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By Kelechukwu IRUOMA
EIGHT years ago, there was a communal clash between Ogwu-Ikpele community in Ogbaru local government area of Anambra State and neighbouring communities in Rivers State, leading to bloodshed.
During the clash, several weapons such as cutlasses and daggers were used. Some youths of Ogwu Ikpele were injured while others died due to the injury sustained.
“Some of those who died could have survived if we had a functional primary health center with qualified doctors and nurses,” said Onyedika Ochije, a youth in the village.
“The health center was empty that period and no doctor was around when we rushed them to the center.”
Ogwu Ikpele is an oil-producing community in the Southeast that shares a boundary with Omoku, Okpai, and Uchi communities in Rivers State in the South-South region. The road to Ogwu Ikpele from Ossomala is bushy and not motorable as it has been severely affected by flood and erosion.
Preventable death caused by a lack of quality healthcare
Ochije said some of the injured youths died on the way to the general hospital in Ossomala, which is about 20 kilometers from Ogwu Ikpele. Besides the clash that claimed lives, people also usually died prematurely in the community from common, tratable ailments due to a lack of a functional healthcare system.
“People were dying, including pregnant women,” added Ochije.
“Before you take them to the other town in Ossomala, they would have died.” The existing healthcare in Ogwu Ikpele is dilapidated and underfunded.
The World Health Organization (WHO) says only about 20% of the 30,000 Primary Health Center (PHC) facilities across Nigeria are working, which makes it difficult for Nigeria to achieve Universal Health Coverage (UHC).
Effective delivery of healthcare services requires the availability of adequate infrastructure, diagnostic medical equipment, drugs, and well-trained medical personnel. But where health centers exist, they cannot operate because of a lack of basic amenities due to inadequate funding and financial mismanagement by the leaders.
According to the National Primary Health Care Development Agency (NPHCDA) a PHC should have one or more doctors, a pharmacist, a staff nurse, and other paramedical support staff to provide outreach services.
It should also have a well-equipped open ward, labour room, children and female wards, doctor’s office and staff quarters, an ambulance for referrals, and drugs and equipment for immunization, preventive and basic curative care. But many PHCs in Nigeria lack most of these.
The lack of adequate facilities is the leading cause of maternal mortality in Nigeria. According to the Nigeria Demographic Health Survey (NDHS, 2018), the under-five mortality rate in Nigeria is 132 per 1,000 live births meaning that 1 in 8 Nigerian children never reach the age of 5. One Nigerian woman dies in childbirth every 10 minutes, and 1 Nigerian child under-5 years of age dies every minute.
To address the healthcare challenges in Ogwu Ikpele, NPHCDA awarded a contract worth N21.9 million in 2014 to Gridline Nigeria Limited for the construction of a new PHC.
The project was not completed. It was abandoned at the foundation level.
When contacted, the Managing Director of Gridline, Peter Ogbomo, said the project was abandoned due to non release of funds by the NPHCDA.
“We were not paid. They did not give us anything for that project. One single kobo was not given to us. Even after submitting the bill security, they did not give us anything. That was when we abandoned the project. It was around 2016 we left that place,” he said.
“I went to the agency several times and I did not know what happened. We applied for advance payment and we submitted documents. I could not keep on putting my money into the project. They did not pay us even after we had started the job and spent money.”
Ogbomo is sad that he is still being owed.
The PHC project was, however, re-awarded in 2016 to Maldini Construction Company Limited for N57 million as a Type 3 project, which included a PHC, staff quarters, and mortuary.
The project was initially abandoned until work started on the site in February this year. When the reporter visited the project site in late August, the PHC and the doctors’ quarters had been erected and roofed.
The project site was filled with bushes. Ochije, who is the project supervisor said work stopped in May this year but some young men were seen clearing the bushes.
“Due to the flood and some issues concerning the work, there is a slow pace in the project. By the end of this month [August], we hope the plastering of the building will be completed and by January next year, if there is any other thing, we will continue from where we stopped,” he said.
Work has also stopped at the doctors’ quarters. Due to the long distance of the community to Ossomala, there was also a contract for the provision of an ambulance at 20 million in 2016 to Akunna-Martata Limited for the primary health centre in Ogwu Ikpele but the ambulance has not been delivered.
Ochije said he was not aware of the ambulance and confirmed that no ambulance had been brought to the community.
