By Fortunate Ozo
NWEKE Elu Oji health facility in Ezza North local government area is almost moribund; it boasts rickety wooden beds, no electricity, no water, and no other basic health care equipment.
The officer in charge, Regina Eze, is a midwife and the only staff present when NTA News visited. She says the dilapidation is because residents prefer visiting selected health facilities where they enjoy free services.
” If the government can help us, we will be okay. We don’t have beds, water, electricity. We are going to another place where they have solar energy to store our vaccines,” she says.
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“I will like our facility to be selected to enjoy the BHCPF. If the government will help us to get what others are getting, it will be okay.”
The BHCPF she talks about is the Basic Health Care Provision Fund, enacted under the National health act 2014, which stipulates that 1 per cent of the consolidated revenue of the federation should be dedicated to health.
It has a specific objection of establishing at least one fully functional public or private primary health care facility in each political ward, among other objectives, to achieve universal health coverage.
According to data from the National Primary Health Care Development Agency, the BHCPF is designed to be a sustainable model for equity and financial risk protection for vulnerable populations by guaranteeing access to basic minimum package of health services.
Implementation of BHCPF in Ebonyi state
In Ebonyi State, the implementation of BHCPF started in the year 2020, with the state government paying the initial 25 per cent counterpart fund of hundred million naira that enabled the state to access the direct facility fund (DFF) in two tranches in 2020 to the tune of 601,500 as well as one and two tranches in 2021 and 2022 respectively, apart from the funds coming from other gateways.
However, the state is yet to pay another counterpart fund since then, according to the Focal Person BHCPF Ebonyi State, Leonard Alegu.
“Though the State government tried by paying the initial fund to make sure that both the agencies stand and also that we benefit from the BHCPF, so since after then, we have not been able to receive second counterpart fund though we have been writing and also soliciting making advocacies to make sure that the State pays because if the counterpart fund is paid, it will help us most especially in making sure that supervision is up to date,” he says.
“Because supervision of the activities is very important and apart from that supervision, the office set up, your office and logistics must be taken care of so those things are what we are grappling with. And again, the issue of human resource for health at least, getting the adhoc ones if it can assist us if the money is paid assist us to make sure that we augment the one that comes from the national.”
Out of the 171 selected facilities in Ebonyi State, 169 are fully functional and are benefiting from the basic healthcare provision fund, while two are not benefiting due to inability to meet up with the basic requirement.
Ezza North local government area
The five local government areas captured in this report are Ezza North, Izzi, Onicha, Afikpo South and Abakaliki local government areas of Ebonyi state.
At the Maternal Child, Health Care Facility Okposi Umuoghara in Ezza North local government area, selected under the fund, women, children and patients of all ages were in their numbers,
The office is a plywood partition without windows. The facility has one midwife in charge Martha Nnabu who resides in one of the offices. The facility has only one toilet, which is in a bad shape serving both the staff and patients while most of the workers are ad-hoc staff.
The facility is in dire need of office expansion and professional health workers.
Bernadette Ngozika Aluma, director PHCDA in Ezza North local government area, she said the BHCPF has given women of the area the opportunity of visiting the hospital instead of chemists and quacks.
Aluma commended the prompt release of capitation to health facilities but decried the insufficient manpower in facilities. She further stated that the activities of the facilities are being monitored, although no funds are allocated to the team for monitoring and supervision, which sometimes limit their performance.
“We have LGA team comprising three persons, the A S [assistant superintendent], the M and E [monitoring and evaluation] and one other person. But we are handicapped. We are just struggling to manage and visit and see what they are doing not that we are carrying out supervision as it supposed to be to be frank because we don’t have the resources,” she says.
“For you to visit one health facility, you will definitely spend at least N3,000, and it is just out of your pocket.”
Izzi council area
The PHC Igbeagu in Izzi council area has five functional toilets. The facility does not have drug shelves and water. It has a few beds and one mattress on the floor of the male ward. It also has only two volunteer nurses working with the community health extension worker Mrs Monica Una who is in charge of the facility.
“We prepare what we core business plan after the preparation, we show it to our A S at the Local Government, he will vet it and approve it before sending it to the ministry and to primary health care agency where they will look at it will look at it very well and approve it, after the approval, they will approve the money,” says Una, explaining the centre’s spending process.
“When they approve it, with the WDC chairman and WDC committee, we will all sit down before preparing the business plan, we will all sit down and know the real need of the facility—the major challenge that we are about to face at the particular quarter. When they approve that money, there is someone they send from the local government to monitor what we are doing with the money.”
Chinenye Ogbuinya, pregnant and expecting to give birth soon, said she is happy with the services provided by the Igbeagu PHC.
