Primary Healthcare Centres (PHCs) have not played any major role in the fight against COVID-19 in Nigeria, in spite of huge expenditure on the facilities over the years through yearly budgetary allocations.
Although primary healthcare is the responsibility of the sub-national governments, the federal government between 2015 and 2019 allocated over N5 billion for the construction and equipment of PHCs under the yearly Zonal Intervention Projects (ZIPs). These projects are nominated by lawmakers for their constituencies and are executed by contracts under the supervision of the National Primary Health Care Development Agency (NPHCDA).
In the five years from 2015 to 2019, N912.9million, N2 billion (2,119,485,714), N1billion (1,292,906,059), N779million, and N840milion respectively were allocated to the construction and equipping of 182 PHCs in different communities across the country. Interestingly, these expenditures do not cover other overheads like procurement of buses, health awareness campaigns, and so on.
COVID-19 caught everyone by surprise and unprepared, and for some time overwhelmed the healthcare system, especially secondary and tertiary facilities, in many parts of the world.
With the transition to community transmission of COVID-19, one would expect public healthcare facilities at the local level to assume a key role in the fight against the disease. However, that is not happening in Nigeria.
First Line of Defence
The PHCs are the first line of care and defence in the healthcare system, including against epidemics.
According to WHO, primary healthcare addresses the majority of a person’s health needs throughout their lifetime. These include physical, mental and social well-being. And it is people-centred rather than disease-centred. Primary healthcare is a whole-of-society approach that includes health promotion, disease prevention, treatment, rehabilitation and palliative care.
An NPHCDA data shows that between 2001 and 2014, N32.7 billion was spent on construction of 687 PHCs in Nigeria. This expenditure, however, has not translated into functional PHCs.
Public and Private Development Centre’s (PPDC) monitoring assessment of 18 primary health centres in Benue, Kano, Lagos, Oyo, Osun and Ogun states in 2015 revealed that most of the facilities had one challenge or the other. These range from lack of water supply, electricity, equipment, to inadequate staff and staff accommodation, and the likes.
In 2018, the Premium Times Centre for Investigative Journalism (PTCIJ) tracked about 220 PHCs across the country. The findings are that they were mostly lacking equipment, water, electricity or staff. Many were inaccessible to the communities they were sited to provide services, and had dilapidated buildings. The lack of electricity led health workers in some centres taking birth deliveries in maternity wards lit by kerosene or recharge lanterns. The report indicated that PHCs in Nigeria are dysfunctional or non-existent.
UDEME through an ongoing campaign on how the negligence of Primary healthcare facilities constrains the fight against COVID-19, also confirmed that PHCs across Nigeria are in a sorry state and need urgent attention if Nigeria must flatten the curve of COVID-19.
Because of the failure to provide PHCs in every community in the country, Nigerians are taking up the role at the community level.
Ugonna Egbukichi hails from Egberemiri Eziudo, Ezinihitte Mbaise in Imo State. “There is an ongoing community health centre construction at Egberemiri Eziudo, my community. We are the ones building with contributions from villagers and our brothers abroad,” he told UDEME,
Mr Egbukichi told Udeme that the only community health centre in the area is far from the village and became inaccessible after the larger Eziudo was split into two communities.
Confirming the absence of PHCs from the fight against COVID-19 in Nigeria, the Partnership for Advocacy in Child and Family Health at Scale (PACaH@Scale) in a statement on June 5 said PHCs have been “under-emphasised and relegated to the background in the scheme of things.”
“While infectious disease control requires highly specialised interventions with facilities removed from communities, there is still an important role for PHCs in infectious disease prevention,” the statement said.
“Primary Health Care centres in Nigeria, even if equipped poorly, are the hub for healthcare in the community and well-positioned as the primary point of care under the Primary Health Care Under One Roof (PHCUOR) National Policy. The fight against Covid–19 should not be one which trades off PHCs against a specialised and central command system of service delivery.”
NPHCDA said it recently organised a virtual training programme for primary health workers to help reduce community transmission of COVID-19 in the country.
It announced on May 21 on Twitter, “the successful completion of a 3-day virtual State Training of Trainers (SToT) of over 7,000 health workers from all the states + the FCT, under the guidance and supervision of the Executive Director Faisal Shuaib.
“Preparation is now underway on cascading the training to LGA level, where we will be training over 60,000 frontline health workers from over 30,000 health facilities across the country,” the tweet read.
But in May, when one of our trackers visited the Ikot Oku Model Health Centre in Uyo, Akwa Ibom State, a worker at the facility said they had not received any training on how to handle COVID-19 cases. He said the health centre only received a bucket tap, a hand sanitiser, four pieces of nose masks and gloves.
According to the official the facility is understaffed and may not be able to play any significant role in the fight against the pandemic. It only has a nurse, a community health extension worker (CHEW), a laboratory technician and no doctor. This accounts for the centre operating only in the morning. Patients turn to the general hospital, St. Luke’s Hospital, which is quite far from the health centre, for care.
So aside the centre being unequipped for a role in the fight against COVID-19, the training announced by NPHCDA apparently did not reach all of the workers.
Garba Bulama, the Director of Planning, Research and Statistics at NPHCDA, at a webinar organised by PTCIJ, insisted that the agency was training health workers.
“We just finished with the national and state health workers and are going down to the local government to train as well,” he said.
“The PHCs are not getting the attention they deserve, they (PHCs) are not understood,” he said.
According to Mr Bulama, funding of PHCs is the responsibility of state and local governments. He said the zonal intervention projects of the federal government are only complementing the main funds which should come from the state and local governments.
The NPHCDA official urged Nigerians to see the PHCs as a critical part of the health sector and should charge politicians seeking offices to pay attention to the sector.