One year after the Federal Government flagged off a scheme to revitalise 10,000 primary healthcare centres across Nigeria to make them ‘fully functional’, PHCs especially in rural Nigeria remain in poor state.
Under the first phase, the federal government which is collaborating with the lower levels of government and development partners in the scheme, said it will work on a PHC in each of the country’s 109 senatorial districts in Nigeria. This means, three in each state and one in the Federal Capital Territory.
PREMIUM TIMES in February randomly selected and visited some PHCs in Kano and Kaduna states in the North-west region of Nigeria and found that very little work had been done.
The Primary Health Centre in Shuwaki is one of the three selected for renovation by the federal government in Kano State. Shuwaki is a village in Kunchi Local Government Area of the state.
As the reporter approached the facility, it became clear that it was still awaiting any kind of makeover. A part of the main gate was falling apart, grass covered the entrance to the main building and the paints were peeling off the walls. The dilapidated PHC was built about 18 years ago and is the only health facility in the community. But it has been provided no equipment or personnel to play the role for which it was built.
“We do not have a doctor or nurse,” the officer in charge of the centre, Ado Mohammed, told PREMIUM TIMES.
According to Mr. Mohammed, the workforce consisted of five Community Health Extension Workers (CHEW), one Junior CHEW and a lab technician.
“We don’t have qualified medical personnel and the facility is understaffed. The CHEWs take deliveries of pregnant women and also attend to patients. When there is any case we cannot handle, we refer to Bichi General Hospital, which is about 30km from this centre.”
The building is old and the beds inside the wards just as dilapidated. Mr. Mohammed said lack of water supply was one of the big problems. “We buy water from our own pockets,” he said.
Power supply is epileptic and the centre has no generator or inverter.
The centre also has no ambulance. “When there is a need for referral, we tell the relatives to provide a means of transporting the sick person. So, they hire a bike or vehicle to convey the patient to the general hospital,” Mr. Mohammed said.
Aisha Sani, a laboratory technician has been at the centre for over five years. “Since I have been working in this facility, no renovation has been done. The way I met this place, that is the way it is. No water, the toilet is very bad and no resources at all for a standard health centre.”
Mrs. Sani said she stopped running HIV tests at the facility when the authorities stopped providing test kits.
“The last time an HIV test was conducted in this facility was about three years ago. Whenever we request for test kits, we don’t get them. So we stopped requesting and since then, we don’t run HIV tests here,” she said with a shrug of the shoulders.
Aminu Musa, a CHEW, was seen administering an intravenous injection on a patient. He does stuffs like that because there is no qualified doctor, he explained.
Mr. Musa said the state government provides some drugs, such as anti-malarial and antibiotics, which the centre dispenses to patients free of charge.
A patient who identified herself as Mariam confirmed this. She had been using the facility since 2013.
“I had my baby here. It is about 15 minutes’ walk from my house, so I come here for treatment. It is the only health centre in Shuwaki so I don’t have a choice. They give some drugs free of charge, while we pay a token for some other drugs”.
The sorry state of PHCs in Nigeria is fully reflected in the abandoned centre in this village in Ungogo Local Government Area of Kano State. Located within a thick bush, the facility was under lock and key at the time PREMIUM TIMES visited.
Through the broken windows, walls and doors, the reporter could see rats and insects that had taken it over. After about 15 minutes, the reporter’s inspection of the facility was interrupted by the arrival of a young man in his early 20s.
Musuba Yahaya brought out a key from his purse and opened the gate. The reporter accessed the rooms, old and dirty and covered with cobwebs. The ceilings appeared ready to fall off.
Mr. Yahaya is not the gate or security man. He is a CHEW, he told PREMIUM TIMES. Since the facility was built in 2008, no renovation had been done, he said.
“This facility is an empty building and there is actually nothing going on here.
“Whenever there is a patient, those people over there (pointing towards a group automobile mechanics) will call me and I will give the patient the drug available. There are no drugs now. We refer patients to Waziri Shehu, about six km away or Murtala General Hospital, which is 15km away.”
