Primary healthcare centres (PHCS) are meant to be the first point of call for health service delivery, but are they equipped for this role? Mustapha Usman who visited several PHCS in Kwali and Abaji area council of the Federal Capital Territory (FCT) reports the findings.

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TWENTY-FIVE years-old Olaniyi Dorcas is one of the many residents who have suffered the brunt of the lack of quality healthcare delivery in Ijah Sarki of Yangoji Public Health Centre (PHC), Kwali Area Council of FCT. Dorcas lost her first child as a result of what she described as negligent and ‘nonchalant’ behaviour exhibited by the PHC staff.

On June 3, 2022, Dorcas woke up with pain in her stomach after sensing a kick from her unborn baby. Alarmed by her condition, Dorcas, together with her husband rushed to the nearest PHC at around 7:00 a.m. but there was no staff at the centre.

Suspecting she might have arrived too early, she headed back home with her husband and had to return to the Health Centre two hours later. This was despite the severe pain she was experiencing. 

Still, the PHC was closed.

Dorcas and her husband had no choice but to explore an alternative, a private hospital where she would later lose her baby. 

At the hospital, she said after some checks the health worker said he would only attend to her in the evening as that was the best period to welcome her baby.

“When we got to the hospital, the Doctor asked me to lie down, which I did. He tested me and told me that the time for my delivery had arrived. However, he called someone else to attend to me and he went inside the house to do something else. I was there till around 4 a.m. nursing the pain because the Doctor told me that I could only deliver in the evening that was the time that the child would come out.” 

“Later, he came to visit me and told me the baby was fine and that I shouldn’t be worried. So when the doctor couldn’t resist people’s agitation, he attended to me, but by then, I think the child had become so weak the child couldn’t come outside. I pushed and tried, but the child didn’t come outside until after many trials before he came out. At that time, he was not crying. He gave him an injection, but the child still didn’t cry; that was when the Doctor said the child wasn’t okay. The placenta, too, didn’t come outside.”

Dorcas, couldn’t fathom that her baby had died. She said she didn’t know such could happen as she had never heard of stillbirth.

She believes that the tragic loss of her child could have been prevented if the PHC had been operating regularly and frequently holding antenatal classes for expectant mothers like herself.

The death was not inevitable as World Health Organisation (WHO), believes that most stillbirths can be prevented with proper healthcare delivery.

There are close to two million stillbirths recorded every year, equivalent to one in every 16 seconds. Sadly, over 40% of these stillbirths happen during labour, a tragic loss that could be prevented with better quality healthcare, which includes routine monitoring and prompt access to emergency obstetric care when needed, World Health Organisation stated.

Meanwhile, a year has passed but staff of the PHC were still nowhere to be found. When The ICIR, visited the Community’s PHC, it was in a shocking state. The premises were overgrown with bushes, and there was no sign of any staff or patients inside, despite the facility having more than seven rooms, including three wards.

It was in a dilapidated state as rain has inundated the building through the collapsed ceiling and roof and visibly caused distress to the health centre. Out of the three wards The ICIR had access to, there were at least eight bunks altogether with no beds and also needing refurbishing. There were about two stores that were in a sorry state, and the reception, visibly seen with chairs, could hardly be seated under for fear of collapse.

The staff housing facility, despite being completed, had been turned into a farm store as all the rooms in the building were not in a good state and were littered with processed cassava.

This was the usual situation of the PHC, as few residents confirmed that the staff in the hospital visited the building ‘once in a blue moon’, not minding the villagers’ plight and also failing to improve even after speaking to the government officials at the council.

There were also conflicting narratives as to what few residents revealed to The ICIR. All the residents who spoke to The ICIR agreed with its finding about the worrying state of the building, but the village head Ibrahim Ayewon, argued that the staff were always at the hospital.

However, when The ICIR pushed further, the community head disclosed that the hospital  lacks amenities and also needed the constant presence of the staff but didn’t want to expose the staff to possible backlash.

This state of the Public Health Centre cripples access to proper healthcare by residents of the community and poses many to a dire situation like Dorcas experienced. 

Maternal mortality in Nigeria

The WHO in its 2023 progress report, shows that there were a combined 4.5 million maternal, stillbirths and newborn deaths in 2020.

Sub-Saharan Africa and Central and Southern Asia are the regions experiencing the largest number of deaths across all regions. India and Nigeria lead with 17 per cent and 12 per cent of global maternal and neonatal deaths and stillbirths, respectively.

According to the WHO, in 2020, 788 women and children died per thousand in India, while 540 women and children per thousand died in Nigeria.

The trend shows global progress in reducing maternal and newborn deaths and stillbirths has slowed during the last decade (2010-2020). The progress made between 2000 and 2010 was faster than they have been in the years since 2010. WHO attributed the slow progress within that period to climate change, conflicts and other emergencies, as well as the cost of living increases.

