Tips for Increasing Access to Primary Care

Access to healthcare should be a right, not a privilege. Yet in Nigeria, many face barriers that make essential care out of reach, from geographical challenges to financial constraints. Making healthcare accessible is about bringing care closer to people—wherever they are and whatever their circumstances. Improving access requires targeted solutions that address the unique challenges in our communities. Here’s how we can create a more accessible healthcare system across Nigeria: 1. 𝐃𝐞𝐜𝐞𝐧𝐭𝐫𝐚𝐥𝐢𝐬𝐢𝐧𝐠 𝐒𝐞𝐫𝐯𝐢𝐜𝐞𝐬: Establishing primary care facilities in underserved rural areas is essential. By adopting a “hub-and-spoke” model, with community-based centres connected to larger facilities, people can receive timely, appropriate care without long travel distances. 2. 𝐄𝐱𝐩𝐚𝐧𝐝𝐢𝐧𝐠 𝐓𝐞𝐥𝐞𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞: Technology can bridge the gap between rural populations and healthcare providers, enabling remote consultations and assessments. Telemedicine has already shown promise, particularly during the COVID-19 pandemic, when in-person visits were limited. 3. 𝐀𝐟𝐟𝐨𝐫𝐝𝐚𝐛𝐥𝐞 𝐎𝐩𝐭𝐢𝐨𝐧𝐬: High out-of-pocket costs deter many from seeking care. Subsidised programs, insurance schemes, and innovative financing models can ease the financial burden and make care more attainable. 4. 𝐏𝐮𝐛𝐥𝐢𝐜-𝐏𝐫𝐢𝐯𝐚𝐭𝐞 𝐏𝐚𝐫𝐭𝐧𝐞𝐫𝐬𝐡𝐢𝐩𝐬 (𝐏𝐏𝐏): Collaboration between government and private sectors can expand healthcare reach. Through PPPs, we can build and manage facilities that meet high standards of care while remaining accessible to the public. 5. 𝐂𝐨𝐦𝐦𝐮𝐧𝐢𝐭𝐲 𝐇𝐞𝐚𝐥𝐭𝐡 𝐖𝐨𝐫𝐤𝐞𝐫𝐬 𝐚𝐧𝐝 𝐌𝐨𝐛𝐢𝐥𝐞 𝐂𝐥𝐢𝐧𝐢𝐜𝐬: Trained community health workers can bring education, preventive care, and basic treatments into remote areas. Mobile clinics can deliver essential services like vaccinations and screenings to populations without easy access. 6. 𝐑𝐞𝐝𝐮𝐜𝐢𝐧𝐠 𝐭𝐡𝐞 𝐔𝐫𝐛𝐚𝐧-𝐑𝐮𝐫𝐚𝐥 𝐃𝐢𝐯𝐢𝐝𝐞: The disparity in healthcare between urban and rural areas must be addressed. Investing in rural healthcare infrastructure ensures that all Nigerians, regardless of location, can access quality care. 7. 𝐒𝐭𝐫𝐞𝐧𝐠𝐭𝐡𝐞𝐧𝐢𝐧𝐠 𝐏𝐫𝐢𝐦𝐚𝐫𝐲 𝐂𝐚𝐫𝐞: Emphasising primary care as the first point of contact allows for early intervention, reducing the need for more complex and costly treatments. Strengthening primary care access also alleviates pressure on specialised facilities. Creating an accessible healthcare system in Nigeria requires focused efforts addressing geographical and financial barriers. By prioritising community-level care, supporting it with technology, and forming partnerships that reduce costs, we can make healthcare inclusive for all.

A network on paper isn’t access. A provider listing isn’t care. A wait time isn’t an excuse. The recent WSJ investigation ( 🔗 in comment) laid bare a troubling reality that I remember quite clearly in my FQHC clinical experiences: in many states, Medicaid provider networks appear “adequate” on paper but collapse in practice—filled with clinicians who don’t accept Medicaid patients, aren’t taking new patients, or have no timely appointments available. In my experience overseeing VA Community Care, particularly following the MISSION Act of 2018, these issues are deeply familiar. That law expanded veterans’ access to community providers when VA wait times or distance created barriers—and it also exposed how network adequacy failures often reflect geographic gaps and unacceptable wait times. Medicaid beneficiaries are now facing the same access inequities. A directory that promises care but delivers neither timeliness nor proximity is not a network—it’s a barrier. This is why joint accountability across the ecosystem is essential: ➡️ States must validate networks using real-world appointment availability, geographic access, and true Medicaid participation—not static provider lists. ➡️ Payors/Insurers must commit to transparency: verifying active participation, reporting wait-time data, and partnering with providers to strengthen capacity. ➡️ Providers must share timely capacity data, accept Medicaid patients at sustainable reimbursement levels, and participate in integrated care models that reduce fragmentation. A critical lever is telehealth, but not as a disconnected workaround. Telehealth must be a coordinated extension of integrated care, used strategically when geography, transportation barriers, or long wait times make in-person care unrealistic. When primary care, behavioral health, and pharmacy teams use shared information systems and telehealth as part of a unified workflow—not a separate system—patients finally get timely, coordinated access. We cannot continue calling networks “adequate” when patients wait months or must travel hours for essential care. True access requires shared responsibility, transparent data, and integrated models that meet people where they are—whether in person or virtually. #Medicaid #AccessToCare #NetworkAdequacy #MISSIONAct #HealthEquity #Telehealth #IntegratedCare #PrimaryCare #BehavioralHealth #Transparency #ValueBasedCare

