There are some dilapidated, ill-equipped public health centres across states in Nigeria where residents go to access healthcare for lack of better alternatives. SUNDAY PUNCH writes about the facilities
One of the reasons given by the military junta when they took over power on December 31, 1983 was that the country’s hospitals had become mere consulting clinics. The late Gen. Sani Abacha, who announced the coup that foisted Maj. Gen. Muhammadu Buhari on Nigerians on radio, said, “Our economy has been hopelessly mismanaged; we have become a debtor and beggar nation… health services are in a shambles as our hospitals are reduced to mere consulting clinics without drugs, water and equipment.”
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But 35 years after including 19 years of democratic rule, investigations carried out by SUNDAY PUNCH revealed that not much has changed in the nation’s public health sector. This is because most public health centres visited by our correspondents in some states are in deplorable state. Most are ill-equipped while the majority are inadequately staffed and underfunded.
From Kwara, Ogun, Osun, Edo, Rivers, Kano, Imo to Akwa Ibom, the story of the appalling state of public health centres is the same.
Derelict Ekosodin facility in Edo
For instance, the Ekosodin Primary Healthcare Centre is one of the community health facilities located in the Ovia North-East Local Government Area of Edo State. But it smacks of neglect. It was gathered that the centre, which was last renovated in 2008 by a corps member, had only five employees, until five others were added, through the N-Power programme of the Federal Government.
However, inadequate manpower is not the only challenges facing the facility. The building housing the centre is in a state of disrepair. A portion of the roof, it was learnt, caved in during a rainstorm, while the ceilings and windows are in dire need of attention to prevent them from falling off.
A visit by one of our correspondents to the centre located in front of a market revealed that the unkempt environment surrounding the centre subjected it to invasion by rodents and insects. Also, workers and patients usually defecate in a nearby bush as there was no toilet facility.
A worker, who spoke to SUNDAY PUNCH on condition of anonymity, said that the facility did not get any supply of medical aids, including drugs, from the local or state governments.
According to the worker, they use the little resources they make treating the residents to buy medical needs.
“We buy drugs from pharmacies with the money we generate. We do not get any supply from the government. You can see the ceiling and how bad it is. That is how we manage when it rains,” the worker lamented.
The Chairman of the council, Mr. Scott Ogbemudia, could not be reached for comments as he was said to be in a meeting when he was contacted. But one his aides, Mr. Valentine Osunbor, said the leadership of the council recently concluded a tour of the health centres in the area with a view to identifying the problems and carrying out appropriate renovations to complement the state government’s plan to build modern centres across the 192 wards.
Osunbor stated, “Hopefully, the renovation will start soon. We visited the one in Ekosodin. We are even thinking of relocating it because it is very close to a market; it is supposed to be in a serene environment.”
In Kwara State, residents of Ilorin have cried out over the deplorable state of infrastructure of Civil Service Hospital at the Government Reservation Area, Ilorin.
They have continually decried the terrible state of the centre. One of them, Mulikat Jimoh, who called on the government to rehabilitate the centre, said that it was sad that the facility had been left to deteriorate.
She said, “It is sad that the centre which is in a highbrow area is a shame because its buildings have been left to deteriorate. It is doubtful if enlightened persons go there for treatment. Apart from infrastructure decay, there are insufficient personnel. Government should address this shame of a hospital. “
Some of the residents felt it was even worrisome as the centre is even close to the Ile-Loke residence of Senate President, Bukola Saraki and less than a kilometre to the Kwara State Government House.
Another resident, Sulyman Kunle, told one of our correspondents that there was no justification for the neglect of the hospital.
He said, “I don’t understand why the facility is neglected by both the administrations of Bukola Saraki when he was governor for eight years and the current Governor Abdulfatah Ahmed who has been in office for seven years. The rulers in the state cannot claim to be unaware of the situation in the hospital.”
Reacting, the Senior Special Assistant on Media and Communication to the Kwara State Government on Media and Communication, Dr. Muyideen Akorede, said the state would soon overhaul the hospital.
Akorede, who stated that the repair of the centre had been captured in the 2018 budget, acknowledged that though there were insufficient health workers at the hospital, quality health care services were still being delivered.
According to him, new equipment and more drugs will be provided.
Akorede said, “The Kwara State Government is rehabilitating health facilities on phased basis. We have started with the rehabilitation of general hospitals at Ilorin, Offa, Omu Aran, Share, and Kaiama as well as provision of equipment and drugs to some general hospitals across the state. Having done that, the state government is going to repair some set of hospitals this year. They are in the budget already. These hospitals include the General Hospital, Oro, the Civil Service Clinic Ilorin and the health facility in Patigi.”
He also said he was unaware of the dearth of drugs in the centre, adding that the state had challenges of personnel across the state because health workers left for hospitals in Abuja where they felt they would be better paid.