Mr. Yahaya said the facility ‘serves’ eight villages.
“Binta is in charge of delivery but she is out of town now. She is a graduate of School of Food Hygiene. There are no nurses or midwives in this facility. We only have one CHEW, one JCHEW and one volunteer health worker,” Mr. Yahaya said as he gave a rundown of the operation of the PHC.
“We do not have enough health workers, no ambulance, no equipment, no light, no generator, no toilet, no water,” he said in response to the reporter’s inquiries.
The village head, Umar Chiromawa, said no individual or government official had been around to inspect the facility, “not to talk of renovating it.
“This facility was built in 2008 and ever since then, nothing has been done. As you can see, the building is old, the windows are broken, no equipment, no adequate manpower and no resources at all. And even the CHEWs and JCHEWs that are assisting us here are not being paid,” the village head said.
“Government should renovate this facility and also equip it for our community. Other hospitals are far from this community and cannot be easily accessed. About eight other communities depend on this health centre, so the government should make it a better place to (deliver) health services,” Mr. Chiromawa said.
PHC Tsangaya Damagar
This centre is located in Doguwa Local Government Area of Kano State. It was 10:15a.m when the reporter arrived. She observed the facility had just been renovated, but it was empty. The main gate laid slightly open but the door of the building was closed, although not locked.
The rooms were newly painted and the environment neat, but there were no equipment to be seen. The labour room was bare. Some record books were left carelessly on an old wooden table, an indication that someone had been in the facility earlier that morning. By 12 noon when the reporter left, no staff had showed up at the centre. Only a man of about 45 years had.
“My wife left the house last night with my sick child that she was going to the health centre and since then, she hasn’t come back home. So I came to check on her but she is not here. I don’t know where they took my wife,” the fragile looking man said before hurrying away on his bike.
All efforts to locate a worker at the facility failed: no resident knew the whereabouts of any of them.
PHC Unguwan Shanu
From afar to a close up view, the facility was welcoming with its gate and building wearing a new coat of creamy orange paint. It is one of the three centres in Kaduna State selected for renovation by the federal government. Located in this community in Kaduna North Local Government Area, the centre is sited to provide care for about 28,000 people from seven villages, including Unguwan Shanu. But despite the evident renovation of the building, basic equipment and manpower remained to be provided.
In a brief conversation with the reporter, Hauwa Ahmad, a medical lab technician, pointed out that the facility was renovated but not yet revitalised. She said the factors that make a fully functional health facility were still missing.
“The government has done well by renovating the building but they should do more on the inside than the outside,” Ms. Ahmad said.
“The building is beautiful and neat on the outside but we lack adequate equipment inside it. There are cases we should be able to handle in this facility but because of inadequate equipment, we refer to Kawo Comprehensive site, which is about 45 minutes’ walk from here. So the government should provide equipment because we are willing to work but the equipment are not there,” she said.
“This building was renovated in 2017 by the state government, in collaboration with the federal government,” the officer in charge of the centre, Ruth Yakubu, later explained.
“As you can see, the paintings are still very new and clean and the environment is also clean but that is all that was done. The government did not provide us with equipment that will make our work easy and effective,” she said.
Pointing to an abandoned room, she said, “We do not even have a labour ward, talk less of equipment for delivery. That is the corner we use for delivery. We do not have an ambulance or even a small car that can be used for referrals or in cases of emergency. So whenever there is a need for referral, the relatives of the patient hire keke or borrow a vehicle to transport the patient to the destination,” she said.
The chairman, Facility Health Committee, Unguwan Shanu, Garba Mohammed, lamented that the centre lacks adequate staff to attend to the thousands of people that access it.
“We have only seven workers and the work is too much for them. We only have one nurse, six Community Health Extension Workers (CHEWs), no doctor or pharmacist at all. So, we need the government to employ more workers to reduce the workload on our staff. About 28,000 people access this centre, people come from six other villages to get medical service here.
“The issues of water and electricity supply are also of great concern. Though we have a solar-powered borehole which the state government mounted for us, we still buy water, as the borehole is not yet functioning,” he said.
