Manpower shortage and deficient infrastructure, especially inadequate equipment and power supply, are the major obstacles to meaningful primary health care delivery in Nigeria, an investigation by PREMIUM TIMES has revealed.
The All Progressives Congress-led federal government under President Muhammadu Buhari has anchored its public health agenda on a scheme to revitalize primary health care, PHC, facilities across the country “to avail poor Nigerians with qualitative and affordable health services”.
The initial plan of the administration was to build new primary care centres but it later tweaked this plan last year to revitalizing 10,000 existing centres. The scheme, dubbed the National Primary Healthcare Revitalization Initiative, and assigned to the National Primary Health Care Development Agency, NPHCDA, and the Federal Ministry of Health, “aims to make at least one primary health care centre fully functional to deliver a number of services in each of the wards across the country”.
President Buhari flagged off the scheme on January 10 when he commissioned the renovated Primary Health Care Centre in Kunchigoro, a suburb of Abuja. The centre was adequately staffed and fully equipped, including with ambulances and drugs, and has since been providing services to the appreciation of patients.
But that is not the case in most other primary health care centres in the country.
A visit to Asata Primary Health Centre in Ogui community, Enugu North Senatorial District of Enugu State revealed the poor state typical of these centres around Nigeria and the struggle of their workers to deliver services to patients, especially at the grassroots.
“We use torchlight or our phone light to deliver women at night or whenever the room is dark”, an official at the centre in Asata told our reporter on condition of anonymity to avoid victimisation.
“Though this facility looks very small, a lot of people visit here on a daily basis. But because of lack of funds, people have been suffering severely to the extent that some of our staff cannot even afford transportation fares to come to work on daily basis.
“We don’t have enough staff in the centre; we lack adequate manpower”, the official stated.
“We are supposed to have cleaners, night watchmen and care takers, but we don’t have any. The building is too small and not conducive at all. As you can see, all the nets and windows are gone.
“The issue of light (lack of electricity supply) has been on for a long time. For over a year, we had no light at all; not even for a day. When there was no light, we just used our torch lights or phone light. That’s the only option. There is a standby generator but it has been faulty for a long time.
“Considering the fact that we run two shifts, both morning and night, light is needed. So recently, we borrowed money to fix the light. We need light to preserve our vaccines and to take (birth) deliveries at night. So, we went to good spirited Nigerians to lend us money. We are still owing that money up till now.
“Despite all these challenges, women prefer having their babies here. In a month, we have between 17 and 20 deliveries”.
Asked what she expected from the federal government’s revitalization scheme, the official eagerly unfurled her shopping list.
“We want the Federal Government to expand this building for us as this is a centre that serves so many people. Expansion and equipping of this building will make it more conducive and friendly for both the workers and the patients.
“We have only five rooms and OPD (Out Patient Department) here. If the government can put up five more rooms, it will be good for everyone.
“We also call on them to train our staff. We need to be updated of recent discoveries, to enhance our knowledge on how to handle certain health issues. If the staff here can be updated, especially in child bearing, it will help us work better”.
Other members of staff joined in to remind her of the lack of ambulance or any vehicle that can be used in cases of emergency. She stated that patients who needed to be transported to other locations either use “Keke” (tricycle) or get a taxi.
At the Primary Health Centre, Kuduru in the Bwari Area Council of Abuja, it was discovered that there has never been any form of power supply in the past four years since the centre started operating.
“We have never had light or water in the centre” said an official who also prefers not to be named.
The centre was commissioned in May 2011 and started operation in 2013.
“In all these years, we have never had light or water. We buy water on a regular basis from Mai ruwa (water vendor)”.
Asked how the centre operates at night without light, the official said “We run only one shift daily. We resume 8 a.m. and close by 4 or 5 p.m., depending on the day’s work.
“When there is a delivery and the labour room is dark, we make use of rechargeable lamp. That’s the only option since we do not have a standby generator.
“The residents already know our plight and the reasons we close early, so when there is a case of delivery after that time, they go to other health clinics”.
At the Primary Health care centre in Dutse Makaranta also in the Bwari Area council of the Federal Capital Territory, the story was like a recap of the earlier ones in this report.
Except that light is not a primary challenge in the facility, as a standby generator is available. The building, however is dilapidated and would almost not pass for a place where people receive treatment and are delivered of babies.
“As you can see madam, the building is too old and not conducive at all”, said one of the nurses on duty.
“We usually have large number of patients every day, so we need the building to be renovated to ease our work and keep the environment neat”.
At the Primary Health Care Centre in Idu Karmo also in the FCT, however, power supply is expectedly a big problem.
But, according to a source, the staff contributed money to purchase a solar facility which now provides power at the centre.
“Once there is no light, and since we do not have a standby generator, we use the solar. We bought the solar because of the innocent patients that visits the clinic on daily basis. We cannot continue to wait for the government”, a worker at the centre explained.
Many Nigerians who have to use the primary health care centres across the country will be eager to see what the 2017 Budget, which was passed by the National Assembly on Thursday, has for the centres within the revitalization scheme of the President Buhari administration.
The National Primary Health Care Development Agency, NPHCDA, is a parastatal of Nigeria’s Federal Ministry of Health with policy and oversight roles on PHC implementation at the state and local government levels in Nigeria. Allocation proposed for the agency by the federal government in the 2017 Budget is over N19 billion (N19,212,923,655) including cost of rehabilitating some of the PHCs.