Same in Osun
In Osun State, although the Primary Health Centre, Okinnin in the Egbedore Local Government Area of the state had been renovated, there were still some things to be done to make the facility cater to the health needs of its large patients.
The health centre is the only health facility known by some residents of the town especially those who cannot afford the services of private hospitals nor travel outside the country to seek treatment like some few privileged Nigerians.
SUNDAY PUNCH gathered that the centre has only one doctor who visits on specific days of the week while patients with urgent cases wait for the time when the only doctor is around.
Although the state government operates a free healthcare policy, it was discovered that the policy is not completely true in practice because a new patient still needs to pay N1, 000 to obtain a card to open a file at the centre. Consultation is free but a patient, Mrs. Adenike Ogunwale, said things like plasters and other petty things might be paid for at times.
One of the workers at the centre who spoke on condition of anonymity said although the facility did not have everything needed to be very effective, workers there always tried their best to treat cases brought to them.
But a resident of Okinin, identified only as Mrs Tajudeen, told one of our correspondents that her neighbour, a primary school teacher residing in Okinin, who went to the centre to be delivered of her baby, lost the baby there.
Tajudeen said the school teacher was registered at the centre and attended ante natal classes prior to her expected due date.
She said, “I won’t blame the hospital for the loss because if the woman had money, she would probably not register there or her relatives would have asked that she should be referred to a better equipped hospital.
“The pregnant teacher went to the health centre to be delivered of her baby but the baby came out with the leg. The baby eventually died while the nurses on duty were trying to adjust the baby so that it could turn and come out with the head.
“I was told that there was no doctor on duty that day. I think it was on July 7, 2018 but those who attended to her were said to have tried their best. Thank God the woman is alive. But I believe the state government can do better by procuring more drugs and employing more qualified health workers.’’
When contacted, the Commissioner for Health in the state, Dr Rafiu Isamot, said it was not possible for the state to have doctors available every time in all the health centres in the state.
He added that the state government was striving hard to ensure that necessary things were always available at the centres, noting that it might be true that some health workers were asking patients to buy plasters and other things.
He noted that the state was working hard to check such practice so that some of the health workers would not give the state government a bad image.
The commissioner said, “One thing is that even the WHO does not recommend that all the primary health centres must have doctors available day and night. It will be difficult for us to have doctors available in about 1,000 health centres in Osun. Not even Lagos can afford that.”
Ondo not different
The public health sector generally in Ondo State needs urgent attention of the state government as many health facilities in the state, especially at the grass-roots level, are nothing to write home about.
SUNDAY PUNCH gathered that the present administration in the state had not done much in the sector since inception 18 months ago. Many health centres in the small towns and villages in the state lacked adequate equipment while many patients were referred to private hospitals in the cities for proper treatment.
Recall that the immediate past administration of Dr. Olusegun Mimiko made some giant strides in the state health sector by establishing Mother and Child Hospitals in Akure and Ondo towns with the execution of some health programmes like ‘Agbebiye’, ‘Abiye Safe Motherhood,’ ‘Orirewa’, among others. Medical services then at the hospitals were free for pregnant women and children under five years old.
Also, many health centres which included the Gani Fawehinmi Diagnostic Centre, Trauma Centre and Kidney Care Centre all situated at Ondo town were established by the Mimiko administration.
The Mother and Child Hospitals and other health centres built by the past administration however lacked quality health facilities.
A health worker in the State Hospital, Ikare who spoke on condition of anonymity, told one of our correspondents that there were workers in the hospital but no equipment to use.
The worker said, “There is nothing here. We can’t treat patients with serious health condition. We lack equipment. If there is a serious case, we refer it to the Federal Medical Centre, Owo because we don’t have equipment to handle serious cases.’’
A source in the Ondo State Hospital Management Board revealed that there were inadequate workers and equipment at the health facilities in riverine areas of the state as many medical workers did not like to be posted there.
“As a matter of fact, many health workers don’t like to be posted to the rural areas, particularly, the riverine communities because there are no amenities there. This factor makes health centres in the areas empty. There are no drugs, equipment and we also have insufficient personnel. These are the problem we are facing in the state,” the source added.
But the Chief Press Secretary to Governor Akeredolu, Mr Segun Ajiboye, said it would be mischievous to say the Akeredolu adminstration had not done anything in the health sector.
He said the government had started to renovate some of the hospitals while new ones would soon be built and equipped with modern equipment.
According to him, the Akeredolu administration has continued to offer free health services to pregnant women and children in the state to reduce maternal mortality rate.
Ajiboye said, “Apart from renovating the hospitals, the governor has secured a N2.1bn worth of new medical equipment from MedShare, a US-based non-profit organisation in Atlanta. The Mother and Child Hospital located in Akure and Ondo towns has been extended to other towns and local governments in the northern and southern senatorial districts of the state.
