SITTING on a bench in the waiting room at Wumba Primary Health Centre, located in Apo Resettlement Area, an outskirt of Abuja, Nigeria’s capital city, Aishetu Audu fans herself with a notebook.

The sweltering heat in her ward which she also shared with another patient was unbearable. She later sought respite outside the ward where hours earlier she was delivered of a baby boy.

The Wumba PHC which is the closest to Aishetu is about 45 minutes from her home. She was rushed to the clinic early that August morning.

From the ward window, she could see glowing light bulbs across some houses on the street, but the health centre had no electricity.

“Houses across the street at least have a few hours of power supply daily, but a clinic that should have lighting for patients is in darkness. Look at me running around the clinic looking for fresh air and cool breeze,” she said.

The ceiling fan in Aishetu’s wardroom had not worked since February 2019, after the Abuja Electricity Distribution Company, AEDC, disconnected the community health clinic from the national grid.

The health centre was disconnected because its outstanding electricity bills had accumulated to over N100,000 ($262.5) which it cannot afford.

Currently, it depends on a petrol-powered 1.5Kva generator which gulps s N6,000 ($15) worth of fuel every week, according to Mary John, the health officer in charge. This means N24,000 ($62) is kept aside monthly, as fuel costs.

“We put on the generator mostly at nights or whenever there is an emergency such as when a woman is in labour or during cases where minor surgeries are performed at the centre,” she said.

But the noise from the generating set is another problem.

Patients at the hospital who spoke to The ICIR  said when the generator comes up they can barely cope with the loud noise it makes as it is kept very close to the clinic’s building.

Unlike other facilities that provide a small house for the generating set, the health centre has no special room to keep the generator.

This explains why Mary and her medical staff of three at the Wumba PHC resort to charging patients extra fees to raise the funds to support the expenses on the generator.

“At the peak of the coronavirus pandemic, we had very few patients at the clinic because people were afraid of coming to the centre for fear of being labelled a COVID-19 patient. Notwithstanding, there was little we could do here without power supply,” she said. 

“The generator we have cannot power the scanning machine for antenatal care or the refrigerator which we use to keep vaccines at a suitable temperature for immunisations so we referred parents who came to the Dutse health centre which is more than one hour away to vaccinate their children,” Mary said.

Aishetu will travel a distance of 34.9km from Wumba which would take more than two hours due to the poor condition of the road to the Dutse PHC the nearest health facility if she wants to get her newborn baby vaccinated in the coming months.

Her struggle is similar to that o millions of women in Sub-Saharan Africa who must embark on a long journey to access the nearest emergency health service and obstetric care, according to a 2018 study published by Lancet Global Health.

A resort to dirty energy alternative

In Gwagwalada, which is over an hour drive or a 65.6km distance away from the relatively up-scale part of at the Gwagwalada Primary Health Care, Phase 3, Adebosin Felicia, the deputy health officer in charge of the facility rummages through a medicine cabinet for a patient’s drug.

“It has been challenging working at a health facility without power supply because of the frustration associated with it. We spend about N5,000 weekly which is exorbitant to keep the generator running in order to maintain operations at the clinic,” she told The ICIR.

Months after the health centre was inaugurated in 2019, burglars broke into the facility carting away electrical cables and other items of value. Though the building was enclosed with a fence there was no security personnel attached to the health centre at the time.

“Since the clinic was vandalised, we always head to the cold-chain office in Gwagwalada whenever it is time to get vaccines for immunisation of children since we have no way of storing the vaccines without power supply,” she said.

With this situation in most African countries, immunisation policy by the World Health Organisation, WHO, faces a huge energy challenge if it is to meet its target for vaccine refrigeration capacity expansion by 2025, and cater to the vaccine needs of the growing global population.

In April, when the COVID-19 pandemic was at its peak in the country Adebosin said several patients did not agree to be admitted at the clinic but preferred to receive treatment at home because the clinic had no power supply.

Fumes from the generator would usually find its way into the ward making patients uncomfortable, prompting them not to think twice before exiting the clinic.

“So we’ve been losing patients on a regular basis especially during the COVID-19 pandemic early this year where the turnout of patients was very low because most of our machines were not working. Patients preferred other facilities where their needs would be addressed,” she said.

In 2018, Nigerians spent about N145 billion ($477 million) to import generators into the country. Nigeria is ranked fourth in the world for deaths caused by air pollution, an offshoot of the use of dirty fuels while an estimated 114,000 Nigerians die prematurely from air pollution each year.

As PHC’s across Nigeria’s capital city turn to dirty fuels for lightings and to power their medical machines, due to the failing national electricity supply. However, PHC’s which should be lifesavers by adopting the use of dirty fuels now serves as a conduit of death.

Still in the dark after 6 years

It was almost sunset, as Umar Sadiq prepared for the end of his shift which would commence in an hour. He had been away from home since 10 am, and his wife and five children were eagerly expecting him to be home.

Umar was clearing his desk in the almost deserted Manderegi PHC in Abaji Area Council as there was no patient around for the one hour the reporter spent at the facility.

There was hardly any medical equipment, or electrical appliance in the four rooms of the facility, which serves a population of 2,000 people. 

Speaking to The ICIR he said the lack of power supply has affected the quality of healthcare delivery at the PHC from vaccine delivery to the period of operations at the clinic. The clinic is closed by 6 pm unless there was a medical emergency.

He has to embark on a 6km distance to reach the cold-chain office in Abaji where he would get the vaccines and before the temperature of the vaccine gets warm.

“We do not store vaccines here so we collect our vaccines from the cold chain office on immunisation days. We also return the ones we do not use to them. That is how we have been operating,” he said.

