From Obinna Odogwu, Awka
Words may not be enough to explain the magnitude of pain, trouble and stress the people of Ugbene, Ugbenu and Awba Ofemmili communities go through each day to access healthcare services in other lands.
Every day, residents of these communities in Awka North Local Government Area of Anambra State cross the proverbial seven rivers and forests to get medical services in faraway Ebenebe, Awka and other towns.
They go this far because they do not have functional hospitals in their lands. The ones built by the government have deteriorated due to many years of abandonment. And at the moment, they serve rodents, snakes and other dangerous creatures as safe havens.
The decrepit condition of these PHCs become even more heartbreaking when one considers the humongous amount of money which the state government claims to have spent in building and running hospitals in the state.
From 1999 when Nigeria’s 4th republic commenced, various administrations in the state reportedly spent billions of naira on the health sector but there was very little to show for the money. And till today, not much has changed.
With the exception of the administration of Mr Peter Obi which did fairly well in the health sector, every other administration paid little attention to the hospitals in the urban centres while almost totally abandoning the ones in the rural communities.
Given the high level of decay in the country’s health sector and the grave need to scale up healthcare service delivery especially in the rural areas, the Federal Government in 2014 enacted the National Health Act (NHAct 2014).
Part 1, Section 11 of that Act provides for the establishment of the Basic Health Care Provision Fund (BHCPF).
The aim of the BHCPF is to significantly move Nigeria towards achieving Universal Health Coverage (UHC) by utilising the 2nd National Strategic Health Development Plan (NSHDP II) (2018-2022) in the medium term; and in line with the health-related sustainable development goals (SDGs) in the long term.
Based on this, the government said the BHCPF, in its initial phase spanning three years from its commencement, will be targeting the reduction of maternal mortality from 576 to 400 per 100,000 live births, representing a 31 per cent reduction.
This, it said, would be in line with the NSHDP II goals. With this, it would also target the reduction of neonatal mortality from 39 to 26 per 1,000 live births representing a 33 per cent reduction. It also aimed to reduce under-5 mortality from 120 to 85 per 1,000 live births representing a 29 per cent reduction as captured in the NSHDP of 2018. The BHCPF also aims to ensure that medical emergencies are attended to without delay to minimise mortality and morbidity.
The funding for the BHCPF comes from the consolidated revenue fund of the Federal Government, in addition to other sources including grants from the international donor partners.
Initially, the disbursement of the fund was meant to go through three gateways, namely: National Health Insurance Scheme (NHIS), National Primary Health Care Development Agency (NPHCDA) and the National Emergency Medical Treatment Committee (NEMTC).
But later on, the apex government added the Nigeria Centre for Disease Control (NCDC) as the fourth gateway in line with the NCDC Act of 2018. it was learnt that 48.75 per cent of the fund is disbursed through the NHIS gateway, 45 per cent through the NPHCDA gateway, 5per cent through NEMTC gateway and 1.25 per cent through the NCDC gateway.
NEMTC gateway is deployed towards emergency medical treatment while that of the NCDC is to ensure provision of public health security.
For the NHIS gateway, the fund is deployed towards purchasing of the Basic Minimum Package of Health Services (BMPHS) in eligible primary or secondary healthcare facilities nationwide.
Funds disbursed through the NPHCDA gateway are deployed to strengthen the PHC facilities through the provision of essential drugs, vaccines and consumables, provision and maintenance of health facilities, equipment and transport; and development of human resources.
Although the National Health Act was signed into law in 2014, the government did not implement the BHCPF aspect of it until 2018. And when it began, state governments benefiting from it paid a counterpart fund of about 20 per cent.
So far, a total of N56 billion has been released to the beneficiaries of the fund across the country.
Minister of Health, Dr Osagie Ehanire, revealed that the amount was a part of the N89 billion so far released by the Federal Government to the BHCPF. He said that the money was disbursed to the 36 states in the country and the FCT.
Ehanire made the revelation on Thursday, August 11, 2022 in Abuja during the 3rd Quarterly Ministerial Oversight Committee Meeting of the BHCPF.
“With the disbursement so far made to states, we are providing operational funds to 7,250 primary healthcare facilities in 35 states and the FCT. With this initiative, many of our primary healthcare facilities are now able to provide care for our people in the communities.
“The goal is to ensure at least one functional PHC in every ward of the federation”, the health minister said.
Interestingly, Anambra is among the states that qualified to access BHCPF for meeting the requirements set by the Nigeria Governors’ Forum (NGF) for its Primary Health Care Under One Roof (PHCUOR).
