At dawn on August 15, 2021, Aisha Mohammed noticed Habib, her five-year-old son’s temperature was high and his bed sheet was badly soiled. He had vomited and stooled over the night.
Startled by the unexpected illness, she rushed to the open well outside the house to fetch half a bucket of water and dipped a piece of cloth in it which she used to gently massage his body, hoping it would put him to rest.
It did but for an hour. After that, the vomiting and stooling increased, coupled with restlessness. Left with no other option, she rushed to the Primary Health Centre (PHC) in her community, Katanmi, and met 20 other patients with a similar condition.
The doctor diagnosed her son with cholera, which was said to have been caused by consumption of contaminated water.
At Mrs Mohammed’s home, the open well outside is just six metres away from their toilet and this is common in almost all the homes in the community, according to the health officials.
But the health facility’s poor state and inadequate medical supplies forced the doctor to refer her to the general hospital in Silame local government of Sokoto State, 20 minutes from Katanmi, which is a lot of time depending on the critical condition of the patient.
These constant referrals, for which many cannot afford the transportation fare, is one of the contributors to increased deaths in the community.
To get to the general hospital, the residents pay either N350 for a cab ride or N500 for a motorcycle taxi. But the health workers said many residents who cannot pay the fares, usually resort to herbs and local means to treat the sick, giving them a slim chance of survival.
Health workers said this alternative has led to the death of hundreds in the community, which could have been avoided if the PHC was fully functional.
While this is the ritual for many residents in Katanmi, Mrs Mohammed used part of the money meant to stock her shop to transport her son to the hospital for proper treatment. He survived.
Promised revitalisation of PHCs
In January 2017, President Muhammadu Buhari flagged off a scheme to revitalise 10,000 PHCs across the country to avail poor Nigerians with qualitative and affordable health services.
Under the revitalisation plan, the Buhari administration, through the NPHCDA and the Federal Ministry of Health, said it would make at least one PHC fully functional in each of the wards across the country.
In the first phase of the plan, the government selected a PHC in each of the 109 senatorial districts, meaning three in each state and one in the Federal Capital Territory. The Kantami PHC in Silame Local Government Area of Sokoto North senatorial district is one of the 109. State and local governments, as well as development partners, were expected to complement this gesture
PREMIUM TIMES findings show that although their services are mostly free, the primary health centres are largely underequipped or nonfunctional, despite funding from the annual allocations of the Basic Healthcare Provision Fund.
In December 2017, the federal government initiated a N28 billion health fund that targetted the revitalisation of the PHCs, which the then Minister of Health, Isaac Adewole, said would be rolled out in 2018.
As of December the following year, 4000 PHCs across the country, according to the Executive Director of NPHCDA, Faisal Shuaib, had been renovated.
PREMIUM TIMES exclusively obtained the list of the 109 PHCs to be revitalised in the first phase and visited some PHCs in Borno, Nasarawa, Ebonyi, Ondo, Kano, Benue, Niger and Kaduna states and found that very little work had been done on the facilities.
This corroborates a 2017 study published in Researchgate titled “Primary Health Care in Nigeria: 24 years after Olikoye Ransome-Kuti’s Leadership”, which said only 20 per cent of the 30,000 PHCs across Nigeria were working.
Dilapidated facility, staff shortage at Katanmi PHC
The blueprint of the National Primary Healthcare Development Agency (NPHDA) requires that a standard Primary Health Centre has a well-open ward, labour room, children and female wards, doctor’s office and staff quarters, an ambulance for referrals, drugs and equipment for immunisation, preventive and basic curative care. But Katanmi PHC is a far cry from the outlined requirements.
When PREMIUM TIMES visited the PHC in Katanmi in September 2021 during the rainy season, the reporter’s first sight was a four-year-old boy carrying a black bucket on his head as he meandered through a large pool of stagnant water from which he had just fetched, at the front of the health centre.
Health officials ushered the reporter through another route into the facility, which was not any better as the path was muddy. The entrance of the second route is a broken fence surrounded by outgrown grasses and filthy latrine toilets at the corners of the centre’s premises.
A more terrible sight would be difficult to imagine. Entering the facility, the reporter noticed a ceiling board dangling from the top while some pieces litter the floor in different corners of the building.
In the wards, most beds either had worn-out mattresses or were without one. Some patients were seen lying on piled cartons fixed to the iron-framed bed.
Most of the offices had empty packs of syringes and drips scattered on the floor, worn-out tables, chairs and shelves. The toilets in the facility were covered by cobwebs and dust. The only neat area was the maternity ward cleaned by the head of the unit. The centre does not have cleaners.
Mohammed Mohammed, the Officer In Charge of the PHC, said the facility was established in 1999 by the Association of Local Governments in Nigeria (ALGON) and later renovated in 2013 under the Millennium Development Goals/Conditional Grant Scheme, a project of former President Goodluck Jonathan’s administration. They fixed the ceilings and painted the building then, the official said.
Contrary to the promise of the Buhari administration in 2017, the revitalisation exercise is yet to reach the PHC in Katanmi.
Erratic power and water situations cause death among pregnant women
A year before the renovation during Mr Jonathan’s presidency, in 2012, ALGON bought the centre a generator but it got bad in 2016 and has since not functioned due to paucity of funds. Consequently, the borehole and water storage are no longer in use since the generator developed a fault.