“Since I began to come here, I have not had anything like regret. Since I began to go to hospital, I can say that this is the best place I have seen,” she says.
“It’s just somebody that directed me here, and since then, I am happy with the way they attend to me, the way they address me. They don’t neglect, and they don’t charge much that’s why I am here.”
PHC Onuebonyi on the other hand, has no toilet except one still under construction. It has no water and depends on the rain. The facility has a lab technician, a community health extension worker to assist, a community health officer, three volunteers and intern students. The beds are few, and the wards are unconducive.
“When we came here, here was a hall. It is the BHCPF that helped us demarcate everything here. Even drugs, seats, this tank and the toilet and bathroom which are still in progress. We even built a placenta pit,” says a volunteer community health extension worker (CHEW) Blessing Obasi, who stands in for the officer-in-charge.
The Director PHCDA Izzi local government area, Philomena Ibor said their major challenge is lack of human resource.
“It’s affecting all the selected facilities because the highest they will have in our own selected facilities is two, and they are CHEWs,” says Ibor.
“We don’t have nurses just as what you have said, the nurses/ midwives they employed as adhoc staff ran away because of non-payment of their allowance. So, we are feeling it so much, like in this place now, if the officer in charge goes to rest, nobody will help her.”
Despite the near success story of BHCPF in the state, one of the major challenges discovered in the course of this investigation is the unwillingness of some rural dwellers to enrol and access medical care in nearby health centres.
Onicha council area
NTA news witnessed a sad incident of a 12-year-old child who was rushed to Onicha PHC Egunkwo/Ezukwa ward and died a few hours later.
His parents had been self-medicating the boy only to rush him to the hospital at the last moment, and it was too late.
The PHC in question has four community health extension workers, three volunteers and one health attendant. The officer in charge of the PHC, Ugonna Eze, who is a community health extension worker, lamented that the roof of the facility leaks water. The facility has one general ward with one side closed off with plywood to make for a delivery room. It has no water and toilet while some rooms have no windows and doors.
“My challenge now is all our windows are just out, and the beds, even the ward,” she says.
“We don’t have enough accommodation. It is only that hall; then I used this plywood and demarcated it in case any woman delivers. If not for that board, it is open for even male and female, everybody.”
Oshiri PHC Nwodo Orgbu Ebia Ward in the Onicha council area is an old facility, with parts of the building almost dilapidated and not in use. The facility has six toilets with broken septic tanks.
Amas MDGS in Onicha council area, on the other hand, has two functional toilets for patients and staff, although the patients prefer open defecation. The facility, which has one senior and one junior CHEWs as well as one volunteer, also has a functional borehole, but its solar-powered fridge is not functional as of the time of filing this report because, according to the officer in charge, Bridget Nwota, the money to fix it is not available.
“My cold chain system has a fault. It is spoilt. For immunisation, I used to go outside here to get an ice pack and my vaccines before I can give immunisation,” says Nwota.
“If the government can help me to provide a solar fridge and solar light because it was working, but now, it is no longer working.”
The Director PHCDA Onicha council area, Mgbonshi John, said lack of manpower is their major challenge in the council area and commended the facilities for making judicious use of the funds they receive.
“The BHCPF is very important and very helpful to the healthcare delivery system in Onicha in particular, as well as other local governments. In the first place, some of the structures in dilapidated situation most of them are coming to normal shape.”
Afikpo South council
Amangwu PHC in Afikpo South council area is domiciled in an old structure with parts of the buildings in deplorable condition. The PHC has no placenta pit, no toilets and bathrooms. However, the PHC has one lab technician, a community health extension worker Mrs Ugwoma Inya Okoro, who is in charge and two volunteers who she says she pays from her salary.
The PHC is currently constructing a toilet through the BHCPF and has also constructed the culvert leading to the entrance of the facility.
Business plans are made and executed with all key players coming together, said the WDC chairman of the facility, Umemba Vincent Ejegba.
“The Ebonyi State Health Insurance Agency EBSHIA gave us N60,000 to N70,000 for three or four months, and it has not been constant, and that has been going on drugs. Formerly, it was monthly, but now they pay either twice or quarterly.”
At Owutu PHC, the story is not different as the facility boasts of having a community health extension worker Esther Uwaezuoke who is in charge and four permanent staff, one lab technician, one junior CHEW, two cemetery and sanitary keepers, as well as three volunteers. It has no functional toilet and depends on rain for water. The facility also lacks IV drip stands, sufficient beds and mattresses.
” If they can help us to maybe give us one borehole, it will be okay. Our fence has fallen down,” says Uwaezuoke.