However, a report by the National Primary Health Care Development Agency (NPHCDA) on maternal and child health in 2019 revealed Nigeria has made no progress in maternal mortality for 29 years, as the country loses 2,300 under-five children and 145 women of child-bearing age daily.

The report, which was presented by the Executive Director of NPHCDA, Faisal Shuaib, at a stakeholder meeting in 2019, revealed that “Nigeria has a maternal mortality rate of 560/100,000 live births, which means 33,000 women die each year and one in nine maternal deaths worldwide is a Nigerian.”

“Infant mortality rate is 75/1,000 live births, which is eight per cent of the global total, and an estimated 70 per cent of these deaths are preventable.

“Child mortality rate is 117/1,000, which means one million deaths yearly and accounts for 10 per cent of the global total.”

The NPHCDA listed inadequate health facilities, shortage of critical human resources, inadequate power or water supply, commodity stock-outs, equipment inadequacy, weak standards/quality, and very low demand for critical services primarily driven by the loss of confidence in the system as the causes.

Meanwhile, in one of the efforts to bridge the gaps in primary healthcare delivery services, particularly for the poor and vulnerable, former president Buhari, in 2019, rolled out the Basic Health Care Provision Fund (BHCPF) and enshrined it in the 2014 National Health Act.

The BHCPF is a pool funded with at least one per cent of the nation’s consolidated revenue and other funding sources, including donor contributions.

Read the series of reports on BHCPF and MSS done by the ICIR here

The fund is disbursed through three gateways: the National Health Insurance Scheme, the National Emergency Medical Treatment, and the National Primary Health Care Development Agency (NPHCDA).

In 2019, the Federal Capital Territory Administration (FCTA) disclosed that it has flagged off the Basic Health Care Provision Fund (BHCPF), with N100 million as counterpart funding for the programme as part of moves to alleviate the sufferings of women and children.

The programme, according to FCTA, would help improve healthcare delivery for all residents in the nation’s capital, just as it stressed that the BHCPF is an intervention by the Federal Government to improve healthcare services in the country.

However, only one PHC in a ward is expected to benefit from the fund, as confirmed by the Kwali Health Director, Samuel Adudu. 

Residents who live in a very far location from the BHCPF-benefiting PHC are at greater risk whenever there’s a need for urgent medical attention, as some of the PHCs not under this intervention suffer neglect.

Yebu, another PHC in Kwali with similar woes

Aproka Yunusa was so confused as to why the government has abandoned his community PHC since 2008, when The ICIR’s reporter approached him to ask about the status of the centre. He was visibly furious; his eyeballs swelled as he tried to find a better word to describe the situation. 

When he finally did, Yunusa described the Yebu PHC as the worst in the whole of Kwali Area Council.

Meanwhile, it didn’t take long to discover the ‘worst’ and dilapidated PHC the villager had described. 

A peep into the centre revealed that the building, which seems to be the main PHC building, has been worn out by rainfall and breeze. The building has at least seven rooms, but it lacks facilities, equipment, and other basic materials that a PHC should have.

The roof is in tatters, and some parts of the building have collapsed, while termites enjoy most parts of the building.

The devastating state of the PHC extends far deeper as the second building, far smaller than the first one, is devoid of equipment and basic needs. 

At the time The ICIR visited the facility, there were no staff or patients. This, according to a volunteer worker in the community, Madaki Nasiru, could be traced to a shortage of staff.

Explaining the situation, Nasiru said the situation of the PHC has been worsening over the years, with the last time they received intervention from the government in 2008, when the now abandoned building was built. 

“People use to come to complain, but honestly, there are no drugs and other things in the PHC. Just look at the hospital (pointing towards the roof); it does not have anything inside. We used to refer most of the patients to their houses and to a hospital in Kwali.”

When The ICIR spoke with the Community health essential worker in charge of the PHC, Haruna Ibrahim, with its findings via phone call, he explained that he was in training and didn’t have any person to man the facility for him. 

He also revealed that the PHC lacked drugs, digital equipment and wasn’t enrolled in the BHCPF intervention.

“As you see, we are lacking wards, and the abandoned project has collapsed completely. We are lacking some equipment like a BP apparatus, digital thermometer and some beds. We are also lacking drugs; in fact, we have not been getting drugs here. 

“We do not have a borehole and even a toilet in the entire building. We are attending labour here, but we don’t have a good stretcher for the labour bed. Also, we don’t have electricity. I do use rechargeable lambs to attend to patients at night.”

He added that he has been collecting money from patients to buy drugs for them since 2018 and has not benefitted from the BHCPF intervention that was meant to provide basic needs, such as drugs, in PHC across the country. Ibrahim said: “What I do get from the government is only family planning commodities”.

Pandagi PHC, where health workers fetch water from town, lacks electricity

Pandagi health centre in Abaji Area Council is an improved version of the other two PHCs but boasts no electricity, no water, and fluctuating payment of BHCPF. The wards were observed to be in good condition, and it also has an equipped laboratory and store.

