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COVER STORIES

Angst Over 1800 Comatose Primary Healthcare Centres

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Millions of Nigerians are unable to access primary healthcare despite the billions of naira of taxpayers’ money that has gone into setting up thousands of Primary Healthcare Centres (PHCs) across the country. LEADERSHIP Sundays findings revealed that over 1800 PHCs are lying waste as needy people are not getting medical treatment from them.
Among this appalling number of moribund healthcare centres, some are largely completed, some fully equipped, some under-equipped and others partly completed and left to rot in rural communities across the nation. Notably, these vital health facilities are the first point of medical access for millions of Nigerians in states and in the Federal Capital Territory (FCT) where they are treated before they are referred to secondary and tertiary health institutions if necessary. However, for years these facilities have been lying fallow, under utilised, under-staffed, under-stocked and, in some cases, outrightly abandoned by the authorities concerned, leaving Nigerians in search of healthcare to seek it wherever they can find it. No wonder most people at the grassroots resort to herbal concoctions at the first hint of ill health, and pregnant women turn to tradition birth attendants (TBAs ), despite all the attendant dangers. Surprisingly, communities just few kilometres from Abuja city, the nation’s capital, have suffered similar fate of abandonment even after this newspaper reported, about a year ago, a case of abandonment of a primary healthcare centre in Tugan Nasara in Abuja Municipal Area Council in the FCT.

LEADERSHIP Sunday learnt the facility was constructed in 2014 under the Subsidy Reinvestment and Empowerment Programme (SURE-P). The project was part of the Goodluck Jonathan-led federal government initiative to provide Nigerians access to the benefits of savings from fuel subsidy removal. But for the people of Tugan Nasara, who celebrated the federal government initiative, they are left to swallow their joy as the 100 percentage equipped medical facility has been abandoned and is rotting away.

PHCs worst hit by insurgency in Borno
The health sector in Borno State is one of the areas worst hit by the insurgency as the large scale destruction of facilities paralysed medical services, with most PHC facilities across the state suffering destruction. Consequently, equipment and infrastructure are either absent or obsolete, leaving only the referral system put in place by humanitarian agencies. According to the state commissioner of Health, Dr Haruna Mishelia, the insurgents had destroyed over 80 per cent of healthcare facilities, including 19 general hospitals, which he said, crippled healthcare delivery in the state. Statistics by the United Nation Office for Coordination of Humanitarian Affairs (UN-OCHA) show that 6.9 million people need healthcare interventions in the North-East due to humanitarian crisis caused by the Boko Haram insurgency.

According to the UN agency, a greater percentage of those in need are in Borno, who cannot access quality healthcare services, especially in rural communities.
Iun an attempt to mitigate the effects and transform the sector, the Borno State government in collaboration with the federal government and development partners embarked on massive reconstruction and rehabilitation of projects to enhance healthcare delivery at the grassroots.

63 under-utilised healthcare centres litter Delta
Although, the Delta State government was determined to ensure standard in the healthcare sector, especially in the primary healthcare centres across the state, regrettably, several health centres established in era of former governor of Delta State, Dr Emmanuel Uduaghan, did not see the light of day. The under-utilised buildings were never equipped with facilities, not to talk of recruiting health officers, including medical doctors, to manage the centres. Investigation revealed that with over 150 healthcare centres scattered across the state, 63 out of this number are dilapidated and unused, with hoodlums allegedly taking refuge in the buildings. In Burutu, Bomadi, Ughelli, Sapele and Patani communities, health centres in the areas are regarded as “death trap” for patients. For instance, in Burutu community, residents who spoke to our reporter said that the only health centre built by the last administration had not been put into use for lack of facilities.

Only 332 of 1,431 PHCs in operation in Benue State
In Benue State, investigation by our correspondent revealed that out of 1,431 PHCs across the 23 local governments area of the state, only 332 are rendering services. Executive secretary, Benue State Primary Healthcare Board, Dr Bem Ageda, lamented the level of destruction caused by herdsmen and farmers conflict, saying most of them are not operational. Dr Ageda revealed that out of the 1431 PHCs in the state, only 862 are publicly owned. “Most of the PHCs especially in the crises prone areas of Agatu, Guma and Logo are not functional again because of the herdsmen and farmers crises during which most of them were destroyed in the process,” he said.

Shortage of personnel in Plateau State
In Plateau State, most staff of PHCs interviewed complained of inadequate personnel, poor funding and dilapidated buildings.
Our correspondent who went round some of the PHCs in Jos and Bukuru metropolis discovered that some of buildings are begging for renovation while some are in the state of near collapse.
A worker who does not want her name on print told LEADERSHIP Sunday that apart from shortage of personnel, there are no drugs and laboratory equipment to conduct tests on.
He said most of the staff do not want to be posted to rural areas due to lack of social amenities, especially electricity.
At Angwan Rogo area of Jos North local government council the story is the same. The nurses on night duty use candlelight to attend to patients.
Residents decried the poor status of the health facility.
“We cannot continue to go to a clinic that does not have a laboratory and other equipment to run tests and a clinic that uses lantern to take child delivery, ”a resident said.
Against this background, the executive secretary of the State Primary Healthcare Development Board, Miapkwap Livinus, said a new law had just been passed to bring all the primary health facilities under the management of his board.
According to him, with this new development, he is optimistic that the conditions of the PHC facilities would change as many will be renovated.
He said the state government had earmarked N120 million for the primary health centres in 2018.
Meanwhile, Governor Simon Lalong has inaugurated the first ever Primary Health Care (PHC) clinic in his own village, Ajikamai, in Shendam local government area.
Inaugurating the N13 million facility, the governor described the event as “historic”.
“It is the first time my people are seeing an edifice like this in this village,” he said.

