, when ignored, rarely disappears — it mutates.
Has the South-East finally been subdued?
Or is this only a strategic pause — a recalibration before another political rupture?
And perhaps the most dangerous question of all:
What becomes of the Biafra agitation in a post-elite world?
If the political class no longer carries the banner — and the state believes resistance has been neutralised — the struggle may not end. It may simply lose its intermediaries and become harder to predict, harder to control, and more radical in form.
For now, the facts are clear.
South-East elites have chosen power over protest.
Access over agitation.
Survival over symbolism.
Whether the people follow — or resist — that choice will define the region’s political future far more than any endorsement ever could.
And until then, the silence after Kanu’s sentence remains the loudest statement the South-East political class has ever made.
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