Terrible state of Nigeria primary health care

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INVESTIGATION: The terrible state of Nigeria’s Primary Healthcare Centres (PART ONE)
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(In this second part of his investigation into the terrible state of PHCs across Nigeria, Ebuka Onyeji reveals the rot in the system, and the factors leading to the current situation. You can read the first part here).
‘Out of service’ read the network signal on the journalists’ phone at exactly 6:35 p.m. one recent Tuesday evening just as the driver, possibly 18 years old or thereabout, swerved into the muddy road.
After several twists and turns, the vehicle came to what seemed the end of the road. A river? That’s the first suggestion that came to the reporter’s mind. Stretched at a distance of more than 70 meters, almost twice an Olympic-size swimming pool, the drench of the day’s rain formed a pool of flood water ahead. This is where the water is rushing to as there was no gutter on both sides of the road.
To the amazement of the journalist-passenger, the youthful driver accelerated into the pool. The vehicle began to soak and abruptly stopped almost midway into the pool. It took the combined effort of the passengers who had alighted and some locals to push the vehicle over to the other side of dry land.
This is the only route in and out of Adikwu-Icho community in Apa Local Government Area of Benue State. A night’s rainfall means the flood pool will get as deep as 4 ft. However, if it rains more than a day, movement becomes impossible because you will need a boat to cross, which is not always handy.
Luckily, the car ignited again after some touches and the driver eventually pulled over by a structure “This is the place you are looking for,” a passenger pointed to an old building, “That’s the Primary Health centre.” It could be hardly seen because it was already dark and it was still raining.
Although the journalist was given a warm welcome and a place to spend the night, there was a sense of urgency in the facility. Two women were in labour.
The labour room is quite scanty with very few equipment at least to cover emergency obstetric care services. It also had no functional ambulance to aid referrals. Relatives of patients have to provide their own transport in the event of an emergency.
The husband to one of the expectant mothers, who identified himself simply as Basil, recounted their ordeal in bringing his pregnant wife to the health centre.

“It was not easy, me and my brother had to carry my wife who is already in pains because of the pregnancy on our shoulders to cross that flood and get to this side. There was no car or motorcycle that can cross that place because of the water and it’s already night, I just hope and pray she delivers safely,” Basil said.
Clad in white apparel and gloves, a nurse, Grace Diashe, was busy trying to start the standby small generator which powers the facility during deliveries or emergency at night as there was no electricity in the community.
Adikwu-Icho is home to about 2500 people who are predominantly farmers with more than 200 small houses, a typical rural setting.
The silence of the morning was punctured by cries from the new born babies. Buckets were arranged under the roof edges of the building to collect rainwater. This is a tell-tale sign of insufficient water supply. There is not even a borehole in the facility.
About 30 feet away is another health care centre. This one, a beautiful bungalow painted in yellow and ox-blood. It is a N22 million project contracted to Ogason Construction LTD in 2014 by the National Primary Health Care Development Agency, NPHCDA. But since it was roofed about a year ago, it has been under lock and key and now covered by bushes.
Such health facilities are meant to be the bedrock of public health services in the country. In 1978, Nigeria, along with other World Health Organisation’s member countries adopted the declaration instituting the primary health centres as the basic structural and functional unit of public health delivery system.
There has been three major attempts at achieving people oriented PHC in Nigeria. The first attempt was made between 1975 and 1980. A second attempt, led by the late Professor Olukoye Ransome-Kuti, was between 1986 and 1992.
NPHCDA was established in 1992 and it heralded the third attempt.
Signpost disclosing contract details of PHC in Gbaye. Well built but not well staffed PHC in Muye village, lapai LGA, Niger state.
Entrance to Gbaye PHC now used for seed spreading - a tell tale sign that nobody is coming!
Despite these attempts, Nigeria’s primary health care system remained dogged by multiple challenges.
The new health centre complex in Adikwu-Icho is well built but not yet accessible. There were also no equipment and infrastructure when this reporter visited.

Locals blame government and contractors for not involving locals in the project as well as for not planning fo an access road.
Paul Adama, the community’s general secretary, said although the community provided land for the project, it was not carried along during execution.
“We don’t even have the number of the contractor and I don’t think the work he did so far is commensurate with the contract amount,” Mr. Adama said.
“This our road has been like this since I was born. During dry season it can be manageable and motorable but becomes waterlogged in raining seasons because there is no channel for the water to flow out. The community has been cut off because of this flood.
“We have complained severally but nothing has been done. We have two polling units here, the government only come during election period. After their campaign promises, we vote them but they will not do anything.
“With this road, tell me how many qualified health workers will be willing to work here. We don’t have light, good school and other basic amenities,” he added.
The functional health centre, where Mrs. Diashe works, services the health needs of the community. It is a Millennium Development Goals, MDG project of the Goodluck Jonathan administration. This is where the reporter spent the night.
Here, one qualified nurse and three health workers struggle everyday with the challenge of attending to thousands of residents with limited drug supply and no standard equipment.
Worse still, child delivery, pre and post-natal care remain the biggest challenge, health workers say.
Giving a rough mental statistics, Mrs. Diashe estimates deliveries taken in a month to be up to 25, although she was careful not to reveal fatalities.
“We don’t have a lot of things in our labour room which makes delivery difficult. We don’t have enough qualified staff, we need a doctor.
Shattered roofs of a PHC in Maito village, Wushishi LGA where bats dwell. A store room Of a Nigerian PHC.
Shattered roofs of Gbaye PHC already occupied by bats.
“If am carrying out delivery and meet an issue I cannot handle, we normally refer the person to Aliade but it’s always a challenge because of this road. If we have a doctor here, he will handle all these and will save the life of the mother and child.
“Pregnant and nursing mothers in the community normally resort to traditional means due to these challenges,” Mrs. Diashe said.