However, a patient, Bilkisu Abdul, said the centre was providing service to the people “to some extent.”
Speaking in Hausa, she said “I have been visiting this hospital for a long time. I had my three children here and I enjoy their services. Whenever I come here for treatment or bring my children for treatment, I pay for some of the drugs. The workers do not collect any fee for immunization, it is given to the children free of charge. The workers are kind as they attend to us as soon as possible whenever we come for treatment,” she said.
PHC Kwarbal B.
After several hours driving through bumpy roads, due to wrong directions by passersby, our reporter arrived at the newly renovated health facility. Located in the old city of Zaria, Kaduna State, most of the residents did not know about PHC Kwarbal B.
The reason, though, is not farfetched. When PREMIUM TIMES visited, the centre had just been handed over by the House of Representatives. Until the renovation in 2017, it had been abandoned for several years, so residents were not yet aware of its changed fortune.
Lawal Mustapha is a staff of the state Ministry of Health deployed to head the renovated facility.
“This facility was handed over to the local government a week ago, so we are just a week old here. All the manpower are from the National Tuberculosis and Leprosy Centre. A House of Reps member brought all the equipment as directed by the federal government, so for now we have adequate equipment in the facility,” Mr. Mustapha said.
As we drove into Kagarko Local Government Area of Kaduna State, we caught sights of men butchering rams, women cleaning homes or bathing kids in front of huts, and teenagers gathering firewood. We must be very close to Iddah where the PHC we were looking for is located.
But it took a few more kilometres to finally arrive Iddah. The environment of the health centre was eerily silent, like a graveyard; until a bike passed by to change the atmosphere. We drove through a wide-open black gate into an empty building. After almost 20 minutes of waiting and still nobody to be seen, we pleaded with a boy outside to call anybody who works at the facility. The boy soon returned with a young man in his early 30s.
Obadiah Matthew is a CHEW. He was the only worker available at the moment and was only washing behind the building while we waited, he said. He said the building was renovated in 2017; and that was all that was done about the facility.
The surrounding is neat and the building new. Viewing from outside, one would think activities were going on inside the building . But one would be wrong. A tour of the facility showed it could not be functional, as major equipment, manpower, and other resources were missing.
The centre has no ambulance, so patients provide bikes or other vehicles during an emergency.
“We do not have equipment in this facility, I cannot even say adequate equipment,” Mr. Mathew said.
“We just need a few equipment, even if they are just tools for our labour room and other small ones. The light here is not stable so when there is no light and we need to take delivery, we use phone lights or torch lights. The patients understand though; they know we are trying our best. They are also aware we do not have a generator.”
The facility has no qualified medical personnel – doctors or nurses. The CHEWs treat patients ad take deliveries of pregnant women.
“Though the facility does not meet all our health needs, it is better than none. They still give us some drugs,“ a patient who walked in some minutes later said.
Speaking in Pidgin English, the patient who simply identified herself as Blessing, said the general hospital in town is too far away so people around use the PHC. She said drugs are dispensed to them at a subsidized price.
In an interview with Premium Times after the visits of the PHCs in the two states, the Executive Director, National Primary Health Care Development Agency (NPHCDA), Faisal Shuaib, said the revitalisation scheme of the federal government will be implemented over the course of several years.
“What the government is doing is putting funds dedicated from the Saving One Million Lives programme and we are renovating health facilities. Apart from renovating it, before it is said functional, it needs manpower, equipment, utilities and drugs.
“All of that is happening. Maybe some of the health facilities that you have gone to have not been handed over to the communities because we do not even have the human resources.
“We have started the process of mobilizing about 1,600 basic midwives who will be deployed to help manage some of the health facilities. We are looking at also getting funds from the Basic Health Care Provision Funds which hopefully will provide the resources to equip and provide commodities for some of these health facilities,” he said
Mr. Faisal said it will be a misunderstanding of the plan of government to say just 109 centres would be revitalised.
“There is a whole lot more than the 109 health care facilities that are going to be renovated,” he told PREMIUM TIMES.