Many Primary Health Centres (PHCs) across Nigeria are facing acute challenges of water supply, a report has shown.
In September 2020, Nigeria Health Watch in partnership with EpiAFRIC conducted an assessment of WASH services in over 60 PHCs in Abuja and Niger State.
Released a fortnight ago, the assessment revealed that more than half of health facilities experience regular interruptions in their water supply. Many pregnant women prefer to deliver their babies with an unprofessional hand or even at home, where water is available.
For instance, in Pandagi Health Centre of Abaji Area Council, FCT, there had been no water supply in the past year which greatly discouraged women from giving birth to their babies in the centre, the survey found. Relatives of the few pregnant women who give birth to their babies in the PHC, have to source water from a nearby river.
With hand washing flagged as one of the most important ways of preventing the spread of COVID-19, the dire consequences of a lack of safe, clean and regular water for both patients and health workers in PHCs has been brought into focus by the assessment.
Results from the assessment revealed that most PHCs assessed do not meet the WASH requirements, as stipulated in the Technical Guide for WASH services in PHCs by the National Primary Health Care Development Agency (NPHCDA). These lapses in WASH facilities have ripple effects on health outcomes and health seeking behaviour of the community members.
The situation stifles any plan towards Universal Health Coverage (UHC) and derails Nigeria’s effort towards meeting Sustainable Development Goal (SDG) 6 – Clean water and sanitation by 2030 – Managing Director of Nigeria Health Watch, Vivianne Ihekweazu, noted while presenting the findings of the survey in Abuja.
The assessment was carried out in 62 PHCs that were randomly selected in Niger State and the FCT using questionnaires.
In Niger State, 50 PHCs were assessed. Two PHCs – one each from an urban community and rural community – were selected from each of the 25 local government areas.
In the FCT, 12 PHCs were assessed, with two PHCs selected from each of the six area councils.
The questionnaire was deployed through an interview guide, with open-ended questions for information such as health seeking behaviour of the people in the community, common illnesses in the community, distance to health facility, infrastructure in the facility, water, sanitation and hygiene services in the facility from all respondents.
Respondents were health officials in charge; and in facilities where such officials were absent, the most senior health worker in the facility responded to the questions.
Of the 50 PHCSs surveyed in Niger, only six per cent were connected to the government’s water board. About 78 per cent use boreholes as main water source, 10 per cent patronise tanker trucks and 4 per cent have wells.
While 35 per cent of these facilities get water for free, 65 per cent pay for water either from their own purse or through assistance from private organisations.
About 55 per cent of the PHCs experience periodic stoppages in their water supply partly due to interruptions in power supply, while 27 per cent experience seasonal shortages due to weather.
Even though 80 per cent of the PHCs in Niger also drink and cook with water from their source, only 18 per cent of the facilities treat their water before use.
Meanwhile, it takes between 15 and 30 minutes to get water readily available in half of the PHCs.
Also, 70 per cent of facilities assessed do not have running water in the toilets.
Aside washing needs, all 10 facilities assessed in Abuja also drink and cook with water from their source but do not treat their water before use.
Only eight per cent of the PHCs were connected to the government’s water board. About 83 per cent use boreholes as main water source and eight per cent have wells.
Nearly half of the facilities get water on sight and readily available through water vendors.
About 58 per cent of the PHCs experience periodic stoppages in their water supply mostly caused by power outages.
Meanwhile, half of facilities assessed do not have running water in the toilets, the assessment revealed.
The gaps in WASH services in the assessed facilities only adds a layer to the myriad of challenges the PHC system is facing in Nigeria.
The shortcomings of the PHCs have forced women in Nigeria to patronize largely unskilled traditional birth attendants, despite the risks involved.
According to a survey conducted by CISLAC, one in 13 women dies during pregnancy or childbirth in Nigeria.
Several attempts have been made to revive Nigerian PHCs which remain dogged by multiple challenges, including the mismanagement of billions of naira allocated over the decades to keep it up and running.
The latest was in January 2017 when President Muhammadu Buhari flagged-off a scheme to revitalise about 10,000 PHCs across Nigeria.
But more than a year after, PREMIUM TIMES found that very little has been done as PHCs across Nigeria are still in a terrible state.
When it became glaring that the 10, 000 revitalization plan was no longer feasible, the government in 2018 said it can only select and revive one PHC in each of the country’s 109 senatorial districts. This means, three in each state and one in the Federal Capital Territory.
PREMIUM TIMES exclusively obtained the list of the 109 revived PHCs and between February and March 2019 randomly selected and visited at least one in each of the six geopolitical zones.
The findings showed that nothing much had been done as almost all the centres visited were either in a terrible state or revamped through interventions from donor organisations.
The recent water assessment in Niger and the FCT also revealed that Nigeria is far from meeting the SDG 6 which emphasizes ensuring availability and sustainable management of WASH for all by 2030 and a specific SDG 3.9 target to reduce the burden of disease from unsafe water, unsafe sanitation, and lack of hygiene.
Despite being in the middle of a pandemic, far too little attention is given to the enormous, yet solvable crisis of inadequate WASH in primary health care facilities, the assessment revealed.
Lack of access to WASH services is a major contributing factor to various deadly infectious diseases like cholera which kills more than 70,000 under-five children in Nigeria every year, according to UNICEF.
A 2019 joint WHO/UNICEF report showed that worldwide, 896 million people use health care facilities with no water supply and 1.5 billion use facilities with no sanitation services. Nigeria was among the countries where more than 20 per cent of health facilities had no water or sanitation services as of 2016.
Not only does the lack of WASH services in health facilities compromise patient safety and dignity, it can also worsen the spread of antimicrobial-resistant infections and undermine global efforts to improve child and maternal health.
Recognizing the critical importance of WASH services which prompted the survey in the first place, the organizers made the following recommendations:
Evidence-generating studies such as this are recommended to create a true picture and an increased sense of urgency for strengthened WASH services in Nigeria. Further research on the true state of WASH in PHCs and challenges to implementing best practices will help identify unique cultural and geographical issues and areas where there are gaps in government’s service delivery.
National guidelines exist both for minimum standards of care for PHCs as well as WASH in PHCs. The health workforce needs to be strengthened to know, understand and implement these guidelines in their routine delivery of health services.
A theme which featured loudly from this research was the dilapidation and/or unavailability of infrastructure. Finance deployment to improve infrastructure and drive continuous maintenance of WASH facilities in PHCs is a key recommendation.
A major challenge in FCT is that some PHCs still pay for water out of their pockets. A recommendation from this study is multisectoral between primary health care board and FCT water board so that PHCs are prioritised for connection to pipe-borne water.
“Implementation of findings is dependent on political will. We appreciate the good job that Nigeria Health Watch is doing and we believe that the necessary authorities will look into the report and do the needful”, the Executive Secretary of the FCT Primary Health Care Management Board after Iwot Ndaeyo said after receiving the report from the assessment.
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