New Telegraph

Inside Nigeria’s Sick Primary Health Centres

•Patients Urinate In Plastic Containers And Dispose Later
•We’ve Launched Upgrade Of 20 Phcs In The Five Divisions –LASG

Primary healthcare is, according to experts, the first point of contact at the community level and where minor health challenges with the potential of escalation are detected early. However, inadequate funding, lack of equipment, insufficient workers, lack of potable water and inconsistent power supply have contributed to render most of the PHC’s across the country, almost comatose, reports Isioma Madike

A visit to Egbiri Primary Health Centre, in the Ayobo area of Lagos State, revealed a lot. The reports in the media space in recent times propelled this reporter to pay a disguised visit to the centre. While there, patients, mostly women, were seen discussing the terrible condition of the PHC. They alleged that patients urinate inside plastic containers and dispose at a later time because there is no proper toilet system.

They said that the ones provided when the centre was built got spoiled and that little or no effort has been made to effect the repairs ever since. Add to that is the issue of scarcity of water in the centre. Sensing greater danger, selfless community members occasionally take it as a challenge to render some help in this direction, said one staff member who does not want her name in print.

“They come in at times to help the centre with water. But for them, an epidemic would have broken out at the centre,” she added. With a handful of health workers and some volunteers, the centre only manages to carry out skeletal duties, treating those with minor ailments and running tests for both malaria and typhoid. There is also epileptic power supply in this centre.

The two medical fridges sighted at one corner of the building are said to be powered by solar panels. At the moment, only one of the fridges is working, the other one is faulty. Even the one functioning usu- ally does not work well because of the rains which make the solar panels in- effective most of the time. Other equipment in the centre are either damaged or not working as they should.

A nurse, who also pleaded not to be mentioned, told one of our reporters that patients shy away from coming to the centre because of these complaints. “We also don’t have a doctor here. We only refer medical issues we can’t handle to other hospitals, mostly the nearest general hospital within the vicinity,” the nurse said.

The centre also has a defective protective fence, making miscreants and domestic animals to frequently intrude on the premises. These disruptions of- ten compromise hygiene and safety standards of the few patients who visit the centre. The centre serves as the only health facility for the entire residents. The road leading to the community is an eyesore, disfigured by deep gullies caused by erosion.

This makes it difficult for residents who wish to access the health centre. Despite the state of the PHC, residents said it is manageable to an ex- tent because one or two workers would come to attend to them. A mother, who claimed to visit the centre intermittently, told our reporter that others like her still visit the centre because “we have no better option.”

She couldn’t hold back her frustration, saying she is disturbed about emergency cases, especially of infants and other children in the community. She said: “When our children have a cough, catarrh and cold, even though those might be normal with children, we need qualified staff to attend to them. This is why we are pleading with the government to help renovate the health centre and bring back qualified nurses. “The government can also arrange with the NYSC to post doctors to the centre.

We need a standard PHC in the community, if for no other reason, because of emergencies. “There are no drugs in the centre either. The nurse who attends to a few people that visit the centre would normally ask patients to go outside and buy their drugs. We go to the health centre because we believe that any drug we receive is original.

“So, when you tell a patient like me to go and get the drugs outside, that in itself could be discouraging.” The situation in Egbiri mirrors the state of primary health centres across the nation. It is a shame, according to a Professor of Clinical Virology, Maduike Ezeibe that PHCs, which are supposed to be the first point of contact for people in communities, are in neglect and ruins. Many of the structures are dilapidated with heavy cracks that need to be mended.

Staffing and drugs, which are supposed to be important ingredients of these centres, are also not to be reckoned with. These are foundations that need to be fortified to ensure a resilient defence in case of a new enemy, such as pandemics. Dr. Rotimi Adesanya, a Fellow, Academic of Public Health, also referred to primary healthcare as the most important stage in healthcare service delivery.

Adesanya insisted it is the first level of contact where minor health challenges with the potential of escalation are detected early. Another family physician, Dr. Nnamdi Akabunma, believes there is a disparity between primary health- care in urban and rural areas due to poor governance that exists as one moves farther away from the state capital. Although primary healthcare, he also said, should be under the purview of local government areas, he noted that the LGAs themselves are either dysfunctional or non-existent.

