In Adamawa State, primary health care is not just government’s business. Benefiting communities play active part in mobilising funds to facilitate establishment and running of health centres. And donor agencies are in what has become a tripartite arrangement for the benefit of both rural and urban areas, writes ONIMISI ALAO
Mr Jonah Thompson is the Chairman of Ward Development Committee (WDC) of Sabon Pegi Ward in Numan Local Government Area of Adamawa State who oversees a health centre on behalf of his people.
Recounting his experiences, he said: “The owner of the building we were using ejected us. We looked around and got this place and one politician we solicited assistance from gave us money.
“The politician gave us N1.2 million which was not enough, because this property was N1.85 million. So, we had to source money from elsewhere with which we bought the property.”
By ‘this place’ in his remark, Mr Thompson meant the Primary Health Care Centre (PHCC) in his ward.
As the WDC Chairman of Sabon Pegi, he supervises the centre and another health facility within the ward.
In a peculiar and apparently beneficial arrangement, the community, the Sabon Pegi Ward (as in all other wards across Adamawa State) has a huge role in the establishment and running of health facilities under the state government that are located in their vicinities.
Mr Thompson explained: “We take the health centres in our communities as our responsibility because the primary health care services of the state government does not build houses to establish health centres.
“It is for WDCs to get the building, rented or purchased, for the health facility to be located in the wards.”
Narrating how the Sabon Pegi community was able to acquire the structure that currently houses the PHCC Sabon Pegi, Mr Thompson said: “When we had need of a building after we were ejected from our former place, we resolved to approach our politicians.
“We appealed to one Senator who sent N1.2 million to us. We completed it (the N1.2 million) with Decentralised Facility Financing (DFF) from NSHIP to buy this building.”
While DFF stands for Decentralised Facility Financing, NSHIP means Nigeria State Health Investment Programme. Both are funding instruments contributed by the federal and state governments, in collaboration with the World Bank, towards primary health care delivery.
Currently, Adamawa State is one of the best states in Nigeria that offer quality primary health care services.
That it works in Adamawa is refreshing in a country where public facilities are ‘owned’ by government, patronised by the people and cared for by virtually nobody.
Which is why public facilities, including clinics decay quickly and often irredeemably. In this case, Adamawa State makes a difference.
In the state, benefitting communities, government and United Nations agencies play crucial roles in the establishment, ownership, maintenance and funding of the primary health care centres in the communities. The state has some 400 primary health care centres.
Explaining how the parties’ efforts made the centres to be functional, Mr Thompson said: “EU/UNICEF painted the building.
They did it in their usual way of renovating health centres in Adamawa. They furnished the maternity ward and made the place really good for expectant mothers to be delivered of their babies.
“The role of the state is to maintain the workers. They send members of staff and pay them. But we in the community, we can employ cleaner, washer man, casual or such other members of staff that we need.
“EU also helps a lot. You need to see the beauty of our labour rooms. They tiled the maternity section, acquired delivery beds and baby beds and so on. Sometimes they send us free drugs.”
The Executive Secretary of the Adamawa State Primary Health Care Development Agency (ADSPHCDA) for Numan Local Government Area, Mrs Asalina Apasa, revealed that the LGA has 13 health centres under the agency where the EU/UNICEF is intervening.
The 13 centres, she explained, are those primary health centres which the EU has adopted and for which it provides intervention packages through UNICEF.
She stressed that all the primary health centres remain government establishments for the good of the host communities.
She said: “The adopted centres are government facilities under primary health care. They were identified by the EU/UNICEF for special intervention.
“They are called referral centres because of the quality of services available in them. There are 10 wards in Numan. In each ward we have at least one of such. Two particularly large wards have two and three respectively.
“Apart from the general health services for which the EU/UNICEF provides intervention, the pair funds certain services in their entirety.
Nutrition, maternal health, family planning and immunisation are some of them.
In nutrition, the EU/UNICEF created Community-based Management of Acute Malnutrition (CMAM) centres in some of its adopted centres (six in Numan LGA) at which weekly clinics are organised for malnourished children.
At CMAM centres, UNICEF makes nutritional supplement and other commodities available free. Children ascertained to be malnourished are admitted at the CMAM centres where they receive nourishment until they are certified okay, usually after seven or eight weeks.
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CMAM is in its third year of implementation. Under the programme, children diagnosed with malnutrition are given micronutrients and Ready to Use Foods (RUF). RUF is readymade food for malnourished children.
At the ADSPHCDA headquarters in Yola, the Coordinator of Integrated Management of Childhood Illnesses (IMCI), Sunday Naina, revealed that in all, the agency runs 403 primary health centres across Adamawa State.
He said the EU/UNICEF directly provides intervention to 226 of the number, one per ward.
On ownership and protection of the 403 centres in communities across the state, he said the ADSPHCDA does acquire or put up buildings by itself for use as health centres if identified communities are unable to provide such structures.
“We encourage communities to own structures and some communities actually acquired structures and applied to us to provide the human resources.
But, whichever way they come, ADSPHCDA wants communities to own the centres in their domains, have a say over them, and take care of them,” he said.
In contrast to the relative success in primary health care services in Adamawa State, the secondary and tertiary levels of care leave much to be desired.
The supposedly elite Adamawa Specialist Hospital in Jimeta, Yola, has, for long, been a shadow of itself.
It had a medical director who was accused of mismanaging the hospital but who remained at his duty post without being removed by the governor.
Governor Ahmadu Fintiri was said to have sacked him, but it seemed he is too powerful. Fintiri finally removed the man and replaced him with one Dr Dauda Wadinga.
Wadinga, whose appointment was announced last Sunday, December 22, now has the task of repositioning the specialist hospital and four other general hospitals across the state. Only one tertiary hospital exists in Adamawa State, namely the Federal Medical Centre (FMC), Yola.
The FMC, located in the old Yola Town, has a reputation of being one of the best in tertiary health care services in the Northeast, next only to the University of Maiduguri Teaching Hospital.
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