“Recall that the governor had signed into law the contributory health insurance scheme and also made provision for the vulnerable. These are some efforts of the administration and it will still do more.”
River’s Anyana Health Centre poor
At the Anyana Health Centre in Abua Central, Abua-Odual Local Government Area of Rivers State, findings showed that the staff strength is low while the building is also in a deplorable condition.
SUNDAY PUNCH observed that the centre had scanty furniture as some patients sat on the few hospital beds available while others, after getting tired of standing, sat on the floor.
Anyana Health Centre
A worker in the centre who spoke on condition of anonymity said, “We have few workers in the facility but we are managing. Besides, we don’t have enough furniture for patients to sit when they come for treatment or antenatal.
“Due to lack of furniture, most pregnant women sit on maternity beds. We don’t have a pharmacy; the patients go outside the centre to buy their drugs,” the worker said. Most of the time, the nurses cut the grass in the surroundings.
“Despite the challenges, we still deliver women of their babies safely; it is only caesarean cases that we refer to the general hospital,” she added.
SUNDAY PUNCH also observed that the ceiling of the facility was in a bad shape.
Reacting, the state Commissioner for Information and Communications, Emma Okah, said though the state ministry of health would address the issue, there was no compelling need for primary health facility because of the availability of a general hospital.
“Abua has a general hospital now; it is one of the general hospitals to be inaugurated. These facilities are government facilities and will never be abandoned. But you know that one is for primary health need while the other is for both primary and secondary needs. The general hospital covers both.
“I believe the state Ministry of Health will look into that but there is a more compelling primary and secondary need in Abua because of the general hospital there,” Okah said.
A’Ibom’s Odot centre waterlogged
The state of some of the health centres across Akwa Ibom State leaves much to be desired. For instance, the state of the Primary Health Care (Operational Base), Odot, in the Nsit Atai Local Government Area of the state is extremely bad.
The road to the facility has been taken over by flood. It is surrounded by thick bushes. Reptiles also compete with patients who visit the centre regularly.
Workers and patients also said they always come in contact with snakes.
One of our correspondents observed that the street to the hospital is an eyesore. The water in some other streets is usually released into the street leading to the facility. This is responsible for the constant flooding of the facility.
A youth leader in the area, Mr Enefiok Nteyoho, accused the government of not doing enough to protect the lives of the residents by equipping the centre.
Nteyoho added, “If there is a downpour, there will be flooding reaching the window level of the facility. Documents, files, drugs and other office equipment had been destroyed by rains in the past. Sometimes, when the rain starts, the water usually soaks the beds.
“We wrote letters on the state of the facility to both the local and state governments while Senator Godswill Akpabio was in office but there was no response. Now we don’t know what to do. Mosquitoes are many in the place and the workers cannot admit patients. Instead, the patients are referred to other hospitals to avoid worsening their health conditions. We want the government to upgrade the facility and construct channels for the water.”
A nurse, who spoke with one of our correspondents on condition of anonymity, said many other workers were unable to go to work because of the flood.
She added that they had not been able to work since last week because of the situation.
The nurse stated, “People cannot wade through the water to access medical care in the centre. The former director of the hospital appealed to the state government not to allow the facility to be in ruins, but to upgrade it by constructing road or gutters to divert the flood from the premises. But despite the appeals, government has not come to the aid of the hospital. I have not seen drugs in the store since I started work in 2015.’’
One of the visitors to the hospital, who preferred not to be named, told our correspondent that he had to relocate his children from the hospital for them to survive.
The state Commissioner for Health, Dr Dominic Ukpong, said he had yet to receive reports about the facility since assumption of office some three years ago.
He said, “I have not received any report on the centre in Odot, (Nsit-Atai.) When was a report sent to the governor? Where or through whom was it sent to the governor?
“I can tell you however that due to the Primary Health Development Agency Law, the government has commenced the refurbishment of primary health centres and Nsit-Atai is on the list.”
Same case at Specialist Hospital, Kano
Of the over 1,000 Kano State Government owned Public Health Centres, comprising primary, secondary and tertiary, the female ward at the Murtala Muhammad Specialist Hospital is the most appalling. It also yearns for urgent attention.
For example, the Female C Surgical Ward and Female Orthopedic Wards, lacked sterilisation machines, dressing equipment and bed sheets in all the wards. Some equipment such as the forceps in the facility are rusty.
The two female wards are dirty with human faeces littering the surrounding.
The condition at the Male C ward is not different from the female wards. Equipment being used for cases of burns and surgeries are obsolete.
However, the Muhammadu Buhari Specialist Hospital, Giginyu, recently inaugurated by the President, is equipped with modern facilities. Some of the sections in the hospital have not been put to use.