A senior health economist at the World Bank, Ayodeji Ajiboye, was once quoted to have said that the healthcare sector in Nigeria still suffers from inadequate funding, includ- ing a lack of investment in primary health care by the states. Ajiboye quoted WHO as saying that primary healthcare is critical to making health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services.

The world health body has always insisted that PHCs are the “front doors” of the health system and “provide the foundation for the strengthening of the essential public health functions to confront public health crises such as COVID-19.” The Lagos State government while acknowledging this rot in the PHCs stated that at least 60 percent of them are not in desirable state.

But in a move to address this anomaly, the Lagos State Primary Health Care Board (LSPHCB) launched the upgrade of 20 PHCs in the five divisions of the state to enhance quality healthcare services.

ABUJA

The Isokan, Ojokoro story is not different at the PHC located at Byazhin in Kubwa, on the outskirts of Abuja, the nation’s capital. Lack of equipment, inadequate workers, shortage of water and inconsistent power supply have all conspired to make the centre a no go area for patients, who need its services.

As a result, patients now prefer to go to distant General or district hospitals, ignoring the heavy transportation and long waiting time to access care due to the crowd and heavy burden on available resources. A Nurse, who identified herself simply as Laura, works at the centre. She told our reporter that they hardly get patients who visit the centre.

She said: “I must confess, work is easy for us here because we hardly get patients. Even when there is an emergency, you still find people looking for a vehicle at the dead of the night to convey someone in dire need of medical attention either to a private clinic or general hospital. That’s the situation here. It’s also the situation in most other rural centres within the FCT.”

She added that pregnant women around the area were more comfortable going to Kubwa General Hospital or other bigger government-owned or private hospitals to deliver their babies because of the lack of basic facilities in the centre.

KWARA

Similarly, primary healthcare delivery services in Kwara State prior to the emergence of the administration of Governor AbdulRahman Abdul- Razaq in 2019, were in shambles with dilapidated buildings, inadequate personnel and equipment. But, the governor is currently changing that narrative.

According to the Executive Secretary of the Kwara State Primary Health Care Development Agency, Dr. Nusirat Elelu, “one of our core responsibilities is in terms of health education and health promotion because we know that prevention is better than cure. “So, primary health care is involved in advocacy, sensitisation and stakeholders’ engagements to ensure that people are all aware of certain health conditions with a view to preventing their occurrence. “One of our achievements is in terms of the supplementary immunisation activities.

It will be recalled that in the past, there had been non-payment of counterpart support funds because usually when we have supplementary immunisation activities, the development partners supporting us will expect the state to also provide its counterpart support funds to enable the state to benefit.

“The partnership has enabled us to reel out Polio vaccination campaigns. For this year alone, we have vaccinated over four million children in four different rounds and I’m happy to say that in the last round, all the 16 local government areas in Kwara State passed the Lot Quality Assurance sampling test. “Also, in the area of immunisation, the agency has successfully introduced the measles 2 vaccines at 15 months. It will be recalled that all vaccination activities with children end at 9 months.”

On infrastructure, Elelu said the administration has made some strides in terms of infrastructural upgrade of primary healthcare facilities, adding that the state’s PHCs, which are over 600, had witnessed a lot of decay over the years. Besides, she said that the state government committed millions of naira to equip the primary health centres.

“What I did when I assumed office was to carry out a need assessment of our primary healthcare centres, but we realised that we cannot renovate over 600 healthcare centres in one fell swoop. We then decided to have one functional primary healthcare center in each of our geo-political wards in the state.

“We have 193 geo-political wards, so after the completion of one functional facility per geopolitical ward, we decided to move on to renovate two facilities in each of the political wards, making 386 facilities in Kwara state. “So, obviously if every ward has got two primary healthcare centres, that will increase the quality of health- care delivery services and if we can maximise the number of our health workers, we will be able to run 24 hours’ services in our facilities.

“The Kwara State government, through the Ministry of Health, has renovated more than 25 primary healthcare centres in the state and we hope to do more. This is going to be in phases, there are some facilities that we have to make direct interventions, while some require significant interventions like that of the Baboko-Alapata, Adewole, among others.