I looked very happy in these pictures taken at the Lifecheck medical outreach, but honestly, I was feeling a lot of other emotions because earlier that day, I met Madam Sara. She walked up to me and asked if I could give her two packs of her medicine. She had already pointed it out on the table…….. the orange and white boxes of Losartan 50mg. And, we ended up having a conversation that made me think. She hadn’t stopped taking her medicines because she didn’t think they were important. She couldn’t afford them.  And off the top of my head, I could think of many other reasons behind this. People don’t lack access to healthcare by choice. It’s poverty, the cost of food, the struggles of daily life.… it’s everything else. 𝐓𝐨𝐨 𝐨𝐟𝐭𝐞𝐧, 𝐰𝐡𝐞𝐧 𝐰𝐞 𝐬𝐩𝐞𝐚𝐤 𝐨𝐟 𝐚𝐝𝐡𝐞𝐫𝐞𝐧𝐜𝐞 𝐜𝐨𝐮𝐧𝐬𝐞𝐥𝐥𝐢𝐧𝐠, 𝐰𝐞 𝐚𝐯𝐨𝐢𝐝 𝐭𝐡𝐞 𝐞𝐥𝐞𝐩𝐡𝐚𝐧𝐭 𝐢𝐧 𝐭𝐡𝐞 𝐫𝐨𝐨𝐦. 𝐓𝐡𝐞 𝐬𝐨𝐜𝐢𝐚𝐥 𝐝𝐞𝐭𝐞𝐫𝐦𝐢𝐧𝐚𝐧𝐭𝐬 𝐨𝐟 𝐡𝐞𝐚𝐥𝐭𝐡. Some patients can make the time and afford the cost to come to the hospital. Others simply cannot. 𝐈 𝐡𝐨𝐩𝐞 𝐭𝐡𝐞 𝐭𝐫𝐮𝐬𝐭 𝐛𝐞𝐭𝐰𝐞𝐞𝐧 𝐍𝐇𝐈𝐀 𝐚𝐧𝐝 𝐜𝐨𝐦𝐦𝐮𝐧𝐢𝐭𝐲 𝐩𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐬𝐭𝐬 𝐢𝐦𝐩𝐫𝐨𝐯𝐞𝐬, 𝐛𝐞𝐜𝐚𝐮𝐬𝐞 𝐫𝐞𝐚𝐥𝐥𝐲, 𝐡𝐨𝐰 𝐜𝐨𝐧𝐯𝐞𝐧𝐢𝐞𝐧𝐭 𝐰𝐨𝐮𝐥𝐝 𝐢𝐭 𝐛𝐞 𝐭𝐨 𝐩𝐢𝐜𝐤 𝐮𝐩 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐟𝐨𝐫 𝐧𝐨𝐧-𝐜𝐨𝐦𝐦𝐮𝐧𝐢𝐜𝐚𝐛𝐥𝐞 𝐝𝐢𝐬𝐞𝐚𝐬𝐞𝐬 𝐣𝐮𝐬𝐭 𝐚 𝐟𝐞𝐰 𝐝𝐨𝐨𝐫𝐬𝐭𝐞𝐩𝐬 𝐚𝐰𝐚𝐲? It is one of the ways pharmacists can really help in achieving universal health coverage through primary healthcare. But while we wait for that system to work better, I believe there are things we can start doing. 📌For instance, pharmacies could explore flexible payment options, something like a “pay-small-small” system that allows patients to contribute little by little, and at the end of the month, they can pick up their medicines. This is not a new idea; susu agencies have been doing this for years, and people trust it. We could try adopting it for healthcare. (You could explore doing this with a third party and only dispense when payments are complete) 📌As pharmacists we also need to play a bigger role in continuity of care. A simple WhatsApp reminder or a phone call could make the difference between dropping off treatment and staying on it. (This is actually a win-win because it helps you to build a relationship with your client base) 📌And then there’s partnerships. We could explore working with groups that already have strong networks, market women, taxi drivers, trotro sellers. These associations look out for their members, and if we offer health support into those structures, access to medicines becomes less of an individual struggle And maybe the lesson for all of us is this: access to care is not just about availability. If we want healthier communities, we must remove the barriers that force people to choose between survival and treatment. I would like to know your thoughts on this in the comments Sincerely, Dr. Diane #publichealth #UHC