When the reporter checked the contacts of Akunna-Martata on the website of the Corporate Affairs Commission (CAC), no details of the company were found.
Failed primary healthcare revitalization initiative?
The federal government in 2017 began the National Primary Healthcare Revitalisation Initiative to resuscitate over 10,000 health centres across the country. Then Minister of Health, Isaac Adewole, said the objective of the scheme, which would be executed by the NPHCDA, was to have at least a functional health care centre in each ward in the country.
Three years after the initiative was launched, the impact had not been felt by many communities around the country.
As of 2018, there were over 900 NPHCDA PHC projects abandoned across the 36 states of the federation, according to the agency. It said the health projects were abandoned due to delays in the approval of funds by the National Assembly as well as the lack of political will on the part of the lawmakers.
The agency, however, said it would no longer be involved in the construction of new projects until all the pending ones were completed.
But in August 2019, the Ministry of Health said N5.8bn had been released to the NPHCDA from the N51bn from the Basic Health Care Provision Fund (BHCPH) and this has been disbursed to 15 states, including Anambra state, which received N338 million.
So, why are there still abandoned and uncompleted primary health care projects in the state?
At Udezu village, Achalla in Awka North local government, the PHC project awarded for N21 million in 2014 to Nec Engineering Services Limited had been abandoned. When the project site was visited, it was covered by bushes. Having access to the building was difficult. Lack of a functional PHC is one challenge the villagers face.
This, according to the President General of the community, Boniface Chigbo, troubles him. He is furious that his people are not benefiting from the government.
“I inherited that abandoned healthcare project the way it has been,” Chigbo, who was recently made the community’s administrator. “That project awarded in 2014 has been abandoned for five years now and the ones in the neighbouring communities are working.”
Chigbo has made efforts to find out why the project was abandoned six years after it was awarded but there was no positive response from the government representatives he contacted.
“I traced the reason the project was abandoned, I went to Awka and met the health commissioner. I traced the contractor and he said he had not been paid for the completion of the project,” he said.
He said there was nothing he could do to bring back the contractor since he said he had not been paid and the commissioner was not also helping to see to the completion of the projects.
Emmanuel Nnadi-Akwoku, the chairman, Udezu Welfare Association, described the abandoned PHC projects in the community as “unfair” to the people of the community.
“It saddens me a lot. There is nothing we can do because when we hold some people, they say it is not their concern. I am afraid the people given the money have embezzled it.”
“It pains me that when someone is sick here, we carry the person to another place in Awkuzu and Awka. We do not want to be going elsewhere. We want the assistance of the government because we are suffering here,” he lamented.
When the reporter visited Oraukwu PHC in Idemili North local government in August, where the NPHCDA awarded a project in 2018 to Redeemers Touch Nigeria Limited for the renovation of the facility, the renovation awarded for N15 million was not done on the PHC building but the staff quarters.
The matron of the PHC, Chika Ann, said she was disappointed with the work carried out by the contractors mid last year. Before the work was done, Ann said they had several issues in the PHC and staff quarters.
“It is the quarters that they did alone,” she said. “The ceiling usually leaked so they renovated some of the ceilings. They put the doors, roof, and windows.”
The staff quarters did not look like a renovated building. Only the doors and windows were new and the building was painted.
Ann said the iron gates at the entrance of the building were supposed to be changed but they were not. Rather, the workers used iron wire to hold the gate around the pillar to avoid it from collapsing.
“They should change the gate outside and at the back of the building,” said Ann.
The NPHCDA said it would give the PHC a solar as part of the renovation but the matron said she had not seen any such thing.
“We have a generator but it costs a lot to fuel daily,” she lamented.
When contacted, the Director of Redeemer’s Touch, Titus Okonkwo, denied that the project did not meet expectations.
“The job was duly completed based on what was in the bill of quantity,” he told the reporter on the phone.
“We removed all the roof and re-roofed, repainted, and changed all the doors. That was what was awarded to us. We changed the ceiling and plastered it. The health workers said they wanted the staff quarters renovated as they were equally used as clinics. That was their priority. The bill of quantity was not the health center. It was for the staff quarter. We were paid after we completed the project,” said Okonkwo.
He revealed the project was awarded to his company as N13 million and that he was paid N8 million after the job was completed. “We were at loss,” he lamented.
Not satisfied with the job the contractor did, the community started to mobilize well-meaning people from Oraukwu to renovate the clinic for them.
