Olanrewaju Oyedeji spent time with some communities in Nasarawa state, to have a front-row experience of how they are coping with the dearth of basic primary health care. He documented the plights and pains of the vulnerable Nigerians, who are forgotten and excluded from the sanctuary of quality primary health care.
Amina is in her mid-thirties and also a resident of Saka, a community in Nasarawa state, her story of childbirth mirrors what women in the community experience while giving birth.
When this reporter saw her at Saka Primary Health Centre, she was with her baby, who she says is six months old, Amina had come to the Saka Primary Health Centre for Ante-natal.
Speaking to our reporter, she narrated that her Child delivery could not happen at a proper hospital nor the primary health centre at Saka PHC but rather at home. Amina noted that this is not because she prefers to give birth at home but rather due to the state of Saka primary Health Centre which reeks of absence of medical personnel and facilities.
“I had to give birth at home, if I come to the health centre, there are no personnel that can adequately take care of me, so mama and my people are the ones that help me”
Infact, her ability to partake in Ante-natal is largely dependent on the swiftness of the one community health worker who is the only “expert” on ground and able to attend to women who need Ante-natal care at the PHC.
This is asides the paucity of facilities in the health centre which denies patients adequate health care. Our reporter gathered that many women in Saka rely on the elderly women of the community to deliver their babies, putting their life at risk while doing so.
This situation is not peculiar to Saka alone but to other communities visited by this reporter in Nasarawa state.
Nasarawa state has a history with Child mortality. As at 2018, the infant mortality rate of Nasarawa state (for Children at age of one and under) stood at 64 per 1000 live births while Children of 5-years and under stands at 60 per 1000 live births.
Perhaps to provide better access to healthcare especially for women and children is why the federal government flagged off the Primary Healthcare Centres (PHCs) revitalisation programme in 2017.
Also, in September 2017, Bill and Melinda Gates Foundation donated the sum of $500,000 to the Nasarawa State Primary Health Care Development Agency to give PHCs in the state a face-lift as well as empower it to live up to its mandate.
However, it was not until 2020 that Nasarawa state awarded contracts for the renovation and rehabilitation of the PHCs tracked in this report. The three Primary Health Centres tracked in this report had contract awards totaling over N100 million for their renovation and rehabilitation.
Despite huge investments and awards of contracts to upgrade PHCs in the state, access to healthcare remains a core challenge.
For instance, the case of Saka PHC in Uke, Nasarawa is worrisome given that residents of the community who are predominantly farmers rely on this PHC for access to healthcare.
Their lack of access to hospitals in the major town is not helped by access roads. To get to Saka from Keffi (the nearest town), one will use at least 40 minutes on a motorbike.
Amina who shared the fact she needed to give birth at home noted that persons usually harm themselves in the process of pregnancy in an attempt to give birth without any PHC assistance.
Saka PHC benefitted from the renovation and equipment exercise carried out in 2020. According to details on the Nigeria Open Contracting Portal (NOCOPO), two contracts worth the sum of sixteen million, six hundred and eighty three thousand naira (N16,683,000 million) each were awarded for the exercise in June 2020.
Another sum of eight million six hundred thousand (N8,600,000 million) was again recorded for the equipping and renovation of the health centre in February 2020. These totals N42 million earmarked for equipping of the health centre. The contracts were awarded to M.C Micro Concept Ltd. and Harara Turnkey projects limited.
From investigation, however, only six hospital beds and frames, four long chairs and 10 short chairs were supplied.
The roofing of the health centre was also rehabilitated while a three one- bedroom flat was constructed.
Although, it remains unclear if the three bedroom flat constructed within the premises of the PHC was built from the amount budgeted for renovation and equipping of health centres as a personnel told this reporter that the project was carried out in 2021.
Saka Health Centre Relies on Rain for Water, Lacks Nurses, Doctors
Asides accountability, the health centre lacks the basic and human resources to carry out its daily activities.
Reports indicate that after the construction of the three- bedroom staff quarters project in 2021, the PHC has had no electricity supply due the fact that its power generating set is faulty. It was gathered that the generator which services the healthcare centre developed fault during the construction project and had been abandoned since then, a development which has affected water supply as the borehole too is no longer functional.
The centre, this reporter gathered, relies mainly on rainfall for water.
An official at the facility who pleaded not to be named said: “We usually rely on rain for water or we would go to the nearby community to fetch water which we use to carry out our daily health needs. This isn’t good at all because it is unhygienic and exposes patients to outbreaks.”
While it was revealed that no fewer than two hundred persons visit Saka health centre in their quest to access effective medical care, this reporter can boldly state that their expectations have never been met as there is hardly a nurse or doctor to attend to the patients.
At Saka PHC, only three community health workers were seen at the facility; an environmental health official who handles immunisation as well as two laboratory technicians.
Saura is another community which is supposedly a beneficiary of the upgrade project in its primary health centre. Residents of Saura are mostly rice and corn farmers. They however, plant other crops.
Residents of Saura must have heaved a sigh of relief when a Primary Health Centre was built in their community. Their joy will be strengthened due to the fact that they are ‘cut away’ from the major city and the community is hard to access due to bad and non-motorable roads. With the absence of a standard hospital, the PHC was supposed to be their ‘own hospital’.
It takes at least one hour on motor-bike to get to Saura from Keffi.
When this reporter visited the Saura Primary Health Centre, there were only two personnel on ground. It was later understood that only three health workers were assigned to the centre. An environmental official who specialises in immunisation and two community health workers attached to the centre.