Since the Manderegi PHC was established six years ago, it is yet to be connected to any form of electricity so whenever there is a medical emergency at night the health workers make use of rechargeable lanterns or phones.

Nigeria has suffered over 206 grid collapses in nine years with about 12 breakdowns in 2019. This problem which causes consistent power failures has made health workers continue to rely on rechargeable lamps and mobile phones as an alternative energy backup.

For Umar and his medical staff of six at the health centre, they will continue to practice medical staff best practices like cutting umbilical cords with clean blades and keeping infants warm by placing them on their mothers’ abdomens learning to avoid whatever has to do with electricity.

Praise Ogbebor, a renewable energy specialist told The ICIR that the increasing energy demand in Nigeria’s healthcare delivery can only be bridged by a decentralised renewable energy solution.

“With the consistent power shortages experienced across the country due to the failing national grid, the solution will always lie with sustainable energy. If you consider the amount spent in building healthcare centres a fraction of that money could get an Off-grid solar installation running,” he said

Scaling up to turn the tide

Dakwa Primary Health Center, located in Abuja Municipal Area Council has been touted as a model health facility after the community health centre celebrated a two-year uninterrupted power supply in 2018.

For a curious mind, this feat looks unattainable for a rural health facility situated in Nigeria where 76 million people do not have access to electricity according to a 2019 Price Waterhouse Coopers, PWC, report. 

However, when the PHC was built in 2014, it was in blackout for the first two years of existence without any form of electricity, depending on rechargeable lamps. 

In April 2016, Vaya Energy, a Nigerian renewable energy company which was focused on the deployment of solar-generated electricity solutions, designed and installed a 12-panel solar-powered off-grid system for Dakwa PHC at an estimated cost of N3 million.

The initiative was part of its Corporate Social Responsibility, the solar power project was also replicated at the Karu Health Centre, an outskirt of Abuja which was plagued with frequent blackouts.

Energy experts believe putting solar panels on the roof of every clinic isn’t the right answer as often such projects usually get bad within a year, but building mini-grid systems to support communities, starting with the health centres is a big step in the right direction.

At Dakwa PHC, the shuddering roar of a generator that Thursday afternoon took away the solitude of the environment where health facility is located.

Martha Dikko, the health officer in charge of the centre refused to speak to the reporter when she was asked why the generator was still a major source of power supply to the health centre if the solar installation was still in good condition.

“I can’t talk to you without the approval of my superiors especially when the questions you are demanding answers for is very sensitive,” she said.

Enquiries made by the reporter showed that the solar installation at the Dakwa health centre currently powers the solar refrigerator alone while the generator and electricity from the national grid provide lightings and powers critical devices.

The situation was also the same when the reporter visited the Gbagalape Health Centre, Nyanya and Karu Health Centre, Karu where they both make use of a solar refrigerator which is the only appliance powered by the solar installation at the health centres.

Egwue Yunana, public health analyst who spoke to The ICIR, noted that the major impact of a sustainable power supply in health centres will increase the productivity of health workers, especially in rural areas.

“Health workers usually take the responsibility of providing alternative power supply they need at their various health centres which comes from their personal funds, or the internal revenue generated from services offered to patients but the provision of a reliable power supply will make a huge difference by relieving the health workers of this unnecessary burden,” he said.

Will the fortunes of the PHCs improve

Chris Elemuwa, Deputy Director of the Laboratory and Surveillance, at the NPHCDA, Abuja said the response of the primary health centres in Nigeria to COVID-19 could be better if priority is given to improved energy access.

“During the pandemic, PHCs could not carry out contact tracing or laboratory testing because most of them were ill-equipped to perform that task.

“Power supply is a very critical aspect for laboratories if they are to function optimally because COVID-19 is a viral disease and part of the fight against it should come from the laboratories,” he said.

In 2018, a $350 million World Bank loan was assessed by the Nigerian Government to be used to build 10,000 solar-powered mini-grids by 2023 in rural areas, which will bring power to hospitals, schools and households.

Elemuwa said the PHC’s should always be at the forefront of fighting a pandemic because of its strategic role as the first line of defence in healthcare.

“If there is an aggressive plan to provide reliable power supply to PHC’s, then their fortunes will change for the better,” he said. 

A 2018 Heinrich Boell Stiftung energy report on PHC’s in Abuja showed that the number of PHC’s increased from 234 in 2016 to 248 PHC’s in 2017. 

The Federal Capital Territory Primary Health Care Board, FCTPHCB, disbursed N800,000 to PHC’s in 2016 to fund the purchase of fuel and maintenance of their generators while N947,000 was approved for the same expenses in 2017.

This translates into a paltry sum of N890 and N1,008 monthly for each PHC in Abuja during the period under review which is way lower than the expenses made by the PHCs.

The ICIR sent Freedom of Information, FOI, requests to the NPHCDA and the Federal Capital Territory Primary Health Care Board, FCTPHCB, to provide a financial breakdown of the expenditure made by both agencies, towards building PHC’s in Abuja between 2015 to 2019, and also the amount spent in providing electricity for the health facilities. 

Till date, he NPHCDA has not responded to the FOI request which is a breach of Nigeria’s FOI Act that prescribes that  FOI request should be acknowledged and replied within seven working days which elapsed three weeks ago.

The UN’s Sustainable Development Goal targets 2030 as the year the global population would enjoy access to affordable, reliable sustainable and modern energy. And renewal energy generated from solar could make the goal realisable in Nigeria where over 200 million Nigerians depend on less than 4,000 megawatts of electricity generated in the country. But at the moment, the hope is still dim.