When the reporter visited the PHC in November, the PHC and the staff quarters had been dismantled and in the process of being renovated.
Ann reiterated the community was not happy with the work the contractor did.
But Okonkwo disagrees with Ann, reiterating the NPHCDA visited the PHC, satisfied it, and paid them. “That one [renovation by the community] does not concern the construction company. Any big man that is working there is on their own but what we were awarded was duly completed,” he said.
More challenges in primary health centers
In the same vein, the PHC at Ime Nsugbe in Anambra East local government was not done to the taste of the people and health workers.
The project awarded in 2018 to Vinded Construction Limited for N6 million was to address the physical and internal challenges the PHC was the facility. The matron of the Centre, Philomena Okafor, was not satisfied with the items provided by the NPHCDA as some were deemed not fit to address the issues the PHC was facing.
According to her, “The PHC buildings were painted, cupboards constructed, fan, television, and generator were also provided and a generator house was constructed,”
Okafor was furious that the Elemax 2.2 KVA generator supplied to them could not supply power to the entire buildings in the PHC. As a result, the generator was put in a store.
“I told the agency that supplied the materials that the plant [generator] that was sent to us could not supply light to the entire building and they said there was nothing they could do as that was what was budgeted. We dumped it here and it is not working. We need a big plant to operate fully,” she said.
Okafor also expressed her disappointment at the agency’s failure to provide the PHC with a solar medical refrigerator, which is one major item the facility requires to function effectively.
Ogechukwu Nwosu, a nurse at the PHC also lamented the lack of drugs in the center. “We also want the government to give us drugs. We do not have drugs,” she said.
Vincent Ofumelu, a member representing Oyi/Anyamelum federal constituency sponsored the project. When contacted, he said the project done by the contractor was inspected, verified, and satisfied, and the contractor was paid. He said that was what was in the bill of quantity.
“They [NPHCDA] sent their people to the site before payment was made. Last week they went for inspection for retention. They do not pay you unless they see the projects have been completed. They sent people from Abuja to find out if it was completed. The project was 100 percent completed and I sponsored the project,” he said.
At Nando, in Anambra East local government, the agency awarded a contract in 2014 to Ramax Resources for the construction of a PHC in the community. When the reporter visited the PHC, the project was not seen as the community people could not locate the project site.
When contacted, the Director of Ramax Resources Limited, Chidi Amaechi said the project was abandoned because the agency did not pay to complete it.
“We did the projects up to the lintel [roofing] level and when we put for valuation, we got paid for the one we did. You know how things are done, every year we were told the money for the project will be withdrawn from the parastatals. When we went further, we were told that the national assembly member will put it back in the budget so that we can continue the project,”
Six years later, the project is still abandoned. He said the lawmaker who sponsored the project was no more on the seat after the 2015 election.
“I cannot use my money to do it. There is no continuity. If another lawmaker comes, he will tell you this is not my project. It has to be put back in the budget so that we can complete it. The thing is that the budgeting process in Nigeria runs for 12 months but a contract will not be awarded until October, which is two months to go. Then you rush to the site and you cannot complete such projects in two months.”
“If it is a continuous thing, the project will be completed. About N21 million was budgeted but the whole money was not paid. We were only paid N6 million to get to the roofing level,” he said.
He urged the lawmakers representing the people of Nando to work with NPHCDA to complete the project.
The visit to Ossomala to check the state of the rehabilitation, provision of drugs and equipment at Ossomala General Hospital in Ogbaru local government awarded in 2018 by the Federal Medical Center, Asaba to Pumeco Industries Limited, for N100 million, was positive as the project was still ongoing.
The hospital, which had 4 buildings, had been rehabilitated, plastered, and wired. There were painters seen painting the building walls.
The contractor was supposed to equip the hospital with chairs, tables, beds, and other necessary hospital equipment, including drugs. The equipment and drugs had not been supplied yet due to the ongoing project.
When the reporter called the contractor, he did not pick and did not return texts sent.
At Eziagu village in Orumba South local government, the reporter visited the PHC to enquire about the provision of equipment awarded to African Plus in 2018. The project had been completed.
The matron, Cecilia Uruigwe, was full of thanks to the agency for supplying the facility with such equipment she described as being “more than enough”. The items were delivered in April 2019. She listed 10 beds, two delivery couches, one fridge, a generator, a standing fan, and gas cylinders as the items delivered to them by the agency.