The state Commissioner for Health, Dr Kabiru Getso, said his ministry had put measures in place to check open defecation in the hospital surrounding to avoid epidemic.
Getso stated that the hospital management had ordered for the engagement of security guards to arrest patients and visitors whose children defecate within the surrounding of the female ward.
The awful Ibafo health centre
In Ogun State, the Ibafo Health Centre located in the Obafemi Owode Local Government is in a terrible state of disrepair.
Ibafo Health Centre
The facility strategically sited in the heart of Ibafo probably for accessibility is just a stone’s throw away from the popular Ibafo market.
One of our correspondents who visited the place observed that the centre had no presence of patients safe for those who came with complaints.
A first-time visitor to the place needs to walk carefully in order not to fall into dirty water overlooking the centre.
The workers on duty were unwilling to work when SUNDAY PUNCH called at the facility on Thursday. Some middle-aged women who were munching groundnuts said they were not ready to work that the patient our correspondent came to make enquiries for should come back on Monday.
The correspondent who also coughed intermittently was advised to add lime and palm oil to cure the cough.
A trader, Mama Oluchi selling foodstuff near the facility, told SUNDAY PUNCH that people visited the centre only on Wednesdays when they were sure the doctors would be available.
A corn seller who refused to give her name also corroborated Oluchi’s claim that the doctors only visited the facility once a week.
Also, a butcher selling close to the centre said the facility was usually closed most times except on immunisation days.
In his reaction, the state Commissioner of health, Dr. Babatunde Ipaye, says a doctor is not supposed to man a primary health centre, adding that in the 20 local governments in the state there is one medical officer in each of them.
He said, “The health centre is manned by an apex nurse. The primary health centres are not supposed by requirement to be manned by a doctor because we don’t have enough doctors in the country to man each primary health centre.’’
Ipaye further said he was unaware of the health facility in Ibafo as the state had 477 public health facilities and all were in good state.
“Get across to the medical supervisor of that local government. He would be able to provide you with the necessary information,” he stated.
The health centre in Umuokanne in the Ohaji/Egbema Local Government Area of Imo State is also in a terrible shape.
Umuokanne Health Centre
The facility reportedly built a long time ago through community effort and handed over to the state government is the only public health centre in the community whose indigenes and residents are predominantly farmers.
Apart from the sorry state of the building, its roof begs for attention and parts of the ceilings have fallen. Grasses have overtaken parts of the compound, as some departments in the centre lacked beds and needed medical equipment. It currently has a handful of medical staff which is inadequate to cater to the villagers who throng the place for medical help.
A patient who refused to disclose her identity to SUNDAY PUNCH said that her inability to afford the hospital bill in a private hospital made her to continue to using the centre.
She commended the medical staff for what she described as their compassionate disposition to patients, but maintained that the centre was far from what a public health facility should be.
The patient said that the centre had no water, electricity and security. She said patients often go out to buy most drugs prescribed for them by the doctors and nurses who come to the centre.
On the issue, the state Commissioner for Health, Dr Angela Uwakwem, said that the government was renovating some health centres in the state in phases.
He said, “The government is renovating the identified ones gradually. It is not something you do at once. We are doing our best and we are calling on individuals and communities to partner with the state government in this regard.”
States should show more interest in primary healthcare — NMA
However, the President, Nigerian Medical Association, Dr Francis Faduyile, said the body was in advocacy programmes with state governments regarding primary healthcare centres.
He said, “The primary healthcare centre has a peculiar position. We have some national control through the Primary Health Centre Board and we also have the major control of the facilities on the side of the state governments and that is why we have engaged in different advocacy programmes with the states.”
Faduyile stated that state governments had not been helping, adding that it was the reason most of the facilities were in poor state.
He said. “The major problem we have is that states are paying lip service to strengthening the centres because they have refused to employ doctors and other staff members for appropriate staffing in those places. This has made the health centres non-functional. The work ability is sub-optimal. The state governments should show more interest in primary health care. It is when we have people in those places that we can now say we want to push that it for a proper health centre.’’
According to him, the association has been proffering solutions to the issue through various mechanisms within its capacity.
“Through the machinery of our state chapters, we are getting across to the states. Also, when we met with the President, the issue of primary health care is one of the things we discussed with him. It is what strengthens the health system in the country. We are getting our doctors in private hospitals in the rural areas to contribute to the health centres. We are also working on the monitoring and evaluation of the primary health centres,’’ he added.
By FEMI MAKINDE, SUCCESS NWOGU, PETER DADA, ALEXANDER OKERE, ETIM EKPIMAH, TOPE OMOGBOLAGUN, TED ODOGWU, CHIDIEBUBE OKEOMA and SAMPSON ITODE
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