Unfortunately, the persistent lack of water and electricity has been a longstanding problem at the PHC. According to health workers, these issues have persisted for over a decade, and any expectation of finding solutions has diminished over time.

The health worker in charge, Zainab Alhassan, however, bemoaned the lack of water and electricity in the facility, noting that they embark on about a 15-minute journey on a bike to get water to use. ‘We are lacking so many things. We don’t have water and electricity. We do fetch water from inside the town. Even for deliveries, we had to go and fetch water.”

Another health worker in the PHC, Idris Abdullah, also said there are staff shortages in the Centre as they don’t have pharmacists and recorders. “We don’t have a pharmacist and we don’t have a recorder. It’s voluntary workers that used to help us, and the hospital pays them through other intervention.”

The ICIR gathered that the hospital is one of the beneficiaries of the BHCPF intervention, but there have been fluctuations in the payment of the fund. “They didn’t give us the first quarter of this year. It was the second quarter they gave us,” Abdullah said.

The health worker also explained that the PHC received the fund till the third quarter of last year, when they stopped getting the fund.

“The ones they didn’t pay affect us because as they didn’t pay, we don’t have enough drugs, so most people stopped coming. We only use our Drugs Revolving Fund (DRF), but that one, they will have to pay a little money. And you know if you are used to freeing things, it will be hard to want to pay for such.”

This fluctuation in payment of the BHCPF fund by the government prevents residents of the community access to basic healthcare as some of them could not afford the healthcare fee.

What the authorities had to say

The Director of Public Health Kwali Area Council Samuel Adudu, blamed the dilapidated facilities on the contractors that were awarded the projects, adding that the council is also aware of the errant staff who have refused to report to work and will be sanctioned.

“That PHC was actually built during the MDG era when they were still active. They built facilities around the six area councils. The project was contracted to contractors to build and equip, but unfortunately, some of the contractors didn’t do a good job. 

“As a department, we have written to the Area Council to do something about it, but they haven’t, probably due to some financial constraints. We are still pushing to see what can be done so that some repairs can be carried out there.”

Adudu explained that going around the entire facility in the council was impossible, the reason why they urged members of the communities to report any health-related issues to his department.

“Regarding the issue of staff, staff not going to work is unacceptable. We are already aware of that because it attracts sanctions, but nevertheless, we have always dialogue with the communities to monitor the staff activities. Going around all these facilities is practically impossible. We have what we called the ward development committee for each of the activities, so that forum is for the members of the community to look at the problems within the facility and the community at large, especially health-related issues and address them. “

He also agreed with The ICIR findings on the issue of the shortage of personnel in the hospital. “Another challenge we have is personnel because we have some PHCs that have only one or just two staff. There are programmes we run, and we invite staff to come to the central facility at Kwali for training,” he said.

Asked about the availability of drugs and delivery of proper treatment, he explained that 70 per cent of the entire workforce in the Kwali area council are community health essential workers who have limited skills to provide first-class treatment.

“At the PHC level, most of our staff are community health essential workers. In fact, even 70 per cent of the entire health workforce in the area council are community health essential workers. We have community health essential workers, and we have junior community health essential workers, and they all have their standards to create procedures. 

“There are certain disease conditions they can handle and there are certain disease conditions they can’t handle and ideally, in the healthcare sphere of the country, the best first contact is the primary healthcare. So if you come across a patient who has a condition they can’t manage, they immediately refer him to a secondary facility. We have a general hospital in the area council, Kwali general council.”

Surprisingly, the director of health stressed that the PHCs aren’t expected to admit patients as he revealed that only about two to three facilities in the whole council can run 24-hour services.

Adudu, however, didn’t know about Idah Sarki’s PHC not having beds in the wards. 

Meanwhile, he confirmed to The ICIR that the state of the two PHCs can’t be disconnected from the fact that they didn’t benefit from the BHCPF intervention.

According to him, the council has ten wards, with one PHC per ward BHCPF beneficiary, meaning that only 10 centres benefit from the intervention. 

He also said that efforts are being made to increase the number of beneficiaries to 124, making it two PHCs per ward.

This, according to Adudu, will help them have wider coverage, thereby increasing accessibility to people.

Speaking on the budget allocation to health, he said, “It’s what comes in from the federal allocation that determines the project that can be done. Take, for instance, if an allocation that can barely pay salary, of course, you wouldn’t expect the area council to do anything other than just pay salaries. But we are hopeful that as things improve, we will look into these facilities and work them and also recruit more health workers to man this facility.”

On Thursday, July 20, The ICIR contacted the FCT Director of Public Health, Sadiq Abdulrahman, for his position on the state of the PHCs in FCT but refused to comment, citing that his Agency isn’t responsible for PHC.

This investigative story is produced with support from Safer-Media Initiative under The Collaborative Media Engagement for Development, Inclusiveness, and Accountability Project of the Wole Soyinka Centre for Investigative Journalism (WSCIJ), funded by the MacArthur Foundation.