“If they can help us to renovate it, it will be good because if we lock the gates at night, we will be having a lot of stress from the fence because we have people living here.”
Abakaliki local government area
The major challenges facing MCH Ekeaba, in Abakaliki local government area, include being in the middle of Ekeaba market and sharing space and toilets with the market. The facility needs to be fenced and separated from the market.
The facility needs more structures as it currently operates in a two-room structure and one adjoining room. It also has no water supply. The nurse/midwife in charge Chima Kindness Ogonna says the general ward and unconducive delivery room scare pregnant women from delivering in the facility after completing their ANC.
“We need to have a standard Postnatal ward as it stands now; this is the only ward that I have. A patient is staying there whenever I deliver, a post-natal woman that is not supposed to be here with other patients is also here,” says Ogonna.
“You can see my challenge. So, if possible, I need more rooms, at least five to have that my delivery ward, standard ward. I have two rooms for delivery and consulting and awaiting—that’s what I have here, but just small rooms, not standard ones. Some people will come around and I will now say, ‘let me orientate you’. They will say, ‘mummy this your room now’, you understand. It is already discouraging the person from coming to deliver. So, after managing ANC, you see her going to another place to deliver. Only very few persons deliver here, so you see my challenge.”
However, the chairman WDC Azuiyiudene/Urban ward Christopher Eze said the BHCPF has impacted positively on the lives of the people, especially the poor and vulnerable adding that the officer-in-charge works in partnership with the ward development committee before carrying out any project.
“So, we thank the Federal Government. We are using it judiciously. You can see the nurses, the people that are here waiting for patients to come, and it is the government that is paying them, and they are doing their work,” says Eze.
“Had it been you came here and you didn’t see them, I think you would feel embarrassed but you can see they are here doing their job in their normal time.”
The MCH Azuiyiokwu in Abakaliki local government area is an example of a typical PHC with a large expanse of land and state-of-the-art buildings with functional toilets for patients and staff.
But on the day NTA News visited, the staff who keeps the keys to the toilet was not on ground, and we could not assess its cleanliness.
The facility which competes with some secondary and tertiary health institutions in the state has a nurse/midwife in charge, six community health extension workers, two nurses, a visiting doctor and many students on industrial training. It also has a habitable on-site residence for health workers.
Others include a lab scientist with a functional laboratory as well as virtually everything a standard PHC needs. The officer-in-charge Odo Elizabeth, however, appealed that their ad hoc staff be fully employed for more efficient service delivery.
“It is really actualised in our facility, and as you can see the majority of the women are enjoying it, and that is why in a primary health care like this, you will be talking of 80 to 100 deliveries per month. The BHCPF is part of our success here.”
Government reaction
Responding to questions raised by NTA News from the local government areas, the Executive Secretary Ebonyi State Primary Health Care Development Agency, Catherine Barry Oko said the agency disburses funds to all health facilities as and when due.
“What they are doing now is s setting up of solar light in the facilities, which helps them for the solar fridge and every other thing for the facility to have light as far as the sunshine is on,” Oko says.
“So this is actually what they are doing with the money now, and then we are waiting for another tranche that will soon be paid to them before and they do anything with the money, they will prepare this business plan then we will go through it and discuss it.”
She expressed optimism that the ad-hoc staff will be absorbed as permanent staff when approval is given by the national primary healthcare development authority.
The State Commissioner for Health, Daniel Umezurike, said volunteers are recognised in primary health care with a provisio and are recognised by the ministry with the basic minimum experience to function.
Umezurike said despite the challenges, the BHCPF is serving its purpose and assured that Ebonyi State government will pay the remaining counterpart fund to ensure the continuity of the programme.
“With our governor, we don’t ever take last. So, because this project was implemented from 2021 and 2022 now,” he said.
“In 2021, the state government was able to pay the counterpart fund, and this year has not ended so we will still do that. And the salaries of the workers are also the responsibility of the state so when you check all these things and all the interventions we have done, you see that we are not even talking about the counterpart fund, we have surpassed that.”
The Executive Secretary of Ebonyi State Health Insurance Agency (EBSHIA) Uzoma Agwu said the agency can assist health facilities to address the shortage of manpower by sending doctors to them periodically.
And facilities can pay volunteers from the capitation they receive, she added.
“There is something we started. What I am doing for them. In primary health care centres, I tell them if you want a doctor you can tell us. We have doctors that are ready to mentor these centres. We are pleading with the government to provide manpower,” said Agwu.
But making the enrolment of community dwellers political and charging clients after enrolment are militating against the programme, said Agwu.
* This report first published in October is supported by the International Budget Partnership and the International Centre for Investigative Reporting (The ICIR).