Community PHC Accountability and Stewardship Framework for Ondo State

What happens when a community reports a problem at its Primary Health Centre, but nobody is clearly responsible for following it up?

This is a question I have thought about repeatedly during my work as a National Health Fellow.

I have visited all 38 Primary Health Centres in my local government and engaged health workers, community leaders, traditional institutions and residents. I have seen communities that are willing to support their PHCs, but I have also seen gaps in infrastructure, water, electricity, equipment and maintenance.

My policy idea is for Ondo State to establish a Community PHC Accountability and Stewardship Framework that connects community participation to clear government responsibility.

The idea is simple: communities should have a structured way to report problems, government should have a clear responsibility to respond, and both sides should be able to see what happens next.

The framework could:

• Give communities clear roles in identifying and reporting PHC challenges.

• Create a simple reporting system that routes each issue to the appropriate PHC, LGA or state authority.

• Assign responsibility and reasonable response timelines for reported issues.

• Include unresolved community concerns in periodic PHC performance reviews.

• Require periodic public reporting of major issues reported, actions taken and outstanding gaps.

• Recognise community stewardship in protecting facilities and equipment, while keeping funding, staffing and service delivery firmly within government's responsibility.

• Begin as a pilot across selected PHCs in different LGAs, with clear indicators such as response time, resolved issues, facility condition and community feedback before considering wider adoption.

This is not about asking communities to fix what government is responsible for.

It is about closing the gap between identifying a problem and getting the right institution to act on it.

Ondo State already has community structures and institutions involved in primary healthcare. Rather than creating another layer, this framework would strengthen the connection between those structures and the government systems responsible for responding to their concerns.

I believe this matters because a public health facility is more than a building. It is a public asset, and the people who depend on it should have a meaningful role in protecting it and ensuring that concerns about it are heard.

For me, good policy is not about creating something new for the sake of it. It is about seeing a real problem, understanding why existing systems are not fully solving it, and designing a practical way to close the gap.