The only presence of water is the stagnant pool surrounding the facility caused by a lack of drainage channels which breeds mosquitoes during the rainy season and leads to one of the major sicknesses in the community – malaria.
According to Mariam Umar, the head of the maternity unit, pregnant women in the community are regularly ill with malaria, which she said leads to complications during their pregnancy and as a result makes at least 25 pregnant women die annually in the community.
“Most women while pregnant have malaria, which causes anaemia, high blood pressure and Eclampsia (complications of pregnancy characterised by seizures and coma due to hypertension),” she said.
This complements the 2019 report by the World Health Organisation that 20 per cent of all global maternal deaths happen in Nigeria with an estimated over 600,000 maternal deaths and no less than 900,000 near-miss cases between 2005 and 2015.
Cholera outbreak rampant
In addition to malaria, cholera outbreak in Kantami is alarming. It occurs every rainy season due to the stagnant pool of water found across the community. The facility’s lack of resources to control the increasing contamination has led to recurring deaths.
Buhari Mohammed, another staff who has been working in the facility for eight years, said an outbreak of cholera in August 2021 caused havoc.
“At some point, we had 20 patients in a day. But on average, in a week, we got 50 to 60 persons with cholera. In this facility, we recorded 15 deaths but in the community, more than 100 people died,” he said.
“The cause of cholera is because our source of water is contaminated by our toilets. Our toilets are close to our well and it is not very deep and if we dig far away, we won’t get water. Also, the wells are open.”
Mr Mohammed said there is a source of clean water located outside the community but the residents prefer fetching from the well because of the closeness.
“They will only stop using well water if outsiders come to educate them against it but if we do they won’t listen because they say it is what their forefathers drank,” he added.
Renovated PHC in Dange Shuni crumbling
At the Dange Shuni PHC, another one of the 109 PHCs that the government said would be standardised, it is a similar situation. The first sight in the reception is almost fallen rusty ceiling materials hanging at the top. In the wards, while cartons are used in Katanmi, patients in Dange Shuni lie on mats. Sadly, this is not the worst view.
This PHC was established in Dange Shuni Local Government Area in the Sokoto South senatorial district of Sokoto State in 2007 by the NPHCDA. Unlike that of Katanmi, it was renovated in 2018, according to Mustapha Alkali, one of the officers in charge.
A signpost outside the facility indicated Quardstar Solid General Services Limited, a company based in Abuja, as the contractor that carried out the renovation.
The health worker claimed the renovation focused on roof repairs, floor tiling and repainting, which he noted were shoddily done as seen with the ruined materials.
Asides from the aforementioned, the lives of patients and health workers in this facility are at risk as they occupy an almost collapsed building.
The cracks in the building emerged in 2020 and worsened over time, leaving some sections in the building, like the male ward and the antenatal care unit, uninhabitable.
“Our building is cracked and we are scared it will collapse anytime. We do not have anywhere to relocate to,” he said.
Staff use salary to purchase medical supplies for patients
Inadequate medical supplies is another shortfall experienced in the PHC as some of the staff contribute from their salaries for the purchase of these items, despite being owed.
Mr Alkali said 30 per cent of the staff in the PHC stopped receiving salaries since 2015 and 40 per cent do not receive their full salaries.
This payment anomaly commenced after the state government conducted a verification exercise for the staff in 2015, and as a result stopped some of them from working due to financial constraints.
Despite the slashed remuneration, they still contribute to purchase medical supplies and drugs like ampicillin, Ampiclox, Flagyl, paracetamol, syrup, drip and syringes to help the patients, he said.
Health workers in both PHCs lamented that their facilities threaten their lives and that of their patients. They appealed to the government to urgently intervene in their facilities and provide adequate welfare for the staff.
FG keeps mum
On October 22, 2021, PREMIUM TIMES sent a Freedom of Information Act request seeking details of the highlighted issues in the PHCs revitalised since 2017, the procedure of monitoring the said process and respective issues in both PHCs .
The letter was received but not responded to. A follow-up letter was sent on November 18, 2021. Again, it was received with no response.
This reporter contacted the spokesperson of the agency, Ohitito Mohammad, but he claimed the letters had not been sent to his department. He also declined to answer the questions.
State Health Ministry responsible for revitalisation exercise – Executive Secretary, PHCDA
Responding to our findings, the Sokoto State Executive Secretary of PHCDA, Adamu Romo, in a phone interview with PREMIUM TIMES in February 2022, said his role is to provide service delivery although he was instructed to select the PHCs due for renovation which he said he did ‘late 2018 or early 2019.’
He directed the reporter to contact the Commissioner of Health who he said is responsible for questions regarding the construction and renovation of PHCs.
“We submitted some PHCs that we see should be renovated. We submitted about 10 to 12 and out of these, they ought to select three to be revitalised. Mine is to submit the names of the identified PHCs, which we have done. Once they have selected the ones for revitalisation, they ought to communicate to us,” Mr Romo said.
Asked if he followed up on his submission, the government official said, following up meant he was ‘chasing him.’
“You know as a leader and a subordinate, when you are the subordinate, engaging yourself to do something that you have not been asked to, your leader will look at it as if you are chasing him.”
The state commissioner, Ali Inname, did not reply to calls and text messages sent to him.
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