No doubt primary healthcare is essential to achieving universal health coverage. DANJUMA JOSEPH, in this report, examines the state of Primary Health Care in Nasarawa State.
Primary Health Care (PHC), as conceptualized by the Declaration of 1978 is a grassroots approach towards universal and equitable health care for all.
The model was to address the main health problems in communities all over the world in order to achieve universal health care by providing accessible, preventive, curative and rehabilitative services.
It is the first level of contact of individuals, families and communities with the national health system.
Since Nigeria was among the 134 signatories to this historical proclamation, a strong health care development strategy was initiated with the Primary Health System as the cornerstone.
Before then, the country had struggled to develop its health system, policies made to establish and expand health care infrastructure placed emphasis on curative medicine rather than preventive medicine.
The launch of the first comprehensive National Health Policy in 1988 further strengthened the collective will of government to provide accessible health care facilities across the country and by 1990; the scheme had expanded to the grassroots across the country.
In ensuring the sustenance of the PHC agenda, the National Primary Heath Care Development Agency (NPHCDA), was established in 1992. The agency placed emphasis on preventive medicine and health care services at the grassroots, ensured exclusive breastfeeding practice, introduced free immunisation for children, encouraged the use of Oral Rehydration Therapy by nursing mothers, made compulsory the recording of maternal deaths, encouraged continuous nationwide vaccination and pioneered effective HIV/AIDS campaign.
In Nasarawa State, LEADERSHIP visited some Primary Health Care centres to ascertain the performances of grassroots health care centres.
One perculiar trend that runs through the five council areas of Keffi, Karu, Kokona, Toto and Nassarawa, which formed the western senatorial zone of the state, is that primary health care centres in these areas are desirous of attention.
When our correspondent visited a PHC in Koroduma village of Karu Local Government Area, located in the heart of Koroduma (One man village), a patient, Ladi Yohanna, who was lying on a wooden bench in front of the facility, said it was the only facility she could afford, though she lived several kilometres away. The facility is decrepit with its structure in state of disrepair.
Another patient, Rosemary Ambrose, who was clinging to her one-year old child, said she had brought him there for malaria treatment. Mrs. Ambrose said patients were treated fairly at the centre, although the drugs were expensive and sometimes beyond what could be afforded.J
However, a staff in the clinic listed insecurity as one of the major challenge of the centre as according to him, the clinic was regularly burgled because it is an open building with no security arrangement.
“You can see traces of feet and hand prints on the wall,” he said, pointing at the main building. “That is what happens all the time” he said.
It was discovered that there were no qualified medical staff on the clinic, except community health and extension workers.
“We resume at 8 a.m. and close at 6 p.m. because of the security challenges and depending on how busy work gets. Water is also one of the constraints we have in this facility. We do not have water supply, we buy from ‘Mai ruwa’ ” the JCHEW said.
He said government stopped sending fund to the clinic long ago, so the centre uses whatever it earned from daily treatment of patients to procure drugs and other basic medical needs.
In Keffi, our correspondent was attracted to a dilapidated clinic, surprisingly located directly opposite the palace of the Emir of Keffi, in Keffi Local Government Area. At the time LEADERSHIP visited, the clinic had over 20 patients crowded in the female ward.
The Officer in Charge who did not give his name said the major challenge was power supply to preserve drugs and treat patients. The officer said the centre had power supply for a maximum of five hours a day. But there was regular water supply.
At the time of the visit, the labour room was bare because the delivery bed was broken. Yet some pregnant women were waiting for delivery.
The facility had no qualified medical personnel, doctors or nurses, but there were two CHEWs, two junior CHEWs and six volunteers at the center.
Like the western senatorial zone, the state of health care facilities at the southern senatorial zone of Nasarawa state is not any better especially health centres at remote villages.
At the PHC Clinic in Agwatashi, Obi Local Government Area, the Officer in Charge, Ayuba Adole, was reluctant to speak with our reporter. “I will not entertain any form of interview from you except I am given an order to do so by the Director,” he said.
The facility wasn’t looking better than the others visited, aside the fact that it is spacious, with a large number of patients from within and outside of the community.
It was also however observed that the clinic had functional borehole for water supply and a generator for electricity as well as a cold room, staff quarters and a well-stocked drug store, probably because it was supported by the Decentralised Facility Financing (DFF).
As regards manpower, the clinic has two security men, eight trained medical staff, five attendance and six voluntary staff.
Lack of vehicles or ambulances for transfer of patients was however identified as major challenges facing the clinic.
Also, in Giza, Keana LGA, which is about 30 kilometres from Kadarko, another settlement on the Lafia-Makurdi highway, the PHC is typical of rural PHCs around the country.
The centre, which was built over 20 years ago, is the only PHC in the community and is virtually unequipped and lacks basic amenities.
The centre is run on fund provided quarterly through the state’s Decentralized Facility Financing (DFF). Water supply was also identified as one of the issues as the attendants told LEADERSHIP that they fetch water from neighbouring houses for use at the PHC. Adding that the borehole in the clinic packed up a long time ago.
An attendant who doesn’t want her name mentioned said she had been working at the centre since 1995. Speaking in Hausa, she said: “We don’t have enough qualified medical personnel, the facility is understaffed and we are overworked. As an attendant, I also work as a midwife, cleaner, errand person etc. And my salary is being paid in bits despite the whole stress, which is a problem for my family and me.
A passer-by who would not disclose his identity interjected: “This primary healthcare centre is a disgrace to this community and Nasarawa State.” He urged the government to renovate and equip the facility and employ qualified medical personnel. “The staff should also be trained at least quarterly and be informed on new discoveries and research,” the interloper said.
In the northern senatorial zone, LEADERSHIP visited a PHC clinic in Akwanga East at about at about 7:54 pm and discovered that the centre was in darkness as there is no alternative source of power supply apart from the epileptic power from PHCN.
A community health extension worker (CHEW) was the only medical personnel on duty. He said he was waiting for 9 pm to hand over to the next person.
According to him, he had been working at the facility as a CHEW since 2014, when it was then a small structure before it was renovated as a Millennium Development Goals, MDGs project.
He said lack of water supply was one of the challenges in the clinic. “We have a borehole but the pumping machine was stolen by some hoodlums and ever since, we have been buying water from Mai ruwa (local water vendors)”, he said.
The attendant disclosed that the local government used to supply drugs to the facility until the Performance Based Financing (PBF), system was introduced in the state. He said the PBF sometimes sends money to officer in charge of to maintain the facility and pay the staff.
Another clinic in Gudi, also in Akwanga LGA, was said to have 36 workers but no documentation of the staff was available. The centre had male and female wards, with beds, labour room and others.
At the centre, a patient pay N150 for registration card, as against N50 paid in other facilities visited.
Government Working To Reposition Health Sector
The state government, recently, signed a $500,000 grant with the Bill and Melinda Gates Foundation, aimed at strengthening primary healthcare system in the state.
Mr Dana Hovig, Director of Integrated Delivery, at the foundation, while signing the agreement in Lafia, said the two years grant was to mainstream performance-based financing into the state’s primary healthcare system.
Hovig, explained that the performance-based financing is a result based mechanism used to drive up performance of health systems by addressing the root causes of underperformance.
The gaps include inadequate health services, barrier to accessing quality care, poor governance and financial management practices.
Hovig described the partnership agreement for the grant as a demonstration of the state government to be accountable and provide quality healthcare to the poor and vulnerable people in the state.
“What we see in this strategic partnership between the state government and the Bill and Melinda Gates foundation has the potential to save even more lives.
“We believe that Nasarawa state can maximise the gains already demonstrated from the performance-based financing approach to transform its PHC system in two years,” Hovig added.
Governor Umaru Tanko Al-Makura expressed gratitude to the foundation for the grant and pledged the commitment of his administration to provide quality healthcare to the people through good governance and accountability.
Al-Makura, pledged that government would strictly adhere to the laid down guide for the implementation of the grant in terms of governance, performance management and financial management
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