Shortage of drugs hits Akwa Ibom PHCs
In Akwa Ibom State, government has taken some far-reaching measures to rescue the collapse of healthcare infrastructure in public hospitals in the state following the rise in infant and maternal deaths in most government-owned health centres in the state.
The administration of Governor Udom Emmanuel has in the last three years reactivated some major health care facilities across the three senatorial districts of the state, including Anua General Hospital, Etinan, Ikono Emmanuel hospital in Eket, Ikot Okoro Onna health centres and a host of others.
But checks by LEADERSHIP Sunday revealed that some of the facilities in most primary healthcare centres across the 31 local government areas are in serious state of disrepair.
For instance at Etim Ekpo local government, medics complained of absence of basic facilities and shortage of drugs to take care of pregnant women and treat major childhood ailments including whooping cough, malaria, and yellow fever, among others.
“We cannot take care of even less complicated cases here because of lack of facilities and basic drugs and we have in, most cases, sent them to referral hospitals in Abak,” a senior nursing officer, who would not want her name in print, lamented at Etim Ekpo Health Centre.
She blamed government for failure to supply drugs, update facilities and provision of better working conditions for medics at the centre.
Similarly at Mbioto 2 in Etinan local government area of the state, health centre medics complained of lack of essential drugs and medical consumables.
Dr Effiong Francis, a medical consultant, said the same situation holds across various government health centres across the state. He called on government to take more than a passing interest in making basic healthcare available for the people.
Speaking in an interview with our correspondent, former Chief Medical Director (CMD), University of Uyo Teaching Hospital (UUTH), Uyo, Prof Etete Peters, lamented the collapse or near absence of primary and secondary healthcare facilities, saying this has put too much pressure on UUTH, which is a tertiary health institution.
“Because of the shortage of primary and secondary healthcare system in the state, we now have to accommodate all cases as a tertiary healthcare institution because we cannot send patients with minor cases back”, Etete explained.

Lagos State
With 320 PHCs in Lagos State, about 30 of them are not functional, LEADERSHIP Sunday has learnt.
About 30 PHCs in the state are not functioning optimally due to obsolete equipment, inadequate staffing, stockout of essential drugs, and lack of basic equipment.
Worst still, these PHCs are mostly situated in the Urban areas as about 800 communities have limited PHCs servicing the people.
Recent visit to 15 communities in Ikorodu North local council development Area by our correspondent revealed that only one PHC, which is yet to be fully equipped with essential drugs, nurses, beds etc, situated at Olorunda community, is servicing the over 70,000 people living in those communities.
The Baale of Maya Olorijo and Aiyetoro, Alade Olukoga said the Olorunda PHC has been in existence for over 20 years but did not get attention until recently.

Olukoga said, “The place used to be occupied by bush and was not attractive to the community people, so we told the Community Development Area (CDA) chairman to convey our agitation to government and I think that is why we have that little improvement.
“When you look at the PHC, it is so beautiful outside but no value to the structure if there is no equipment. We want government to help us equip the PHC because it serves 15 communities and the nurses are enable us take deliveries.”
In his response, Lagos State governor, Mr Akinwunmi Ambode, at the second quarterly Town Hall Meeting and seventh in the series held at Shibiri/Ekunpa Area Office in Oto-Awori local council development area (LCDA), restated his commitment to ensure that all residents living in Lagos, irrespective of where they live or their financial status, receive quality healthcare services.
The commission for health, Lagos State, Dr. Jide Idris, said the state government had upgraded, renovated and constructed more than 61 PHCs within one year.
Idris said the focus of the administration was to continue the upgrading and/or renovation of health facilities at all levels of care, completion of ongoing projects, execution of new ones where necessary, as well as putting preventive maintenance on ground.
However, despite these efforts, the director, Family Planning and Nutrition, Lagos State Ministry of Health, Dr. Folashade Oludara, has stated that about 70 per cent of people living in the rural areas in Lagos State do not use the PHC closer to them, adding that some of them do not know where the PHC in their community is situated.
Oludara said, “This is bad. We are losing our people, especially the women, to quackery and some to Traditional Birth Attendants (TBAs). The media have a very big role to play in creating the awareness on the need for people to go to PHCs within their communities.”
She said one of the reasons why people do not use the PHC is due to the attitude of nurses to the people.
“That is receiving attention at the moment. Right now, we are conducting capacity building on communication skills for all health workers at the PHCs in the state, courtesy of the Save One Million Lives Initiative.
“If all these things are in place and the people are still not assessing those services, it will be of no use. I want to plead with our community leaders to please educate their people to start using the PHC closer to them,“ she said.



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