An official who craved anonymity revealed that only one person attends to all patients, including helping pregnant women deliver with the help of the head of the Primary Health Centre at times.
Worse is the discovery that the health workers have not been trained on how to use some of the equipment supplied to the health centre. This also leaves a major gap .
When this reporter sought to know what a particular medical equipment was used for, the personnel on duty, who is a senior staff at the centre could not answer the question but simply said, “I do not know what that is used for”. The personnel at the health centre did not know what other equipment kept in the store and supplied to the PHC were used for.
Their inability to use the equipment supplied also raises concern in addition to accountability and shortage of workforce.
A review of the details on the Open Contracting Portal shows that just like Saka, two contracts worth sixteen million, six hundred and eighty three thousand naira (N16,683,000 million) each and another worth eight million six hundred thousand (N8,600,000 million) were awarded in 2020 for renovation and equipping of the health centre. This amounts to forty two million naira (N42,000,000 million). The contract for Saura PHC was awarded to Muhafims Global Resources Limited.
It was gathered that for this amount, the health centre was repainted, although when this visit was made, the paints were already peeling off the fence of the primary health centre.
When this reporter visited the facility to ascertain the level of renovation work carried out at the facility, it was observed that aside from the replacement of the ceilings, five fans, six beds and frames, one cabinet, four drip stand, fifteen chairs, a generator, a fridge and three fire extinguishers were supplied.
This findings further raises questions as to the cost incurred in acquiring the aforementioned items as against the total sum awarded for the contracts.
Findings revealed that the generator acquired, which is one of the most expensive of the equipment supplied by the contractor, is worth the sum of N257, 300 currently based on checks on Jumia (an online shopping site).
A higher brand of one of the fans supplied is worth N39,899 on Jumia, while five of the standing fans supplied would amount to only N199,495 at the maximum.
If the cost of the three fire extinguishers supplied were to be N37, 500 each, which is the price of the most expensive fire extinguisher on Jumia, a sum of N112,500 would have been spent on the five (5) fire extinguishers.
The brand of refrigerator supplied to the primary health centre is estimated to cost N79, 990 on Jumia. All the supplies put together shouldn’t be up to N1m (One Million Naira) in the open market, thereby raising concerns on how the remaining N41 million was spent.
Checks on the store where the supplies are kept also affirmed these concerns.
Asides from the issue of use of funds, patients have to wait hours before they get attended to.
Patients who spoke to this reporter noted that while the personnel at the PHC ‘try to attend to them’, they spend endless waiting time at the PHC due to the patient to medical personnel ratio.
“The doctors (referring to the community health workers) here try to attend to us but sometimes we have to wait endlessly before we receive care, even some of my friends prefer treating themselves at home instead of coming because when they have emergency, the doctor maybe busy and before getting attention, the situation could have worsened” a patient who prefer not to be mentioned told our reporter.
Despite the apathy of residents in visiting the Saura PHC, it was gathered that at-least 300 patients visit the primary health centre on a monthly basis.
A staff at Saura while speaking to our reporter admitted that the duties at the PHC are overwhelming and lack of adequate experts only leave them as being able to do ‘just what they can do”.
“I try my best to attend to people, it is hard because I barely do any other thing, i stay here for twenty-four hours and as you can see we are just two here plus the head of the Health Centre that comes at times”.
Quipped on how people access healthcare with just one staff treating them, the PHC worker argued that in face of the situation, the patients who have no hospital in the community can only manage.
“My house is nearby, I cannot do it alone but there is not much choice” it was stated.
When Nyangi in Toto was visited, the situation of residents of Nyangi where the Nyangi Primary Health Centre is located was more shocking. While Saka and Saura have issues of unpaved roads, Nyangi has no access road at all.
To get to Nyangi, the only route is a river that has no bridge or walkway. The people of Nyangi have to walk through the river, carrying heavy loads to balance themselves. This is usually after embarking on an over one hour journey on motorbike from Gadabuke (the nearest town to the riverbank that leads to Nyangi).
In Nyangi, over 500 residents, who are reportedly cut off from the major cities, rely on the primary health centre as hope for accessing healthcare.
When contacted on phone, the spokesperson for the Nasarawa state Ministry of Health, Hannah Joshua, said that the state is making efforts to prioritise access to healthcare.
She noted that shortage of personnel is a global issue and as such it is not just peculiar to Nasarawa alone.
Joshua said one of the measures being taken by the state is training Community Health Extension workers on life-saving skills that can help them carry out activities that would be carried out by midwives. She also said there are provisions that allow ‘Visiting Doctors’ to help in the operations of these facilities.
Speaking further, she claimed that primary health centres are not expected to have doctors but instead community health extension workers head such places. When quipped about the importance of such health centres to the people in the rural areas who lack access to hospitals that maybe in town due to distance and bad roads, she stated that there was continual provisions to tackle these problems, such as provision of emergency healthcare ambulances (although findings and visits show that these roads that lead to the health centres visited are not motorable).
Attempts to reach the contractors who handled the renovation and equipment supply contracts for the PHCs, Muhafims global resources and M.C Miro Concept Ltd proved abortive.
The companies do not have active websites nor do they have any online presence that details their contacts. Aside from being listed as inactive on the Corporate Affairs Commission (CAC), the Nigeria Open Contracting Portal (NOCOPO) also failed to list the contacts of the contractors.
The World Health Organization has noted that PHCs are important to helping people access healthcare; describing PHCs as inclusive, equitable, efficient and cost-effective ways of helping people access healthcare.
This report is supported by the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting, ICIR