“But they have not set up the equipment due to a lack of space,” she said. The equipment was stored in a PHC building constructed by the community, which is not functional yet. She is, however, sad the PHC lacks staff.
“I only have one government staff, one volunteer, and one N-power,” she stated. “It is difficult for us to work without staff. We need more staff.”
The Director of African Plus Limited Ogonna Okoli Ogonna confirmed the equipment had been delivered to the PHC and the company has been [paid after the NPHCDA satisfied the project.
“We finished the projects in 2018, handed them over to the community, and we have been paid. We have done our bit of the job and we have been paid. Whatever that is in the bill has been done and it has been verified and we have been paid. That ends our obligation,” he reiterated.
The contract awarded in 2019 for N10 million for the construction of PHC at Isieke village, Alor in Idemili South local government has not been done. When the existing PHC was visited, a signpost showing the contract for the renovation of the PHC as part of the rehabilitation of health facilities across the nation was mounted and contracted to Alewa Nigeria Limited.
The existing PHC was functioning effectively when the reporter visited but the nurses there said no renovation OR construction of a new one had been carried out in Isieke recently. To clear her doubt, the nurse, who refused to disclose her identity, called her matron, who also confirmed no renovation had been carried out in the PHC.
When the contractor was checked on the website of the CAC, no details were found and the NPHCDA could not provide the details of the contractors when a Freedom of Information (FOI) request was sent to it.
When the reporter visited Enugwu Ukwu in Njikoka local government and Umudum in Anyamelum local government to track the revitalization of healthcare centres and construction of a new one respectively, the projects were not found.
Contacted, one of the NPHCDA advisors who refused to disclose his name as he was not authorized to speak said a letter should be written and addressed to the Executive Director/ CEO of the agency.
When he was informed letters had already been sent to the agency, which were yet to be replied, he then decided to speak anonymously.
“We came on board in 2017 and we do not have any projects or awards pending,” he claimed. When he was informed there were projects awarded in 2018 that had not been done, he then revealed the responsibilities of PHCs are domiciled with states and LGAs and members representing such places in the National Assembly.
“If projects sometimes are abandoned, in most instances are due to lack of or poor appropriation of funds for such projects. Lawmakers identified projects in their community, appropriate for it in the budget, and entrust the agency to handle it on their behalf. A concerned lawmaker who knows his onion will follow up and sort it out because it’s their projects,” he said.
A top official of NPHCDA in Anambra, who pleaded anonymity for fear of being suspended is sad that the Nigerian people will allow lawmakers to sponsor and implement health projects, which will either not be completed or abandoned.
“Most of these projects are constituency projects they gave to highly placed individuals through NPHCDA,” he revealed. “What they do is to get the money and at the end of the day not do anything or not do a good job.”
“I do not like contracts being done through a senator or house of representatives member because he will not do what he is asked to do. Some of them are God-fearing and will do the projects very well,” he said.
He encouraged the reporter to contact the agency’s headquarters to find out the sponsors of the projects and the contractors involved to hold them accountable.
“This is the only way we can make these people complete the projects that they have been given money for. I am not aware of all these [projects]. Sometimes I will go to a local government and they will tell me that these [PHC] projects are sponsored by NPHCDA and I did not know. When such projects are being done, the state primary health agency should be aware so that when they ask them, they will know,” he said.
The Director of the Nigeria Health Watch, Ifeanyi Nsofor, described PHCs as a “continuous must care” that must be protected and preserved by the government and communities they were built for.
According to him, “It is important to know what the World Health Organization said about the PHC system that 80 to 90 percent of healthcare needs of an individual’s lifetime can be provided at the PHC level. This tells you how PHC is important and strategic. In Nigeria, we have to remember that health is on the concurrent list and what it means is that the different levels of government have their responsibility.”
He said it was the responsibility of the government to maintain the PHC and every community needs a functional health facility to meet their health needs, emphasizing the importance of functional PHC on maternal health.
“We do not need to be talking about health facilities not having enough doctors in the 21st century,” he said. “Communities should be able to hold the government accountable and responsible for providing functional primary healthcare.”
Ochije is hopeful that when the PHC and staff quarters in his community is completed, it will address the numerous health challenges facing the people of Ogwu Ikpele.
“We all know that hospitals are built for the good health of human beings,” he said. This PHC when completed will solve our health issues.”
* This report was written with support from the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting.