With dilapilated infrastructure, many Primary Health Centres (PHCs) across the country have gone seedy. They cannot even be referred to as “mere consulting clinics” as the late Head of State Gen Sani Abacha once described public hospitals. OYEYEMI GBENGA-MUSTAPHA, WALE ADEPOJU, AUSTIN EHIKIOYA, Abuja; OBINNA OGBONNAYA, Abakaliki; ADESOJI ADENIYI, Osogbo, Osagie Otabor, Benin; Nwanosike Onu, Awka and LEKE AKERE DOLU, Akure, report.
THEY were established to handle what can be referred to as minor health challenges, such as child and maternal care. It was a lofty idea sold to the then administration of former military President Ibrahim Babangida by the late Health Minister, Prof Olikoye Ransome-Kuti. Fifteen years down the line, the primary health care scheme is beset by problems.
Many of the Primary Health Centres (PHCs) nationwide have become an eyesore. They are not what an hospital should be.
Unkept premises; fallen fences; failed sewage systems and dry taps have become their lot. From Lagos to Osun, Edo, Ebonyi, Anambra, Ondo and Abuja, the story is the same. These Federal Government facilities have been left to rot away.
The Lagos PHCs were established in 2001. The situation at the PHC in Ajegunle, Ilo in Ojokoro Local Council Development Area (LCDA) of Lagos State is pathetic. Its equipment are decayed, infrastructure obsolete and the referral system has collapsed.
Primary healthcare, which is supposed to be the bedrock of the country’s health care policy, cater for less than 20 per cent of potential patients.
Besides, the Ajegunle Ilo PHC has been over grown by weeds. The septic tank and soak away have collapsed. The toilets are in a deplorable condition. The building itself is repulsive, as it is too dirty to be identified as a health institution.
At this 12-year-old facility, the infrastructural development and management are not in tandem with the health exigencies of the host communities, as the centre does not have enough qualified and experienced staff. The only qualified worker suitable for employment is the Head of nurses; others are ad-hoc private hospital trained nurses and health workers.
PHCs are supposed to be manned by Community Health Workers/Community Health Officers/Community Health Extension Workers (CHW’s/CHO’s /CHEW’s ) with the National Primary Health Care Development Agency in collaboration with the Institute of Child Health and Primary Care of the University of Lagos.
The Nation observed that the borehole is no longer functional; hence patients buy water sachets to, for instance, cool down rising temperature in children; especially if such is billed for injection.
The Nation’s investigation revealed that out of the four people perceived to be ‘staff’, two or even three may be absent or resume to duty with impunity. The patients comprising expectant mothers, nursing mothers and babies are made to suffer their discrepancies.
It was quite revealing that drugs, even the routine drugs for mothers and children that are given free by donor agencies are scarce to come by.
When contacted on the state of the centre, the Chairman of one of the host communities, Akinde/Kanran Community Development Association (CDA), Adeyemi Adesina, said: “The centre was a beauty to behold at inception. But we learnt that after the creation of Ojokoro Local Council Development Area, some miscreants, assisted by some nurses were alleged to have aided the pilfering and breaking of the centre to cart away drugs and some of the equipments at the centre. The traditional ruler then, late Chief Adenekan threatened to report the case officially but there was pressure from some quaters to let sleeping dogs lie. Since then, there had been changes in the composition of committee membership at the discretion and instance of the late Chief Adenekan,who was the patron until his death.
“As at now, Chief Z.A James still holds sway as the Chairman. He holds the key to the pharmacy where purchased drugs are kept and he is responsible for the purchase and issuance of drugs to the nurses, who recycle same, which is common knowledge.”
Shedding more light on the situation, Chairman, Joint Community Development Area (CDA), Ward G, Olusola Davies said: “Drugs are not always available in the centre since there was no transparency and committed administrative mechanism for purchasing and dispensing of drugs. It has been widely rumoured that fraudulent arrangements were made for nurses and members of the committee to purchase drugs on private basis and sell to patients through the collaboration of nurses.
If the centre is upgraded, it can cater for the over 32 communities in the LCDA.
Vice, Mrs Fausat Olajokun, told The Nation that the LCDA is aware of the problems confronting the PHC.
“And we have written a letter informing and inviting the committee members in charge of the PHC to a meeting where we would forge ahead with our plans to renovate the centre. The letter had been written about two months ago and we do not want to make any issue out of such,” she said.
The sad story of decay of PHCs is the same in Edo, Ondo, Osun, Ebonyi and other states, including the Federal Capital Territory (FCT), Abuja.
It appeared expectant mothers in Edo State do not visit the PHC centres for pre and ante-natal care, and child delivery.
Many PHC visited in state said they have at most two deliveries monthly.
Findings showed that some PHC’s are in two-room rented apartments and the services they render are mainly immunisation for children.
At the Oredo PHC in Ikpema Street, the matron, Mrs Mercy Aigberie was not around but one of the nurses on duty said they were yet to move to the permanent site.
The PHC is a single room with benches where patients can sit.
The nurse said they only carry out immunisation and treat minor ailments such as malaria, pneumonia, among others.
At Iwogban and Ute PHC in Ikpoba-Okha local council, it was gathered there were dearth of staff and shortage of drugs at the centres.
The Matron at Ute, Mrs. Odiase Dolly said they were supposed to operate 24 hours but could not because of shortage of staff. She said they have applied for drugs from the local councils but they were yet to be delivered.
Mrs. Dolly said water is not available at the centre and they have between two or three child births monthly.
In Ondo, Primary Health [PHC] is an essential delivery system, which is often made available to the rural dwellers.
This is because the rural community is a significant part of the larger society. Over 70 per cent of the people in the state live in the rural area.
In Ondo State, the PHCs cut across the 18 local governments and are located in the rural communities where the people can easily get access to health care delivery.
In the last administration of Governor Olusegun Agagu, PHCs came alive, following the priority attention given by the administration.
More medical practitioners were employed and infrastructure upgraded
But the present government in the state focused more on health programmes designed to provide safe delivery for expectant mothers.
The government led by Governor Olusegun Mimiko embarked on the construction of Mother and Child Hospital (MCH) in Akure which is the state capital, with a promise to construct mega hospitals in the 18 LGAs.
This has brought less attention on the health care centres, thereby leading to people seeking medical attention in Akure where the only mega MCH exists.
The state government through its Ministry of Health said it has spent billions of naira to provide accessible health care in rural communities.
Despite the fund expended on the PHC in the state, the health centres visited by The Nation left much to be desired.
In Ose Local government, the Ifon Comprehensive health Centre is still wearing its old look, with little facilities to cater for the demand of the people.
It was gathered that the only available treatment at the health centre is the prescription of Paracetamol and other generic drugs for minor ailments.
The popular thinking is that since the government embarked on the MCH programmes, the health centre has been receiving less attention.
Rural dwellers in those communities are said to be seeking medical attention either in Owo General Hospital or the Federal Medical Centre also in Owo Local Council.
In Araromi, Obu, in Odigbo local government, the health care centre is ill-equipped; the pure agrarian community is faced with infrastructural challenges, coupled with its sub-standard health care centre.
Alaajagbusi in Akure North still lacks functional and equipped health centres. Most of the patients who need medical attentions are either transferred to General Hospital, Iju in Akure North Local Government or the State General Hospital in Akure South Local Council
In Eleberese community, the government built a health care centre which has not been functioning for a long time.
The Nation’s visit to the agrarian community shows that expectant mothers travel as far as Ore to access health care.
The hospital built to serve the community has been abandoned without necessary materials and infrastructure such as drugs, electricity and potable water.
In Osun State, many PHC claimed to have sufficient drugs to dispense to the sick. An investigation carried out by The Nation revealed that there is enough patronage within the limit of the local population. For instance, in Ede, a neighbouring community to Osogbo, the Osun State capital city, records show that the sick visit about 36 health centres serving the ancient town and its environs.
It was gathered that some of the biggest challenges facing the health care delivery in this area is lack of motorised water supply. Others are lack of toilet facilities and electricity to use in the centres.
In Olusokan ward 5 of Ede and health centres in Abere, a community hosting the state secretariat, there are no storage facilities for vaccines and drugs being administered on the local residents. It was also gathered that there are no resident doctors attached to these rural health centres.
At a community maternity centre at Asubiaro community, located on a road leading to the sacred Osun Groove, it was gathered that many women came to be delivered of their babies.
Majority of the PHCs in the 13 Local Government Areas (LGAs) and 63 Development Centes of Ebonyi State could be regarded as mere dispensaries. Rural dwellers now access health care at the mission hospitals.
Most of the drugs expected to relive pains are not readily available in some of the centres. Some centres also lack qualified medical personnel.
The PHC centres in the Federal Capital Territory (FCT), Abuja, which are located in the satellite villages, are in dilapidated state.
The poor decoration and furniture in most of the centres in Abuja are enough to aggravate the illness of a patient.
Apart from few health workers, who normally report for duty, nothing seems to be working in line with the aims for setting them up.
Most of the centres neither have drugs to dispense nor the necessary health equipment to do treat the patients.
The establishment of PHC in Anambra State has raised more questions than answers. Some are located in rented apartment without drugs while others have staff sleeping in them.
During imunisation, the PHC staff find it difficult to go to the field to monitor the exercise which is the main trust of the United Nations Children’s Fund (UNICEF).
The PHC which are suppose to be neat have become dirty. For example, the PHC Centre at Oba -Ofemili in Awka North LGA is a shadow of what it should be but the story is different at Nteje. Mrs Kate Ajaitu, Head of Facility at the centre, said the major challenge is procuring drugs. Despite the condition of Oba-Ofemili PHC patronage is stil high, according to Mrs Fidelia Nwabunie. She said drugs have not been supplied for about two weeks.
