How neglected PHCs leave many in Nasarawa without healthcare

PHC Giza (Photo taken by Stephanie Adams)

The Federal Government flagged off the Primary Healthcare Centres (PHC) revitalisation programme January last year. Several months later, PREMIUM TIMES visited 12 of the facilities across Nasarawa State and found only two of them under renovation. In the others, it was mostly the same case of a few ill-trained staff marking time in unequipped, dilapidated facilities, with a few local people paying them any attention.

The state’s Commissioner of Health, Daniel Iya, referred all enquiries about the revitalization scheme in the state to the Executive Chairman of the Nasarawa State Primary Health Care Development Agency (NAPHDA), Muhammed Usman Adis. But the chairman was not prepared “to speak to the press.”  So it was left to the reporter to make her own judgement.

Below is the account of what she found in seven of the PHCs in the state that she visited over the course of weeks.

PHC Giza

Giza is in Keana Local Government Area of the North-central Nigerian state. The mixed community of Alago, Gwandara and Tiv ethnic groups is about 30 kilometres drive from Kadarko, the headquarters of the LGA, through a dusty road. Apparently, someone once nursed a plan to tar the road but the project was long abandoned.

The poor state of the PHC in the community is typical of rural PHCs around Nigeria and the struggle of their staff to deliver medical care to patients. The centre, which was built 28 years earlier, is the only one in the community and is virtually unequipped and lacks basic amenities.

The centre is run on fund provided quarterly through the state’s Decentralized Facility Financing (DFF).  “I was transferred here a month ago, but we have a lot of issues,” Micheal Ogaja, the medical doctor and head of the centre told PREMIUM TIMES almost unnecessarily.

Water supply was one of these “issues”. The attendants fetch water from neighbouring houses for use at the PHC. Although there is a borehole, it packed up a long time ago, and the doctor was not aware of any plan to fix it.

Giza has not had public electricity for over seven years, so an inverter was installed at the PHC for power supply.

 “We put on the inverter at night for a maximum of three hours daily or when there is need for it, like when a woman is in labour,” Mr. Ogaja said.

The doctor said the facility attends to about seven patients daily, because “patients prefer private clinic”.

Aishatu Sani Okaku, the deputy chief attendant had been working at the centre since 1995. Speaking in Hausa, she said: “We don’t have enough qualified medical personnel, the facility is understaffed and we are overworked. As an attendant, I also work as a midwife, cleaner, errand person etc. And my salary is being paid in bits despite the whole stress, which is a problem for me and my family.

“There is only one security personnel in the facility who resumes at 5pm and leaves very early. I have been working here for the past 23yrs but I have not been properly promoted. My promotion stopped while I was in Grade Level o6, then I was demoted to Grade Level o4 before we were asked to go back to school.”

There was no patient in sight at the time of the visit by a Premium Times’ reporter. It seemed like the people of Giza were not too impressed with services being offered at the PHC.

In fact, the wife of the traditional ruler, called the Sangari of Giza, Umaru Elegu Abu, put to bed on the day of the visit, but in a PHC in another community. Even Mr. Abu could not trust the facility in his own community with the health of his family.

“I am not satisfied with the healthcare centre,” Yusuf Adamu Giza, popularly known as Okocha and an indigene of Giza said. “Each time I am ill, the medical personnel administer the same medication, irrespective of the situation. The last time I was here, there was no anti-malaria drugs at all; I had to go to the neighbouring village to buy some.”

A passer-by who would not disclose his identity interjected: “This primary healthcare centre is a disgrace to this community and Nasarawa State.”

He urged the government to renovate and equip the facility, and employ qualified medical personnel. “The staff should also be trained at least quarterly and be informed of new discoveries and research,” the interloper said before the reporter took her leave.

PHC Akwanga East

This Centre looked like an abandoned facility for a while. It was 7:54 p.m and the centre was in darkness and appeared to have no human inside it, until a coarse voice came through the broken gate: “Come inside now, why you stand for there?” The man who owned the voice appeared to be in his early 60s and had on a semi-white Lab coat.

Mr. Daniel, a community health extension worker (CHEW), was the only medical personnel on duty. He was waiting for 9 p.m to hand over to the next person. He had been working at the facility as a CHEW since 2014, when it was then a small structure before it was renovated as a Millennium Development Goals, MDGs project.

The facility is connected to public power supply but there was no electricity.

”When there is no light, this is what we use,” Mr. Daniel said, pointing at an old blue plastic lantern sitting beside him.

But there were other things to worry about, he would soon explain. “Water is also one of our major challenges here. We have a borehole but the pumping machine was stolen by some hoodlums and ever since we have been buying water from Mai ruwa (local water vendors)”.

He said the local government used to supply drugs to the facility until the Performance Based Financing (PBF) system was introduced in the state. He said the PBF sometimes sends money to officer in charge of to maintain the facility and pay the staff.

At the time of the visit by Premium Times, the drug store was empty. “It’s because there will be (a) series of transfer in two weeks, so the store was not restocked,” Mr. Daniel said.

At 8:18 p.m., a woman in her mid-20s was rushed in on an ‘Okada’ motorcycle taxi by her husband and sister. The patient was groaning and chanting a prayer in Arabic as Mr. Daniel laid her on a broken bench that served as a makeshift bed by the entrance of the facility.

The CHEW then left to search for the patient’s file from 2016 with the dim blue plastic lantern. In the 10 minutes before he returned, the patient kept groaning and praying in the eerie darkness.

Mr. Daniel later administered an injection on her under the dim light of the lantern.

