State of primary health care in Nigeria - do we need more buildings or do we need to make what we have functional! READ ON - Health Resource International West Africa (HRI)

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Sunday, 18 June 2017

State of primary health care in Nigeria - do we need more buildings or do we need to make what we have functional! READ ON

This Abuja hospital is in dire need
By Ojoma Akor | Publish Date: Jun 17 2017 2:00AM 

 '--- However, t he Executive Secretary, FCT Primary Health Care Development Board, Dr Rilwanu Muhammed said many local
government areas could not pay salaries, not to talk of renovating or employing staff for the PHCs. He said the board had already revitalized two PHCs in Bwari Area Council and had plans to revitalize and renovating others. According to him, the board will soon build 12 more PHCs in the FCT ’.'



When Amina (not real name) was in labour that night, residents of her Pasepa community could not take her to the primary health clinic available there because the only nurse at the facility does not live there. 
She was rather taken to a private health facility in Sabo Wuse, a nearby community on a motorcycle, but by the time she arrived there, she was too weak and died before she could be taken to the theater, residents of the community told Daily Trust.
Another resident of Pasepa, Mariam Muhammad, was also in labour one afternoon recently and was taken to the Primary Health Care Clinic in Pasepa. The nurse referred her to a private clinic in Sabo Bwari, a community in Niger State. The road from Pasepa to Sabo Bwari is very bad, and usually difficult for vehicles to ply, so she was also carried there on Okada.
The long ride on the bad road coupled with her condition took its toll on her, and the baby struggled and died in her womb.  When she got to the private clinic, all they could do was to evacuate the dead baby.
A child in the same community had convulsion one evening a few days ago, and the nurse at the Pasepa PHC had already closed for the day. The child had to be rushed to another village to see a patent medicine vendor.  
Many residents of Pasepa and surrounding villages have lost their lives or suffered complications within the past few years   because of the state of the Primary Health Care Clinic in the community located in Bwari Area Council of the Federal Capital Territory (FCT). 
Among the hospitals visited and assessed in the FCT, the Primary Health Care Clinic in Pasepa appears to be the worst. This is in terms of state of the building,  quality of service, staff strength, environment and availability of drugs. 
Structure and staff 
The Primary Health Care Centre in Pasepa which was built in 1988 is a dilapidated structure with two-thirds of its roof caving in and windows with broken and missing panes. A small dirty room at the side serves as the nurse’s office while another smaller,  dirty adjoining room serves as the injection room, with two cartons of drugs on the table at the side of the room.
The two other small rooms have a bed space each, but without bed sheets and covered with cobwebs. When more than two patients  are admitted, the other rest lie on the floor. There is no staff quarter.  
The first impression one gets after entry is that of a long abandoned place, or absolute negligence by those put to work there.
When it rains, any patient on admission is at the mercy of the rain.  Since the clinic has no cleaner, residents volunteer to clean it from time to time, and a volunteer who receives no  salary also supports the nurse occasionally.
Also known as Primary Health Care Clinic, Zhiko,  the Pasepa facility was built to provide healthcare services to 1,500 residents of Pasepa community, and about 45,000 people from Pasepa and eight other communities.
The eight other communities include Apmadayi, Zhiko, Akoyitapi, Goipe, Pasepa, Ijabisa, Pazamu and Quarters. Some of these villages are far from Pasepa. 
Residents of the communities experience severe difficulties going to the Pasepa clinic. Even after the perilous journey to the clinic, most times, they end up not receiving the needed medical care or ‘refer themselves’ to another place. 2 pm is the closing time at the clinic, and any resident who has need for medical care after that would need to find an alternative facility even on the bad road.
There was no worker at the clinic when our reporter visited at 3pm recently, and there was neither electricity nor a power generator.
Drugs 
Two cartons of drugs were seen at the clinic. It was gathered that sometimes, there would no drug at all, so residents at a meeting constituted a committee to task community members to contribute money to buy drugs for clinic.
Aliyu, a farmer and secretary of the committee said: “Recently we raised funds to buy drugs to support the clinic. At the end of March this year, we bought drugs worth N31, 000. Usually, the nurse buys drugs from the Area Council. But according to them, the drugs there are usually more expensive than the ones they get from private pharmacies. So government does not supply drugs sufficiently. We have been contributing money to buy drugs.”
Aliyu said previously, the nurse prescribed drugs and the residents travelled on Okada to Byazhin, Kubwa or Bwari to buy them. He said several people, particularly women and children, have lost their lives in the process of transporting them to nearby communities for medical care. 
He said the community had written to the relevant authorities several times but their challenges had not been addressed till date, noting  that when the facility was built in 1988, it initially had three nurses, but two were later transferred and within the past few years, only one nurse has been working there.
 He said: “Whenever there is an emergency case or women are in labour, we rush them to a PHC in Byazhin or to a private clinic at Sabo Bwari in Niger State or old Bwari.
“Whenever any woman is in labour at night or at weekend, there is always problem,  the nurse posted here sleeps at Sabon Wuse in Niger State.”
Community leaders lament 
The Chief of Pasepa village, Sapepayi Salleh G. Na’Allah, called for a medical doctor and other health workers to be posted to the clinic. He said while the nurse has tried with deliveries during the day, when she closes by 2 pm, they have to use torch light or lamp to find their way to another place for medical care at night during emergencies. 
The women leader of the community, Hajiya Hauwa Muhammed, said whenever people go to the clinic, the nurse usually complains about drugs. 
“When she comes in the morning, she closes around 2pm. When we fall ill around 4pm or at night, nobody attends to us,” she said. 
Another resident, Muhammad Pasepa, a two time councilor, called for the establishment of a General Hospital in the community.
He said government had approved the establishment of a Junior Secondary School in the community but a larger health facility such as a General hospital would help. 
He said: “Some government officials came here last year promising to build a basic health clinic but up till now we have not seen anyone. The bad road can also discourage any staff from coming here to work. The road was constructed since 1987 and was only re-graded in 1990 but to this moment nothing has been done on it. There is no light in the village, poles were brought with a transformer and all have been lying idle for about seven years in spite of all our letters to the government.”
According to him, residents get water from wells because most of the boreholes drilled by the government are not functioning.
Muhammad urged the government to provide potable water and fulfill its promise of establishing a dam in the community.
He said the clinic would have even been in a worse state if not for a few non- governmental organizations that renovated it.
Government’s plans 
The Executive Secretary, FCT Primary Health Care Development Board, Dr Rilwanu Muhammed, said the two major challenges of primary healthcare in the country were poor funding and inadequate personnel. He said while the federal government was in charge of tertiary hospitals, states were in charge of general hospitals and secondary level of care and local government areas were supposed to handle primary healthcare centres, clinics and health posts.
However, he said many local government areas could not pay salaries, not to talk of renovating or employing staff for the PHCs. He said the board had already revitalized two PHCs in Bwari Area Council and had plans to revitalize and renovating others. According to him, the board will soon build 12 more PHCs in the FCT .’

Africa Center for Clin Gov Research & Patient Safety
@ HRI West Africa Group - HRI WA
Consultants in Clinical Governance Implementation
Publisher: Health and Medical Journals 
8 Amaku Street Housing Estate, Calabar
Cross River State, Nigeria
Phone No. +234 (0) 8063600642


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