We’ve all seen ***that*** billboard - flashing ER wait times like it’s a drive-thru - and it’s one of the many reasons health insurance premiums keep climbing 10%, 15%, 20%… year after year 📈 Hospitals and large health systems advertise short ER wait times to pull you in - for a sore throat, a UTI, a minor injury. It feels convenient. It feels fast. But it’s not built for value - it’s built for volume 🏥 Because the reality is this: every ER visit averages around $2,000. That’s not a co-pay - that’s the total cost that ultimately hits you, your employer, and your health plan 💸 Now layer this in: the average deductible for employer-sponsored insurance is about $1,886. On the individual market, Bronze plan deductibless average $7,476 and Silver plan deductibles average $5,304. So for most people, one ER visit = paying out of pocket ⚠️ If you’re a CFO, HR leader, TPA, school district, or municipality designing a benefit plan - this behavior is crushing your numbers. ER utilization for low-acuity issues drives up total spend, and that’s exactly why your renewal comes back 10–20% higher every single year 📊 And here’s where it gets even more important: in Detroit, much of the city is designated as a Health Professional Shortage Area. That means limited access to primary care - and that changes behavior across an entire population 🗺️ If it takes 24 days to see a primary care doctor - but only 8 minutes to get into an ER - you don’t need a PhD in behavioral economics to predict what happens next. People choose access. Even when it costs 10x more ⏱️ But the ER isn’t designed for primary care. It’s designed for heart attacks, strokes, trauma. When it’s flooded with low-acuity visits, everyone suffers - especially the patients who truly need emergent care ❤️ So here’s the big takeaway: if you’re running a health plan - or responsible for one - your performance will continue to struggle until you fix access to primary care. Not tweak it. Not optimize it. Fix it. 🔧 That’s where Direct Primary Care comes in. Roughly 20–30% of American adults don’t have a primary care doctor - and instead rely on urgent care and ERs or go without care completely. That’s not a patient problem. That’s a system design problem 🧩 At Plum Health DPC, we meet those patients where they are - same-day or next-day access, direct communication, no barriers. We also meet employer groups where they are - if you have 1,000 employees who engage with our service, we can build you a custom, near-site clinic. And the results are clear: 40% fewer ER visits, 75% fewer urgent care visits 📉 That’s not just cost savings - it’s better access, better care, and a better experience for patients, employers, and communities. A true win-win-win-win. 🤝 Don’t be fooled by the billboard. Fast isn’t always better. Accessible, relationship-driven primary care is the real solution - and when implemented correctly, it changes everything 🚀

While in Spain 🇪🇸, I was impressed by the community-orientation of primary care teams and how care — and service planning — is data driven. Teams regularly conduct needs assessments of their community. In Vilafranca, I learned the centre routinely partners with the municipality on the needs assessment and hires an epidemiologist to conduct it. Part of the assessment is quantitative, understanding population demographics and disease prevalence. Another part is qualitative, with focus groups of community members to understand the most common health struggles & the types of services they would prioritize. Group education sessions conducted by the team are often done in the community e.g. in a church or community centre. Primary care centres have long-standing relationships with schools & day centres for seniors, often collaborating with them on relevant programming. Health promotion & disease prevention in the community are important activities for all primary care centres. The Villafranca team is located in a more rural community, about 45 minutes outside of Barcelona. To serve the surrounding small villages, the centre uses a hub and spoke model. The main centre is in town and open 8-8. But there are also smaller health posts in the villages which are staffed by a doctor, nurse and receptionist 1-2 times a week, for half a day. This enables patients to get planned care close to home—and for the team to be in touch with the needs of the broader community. For more acute issues when the post is closed, people would travel to the main centre and the doctors serving the villages rotate covering some shifts in the main centre. Centres generally have at least one doctor and nurse responsible for providing urgent care. I’m told patients can always get same day care for urgent issues. In fact, same day care is so easy, sometimes people walk-in to get same day access even though their issue is not acute. It’s one of the reasons why teams and regional planners are trying to put in place systems for more sophisticated demand management. Teams are also routinely given data on a number of different quality indicators including data on timely access, management of chronic conditions, prescribing and more. Data on timely access includes metrics for the % of patients who could get an appointment within 48hrs, 5 days and 7 days. The region measures this through audit of schedules. Managers get centre-level data and can compare their centre’s performance with other centres. Physicians get data on their own panel and can compare their results with peers at their centre (other MD names are anonymized). About 5% of MD and RN pay is based on attainment of quality measures. I should mention that the health centre managers/directors are generally physicians or nurses. They are highly engaged in resource management, improving quality and efficiency, responding to community needs, and more. Photos: a village health post at CAP Villafranca