PHC Koroduma Karu

The centre is located in the heart of Koroduma (One man village) in Karu local government area. As the reporter arrived the facility, she was greeted by a stench oozing from a detached structure of rusted zinc. To confirm her suspicion that it was part of the facility, the reporter asked to use its toilet. A young patient pointed towards the structure: “Na him be that, Aunty”.

The patient, Ladi Yohanna, who was lying on a wooden bench in front of the facility, said it was the only facility she could afford, though she lived several kilometres away. She was there for malaria treatment but had also been advised to take an HIV test.

Another patient, Rosemary Ambrose, was clinging to her one-year old child she said she had brought for malaria treatment. Mrs. Ambrose said patients were treated fairly at the centre, although the drugs were expensive and sometimes beyond what she could afford.

Jetuthan Dako, a Junior JCHEW, complained about the facility being regularly burgled because it is an open building with no security arrangement.  “You can see traces of feet and hand prints on the wall,” he said, pointing at the main building. “That is what happens all the time.”

The facility claimed to have 11 workers on the staff but the record indicated six medical staff and two non-medical staff. There were no qualified medical staff, only community health and extension workers.

“We resume at 8 a.m. and close at 6 p.m. because of the security challenges and depending on how busy work gets,” Mr. Dako said.

“Water is also one of the major constraints we have in this facility. We do not have water supply, we buy from ‘Mai ruwa’. ”

Mr. Dako said government stopped sending fund long ago, so the centre uses whatever it earned from daily treatment of patients to procure drugs and other basic medical needs.

Taking a tour round the facility, PREMIUM TIMES spotted an attendant serving as a nurse to a patient. Asked if it was part of her duty, she replied: “I sabi do am, na him make.”

PHC Gudi

The centre in Gudi was being renovated at the time Premium Times visited. It barely looked like an health centre.

Afinki Tanko, a Community Health worker, said the renovation had been going on for five months, so the centre relocated to the nearby building where the reporter met her.

The centre had only one ward and no bed, so patients laid on paper-like mattresses placed on wooden benches. The same room was being used for delivery and other activities.

The facility was said to have 36 workers but no documentation of the staff was available.

According to Mrs. Afiniki, the major challenge was lack of space as a result of the ongoing renovation. There was also no power supply, so lanterns and candles were being used by staff and patients.

At the centre, a patient paid N150 for registration card, much higher than at other facilities visited where it cost as low as N50.

PHC Kofar Fada

This dilapidated facility, surprisingly, is located directly opposite the palace of the Emir of Keffi. Although there were two wards, the over 20 patients in the centre at the time of the visit were crowded in the female ward. The Officer in Charge, Hadiza Adamu, said they were all out-patients, or visiting as she put it, although she said the facility runs 24-hour services.

The major challenge, she said, was power supply to preserve drugs and treat patients. The officer said the centre had power supply for a maximum of five hours a day. But there was regular water supply.

At the time of visit, the labour room was bare, because the delivery bed was broken. Yet some pregnant women were waiting for delivery.

The facility had no qualified medical personnel, doctors or nurses. Mrs. Adamu said there were two CHEWs, two junior CHEWs and six volunteers at the center.

PHC Wamba Kurmi

Abbas Sani, the Chairman of the Primary Health Care, said the facility was established in 1992 when Nasarawa State was part of Plateau State. Although it looked better than most of the others visited by Premium Times in the state, the centre also lacked basic amenities like the others.

A CHEW, Grace Magi, who was transferred to the facility two years ago, ran the place with three other employed staff and six volunteers. An old man of about 70 years was the sole security official.

The facility opens for 12 hours daily, because of lack of manpower. There were five beds in its two wards. At the time of visit, there were no syringe or drugs.

Mrs. Magi said the centre had of late not been receiving any form of grant or support from government, which made it difficult to run it efficiently.

Maryam Saidu, a 19 year-old woman, who was eight months pregnant, was around for treatment at the time of the visit by Premium Times. “I am being given proper medical attention and the medical personnel treat me like their daughter,” she told the reporter.  “This has been my registered health centre since I found out I am pregnant. As soon as I put to bed, I intend to go back to school.”

PHC Agwatashi

This is one of the three primary health care centres in Nasarawa State selected by the Federal Government for renovation under the PHCs revitalization scheme.

A plaque announced to the visitor that the centre was commissioned on November 9, 1988 by Aliyu A. Umar Kama, a Nigerian Army Lt. Col. Who at the time was the Military Governor of Plateau State. This means the facility was established nine years before Nasarawa State was created.

The Officer in Charge, Ayuba Adole, was reluctant to speak with our reporter. “I will not entertain any form of interview from you except I am given an order to do so by the Director,” he said brusquely.

When a call was put through by PREMIUM TIMES to the Director, Adamu Ladan, for permission to speak with the officer in charge, he gave the go ahead but warned him to be mindful of what he said.

The facility is not much better than the others visited, aside the fact that it is spacious, with a large number of patients from different locations.

Mr. Adole said: “the facility does not lack basic amenities, it is fully-equipped because this facility is supported by the Decentralised Facility Financing (DFF). Most of the funding sent to this facility is by the DFF and we make judicious use of it, as you can see”.

There was a functional borehole supplying water round the clock and a generator to supply electricity mostly at night whenever the Inverter was out of service.

There were two security men, six medical staff, six voluntary staff and one NYSC Corps member. Though Mr. Adole said the lack of trained medical personnel and vehicles for transportation of transferred patients were the major challenges of the centre.

A tour round the facility showed that it is functioning and well-equipped. It boasts of equipment such as a cold room, staff quarters and a well-stocked drug store. The situation of this centre is way different from those at other centres visited in Nasarawa State, indicating the world of difference that a speedy and faithful implementation of the PHCs rehabilitation scheme can make to primary health care delivery in Nigeria.

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