“We also have some facilities on queue like that of Tanke and Fufu, and as soon as we have additional fund- ing, they will be renovated,” she said. On personnel, she said for the first time in the history of the agency, 42 nurses were recruited in 2022, adding that they were judiciously deployed in the PHCs based on needs. Besides, she disclosed that additional 83 health workers, including the community health extension workers, junior community extension workers, pharmacy technicians, health attendants, were recruited by the government.

Notwithstanding the strides of the administration in this sector, it is still not Uhuru yet as there are still some gaps to be filled, which Governor Abdulrazaq also consented to at some public forums.

BAUCHI

Despite the efforts of the Bauchi State government, there are dilapidated PHCs that need urgent renovation, especially in the rural areas. The Permanent Secretary, Ministry of Health Bauchi, Ali Babayo, who gave an overview of the ministry under the present administration, said that the governor has upgraded and renovated facilities inherited by the previous administrations and constructed new ones.

Babayo added that an embargo on employment was lifted for health workers in the state to fill up the existing vacuum in the sector. Similarly, he said that the ministry got a budget allocation of 15.2 per cent, which is higher than the Abuja declaration on this year’s 2023 budget.

On his part, the Executive Chairman of the PHCDA, Dr. Rilwanu Mohammed, said the present administration has renovated and upgraded 192 facilities across 20 LGAs. “We have also built 14 new PHCs, and trained as well as retraining 225 person- nel from different cadres for optimal performance and effective and efficient service delivery to the patients at the facilities,” he added.

CROSS RIVER

Cross River State has been lucky in the last eight years to have had directors-general in charge of PHCs in the state. Besides, distribution of medical commodities to all PHC facilities in the Central and Northern Senatorial District using Drones (Zipline Company) was applauded by many.

The state also partnered with USAID medicines technology and pharmaceutical services for the supply of more medi- cal commodities to the state, among other achievements. But there is the need to strengthen the available manpower at the primary healthcare centres across the state to give confidence to rural dwellers and to justify funds spent on the various facilities by the government.

NPHCDA REACTION

Recall that a few months ago the National Primary Health Care Development Agency (NPHCDA) had said that 25,380 PHCs in the country do not have the required number of skilled birth attendants. According to Dr. Faisal Shuaib, only 463 PHCs representing 1.8 per cent of the 25,843 have the minimum number of four skilled birth attendants per facility.

Shuaib, who added that besides the gross inadequacy, there was the problem of unequal distribution of available skilled birth attendants in the PHC facilities, said the agency in a bid to address the challenge came up with an innovation called Community-based Health Research, Innovative-training and Services Program (CRISP), to leverage the rural posting of Resident Doctors.

According to him, the intervention would specifically focus on increasing, retaining and improving the quality, adequacy, competency, and distribution of a committed multidisciplinary primary healthcare workforce that includes facility outreach and community-based health workers supported through effective management supervision and appropriate compensation.

He had said: “CRISP aims to leverage the rural posting of Resident Doctors from teaching hospitals to boost and guarantee the quality of care at the PHC level through their active involvement in primary health service delivery. “This is targeted at improving Reproductive, Maternal, New- born, Child and Adolescent Health, amongst other health services within the benefiting communities.

“Human Resources for Health (HRH), particularly Skilled Birth Attendants, such as Medical Doctors, Midwives, Nurses, and Community Health Extension Workers (CHEWs) that have been trained on how to manage emergencies would be recruited and deployed to priority PHC facilities across the country.

“We find it extremely important and helpful that we address the human resource for health gaps in our PHCs because 80% of the incidence of maternal and child deaths in Nigeria occur at the community levels, largely due to the lack of services of skilled health workers in the PHC facilities.

“Unfortunately, the primary health care centres are the most unattractive to our skilled health workers who prefer to be stationed at urban secondary and tertiary health facilities.”

•Additional reports by Regina Otokpa (Abuja), Stephen Olufemi Oni (Ilorin), Nasir Shuaibu (Bauchi) and Clement James (Calabar).

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