The requirements stipulated for PHCUOR include a functional Local Government Health Authority (LGHA), an established State Primary Health Care Board (SPHCB), baseline assessment of primary healthcare facilities, an instituted state steering committee and the opening of a Treasury Single Account with N100 million.
One of the objectives of the BHCPF is to have in place, at least, one fully functional public or private PHC facility in at least 30 per cent of the wards within three years, 70 per cent within five years and in all wards within seven years.
But since President Muhammadu Buhari rolled out the BHCPF appropriated by the National Assembly in the 2018 budget, the impact has not been felt in Ugbene, Ugbenu and Awba Ofemmili PHCs.
The fund was appropriated for the first time in the 2018 budget. The federal government earmarked N55.1 billion for the consolidated revenue fund to the basket fund of the BHCPF.
In addition to that, Bill and Melinda Gates Foundation contributed $2 million out of which $ 1.5 million has been released.
The Global Financing Facility (GFF) also committed $20 million to the fund, while the Department for International Development (DFID) is also putting 50 million pounds over the next five years.
Despite the humongous amounts, all that the three PHCs can boast of, as of the time of filing this report, are signboards bearing BHCPF stationed at their gates.
When the reporter visited Awba Ofemmili PHC recently, it was in shambles. Most of the ceilings had collapsed and the wards were all very dirty. Animals and birds’ droppings littered the floors.
Most of the windows and doors have broken down; and the entire environment was bushy. Some birds made their nests on the roof even as bats were seen flying up and down.
That PHC was built by former Governor Peter Obi as a Millennium Development Goal (MDG) project but was not immediately put to use because he couldn’t equip it before leaving office in 2014.
His successor, Chief Willie Obiano, who finished his eight-year tenure in 2021, abandoned it despite receiving the BHCPF money.
In fact, the building did not feel appreciable human presence until around July 2020 when Daily Sun published a report on the dilapidated state of the health centre, via https://sunnewsonline.com/anambra-community-in-ruins/
Before then, a rustic building in the community, manned by a nurse, served that purpose. The government hurriedly moved it to the new building after the report in Daily Sun without equipping it.
The nurse in charge of the facility, Justina Ofuonu, was not on seat when the reporter visited but she told him on phone that she comes to work every day. She also denied allegations that she runs a private maternity in Ugbenu community.
For the BHCPF, she told the reporter that she received the sum of N601,000 in 2021 and N1,202,800 in 2022. For the latter, she said that she received N300,700 each quarter and was yet to receive any money for 2023.
She told Saturday Sun that she used the money which totalled N1,803,800 to buy three pieces of mattress and sent part of it to a certain agency to supply drugs to the PHC.
“I used the money to buy materials – pillows and beds. I renovated the toilet and soak-away pit, renovated the floor. I repaired some of the ceilings and glasses and bought delivery kits”, she added.
But the reporter who went round the dingy wards did not see any bed or foam. The entire place was in ruins.
“I kept the foams inside my office. It is when we have patients that I bring all of them out”, Ofuonu explained.
Asked if that was how she spent over N1.8 million from the BHCPF, she simply said “yes.”
While Ofuonu is the only nurse in the PHC, a few persons she employed, with the exception of Ngozi Ozughaa, assist her in the discharge of her duties.
Ofuonu told the reporter that Ozughaa was employed by the government as a health assistant and that she does not administer injections. She said Ozughaa possessed only a West African School Certificate (WASC).
“The only thing Ozughaa does for me is taking the vitals and the BP, blood sugar”, Ofuonu claimed.
But Ozughaa told the reporter that she administers injections and performs other duties in the health centre.
“I perform a number of roles here. I cut the grasses when they grow. I inject patients and also do the work of a cleaner. I do everything. I can’t treat patients in a bushy environment”, Ozughaa said.
When asked about her academic qualifications, she said “theory” and then mumbled what sounded like JS2. Asked if she meant Junior Secondary 2 (JS2), she said no, that she meant “junior chew.”
Pressed further to give the full meaning of “junior chew” as an academic qualification and what it meant, she blurted out saying “I have told you the full meaning. You know what it means. But if you don’t know, just let it be. Forget about it.”
When the reporter pressed further, the health worker said she attended Girls Secondary School, Isuaniocha, after which “I went to the school where I did theory, junior chew. The school is called Obosi, and junior chew is about nursing.”
Reminded that Obosi is the name of a town, not a school, she retorted: “The school is in Obosi. I don’t have the name off hand. Whenever the need arises, I bring my documents and pick whatever information that is needed.
Asked how one could get to attend the school, she said: “You buy a form to enter the school. You can study nursing for two or three years and they will give you a certificate. They won’t say that you didn’t finish this course or that course. So, me that stopped where I stopped, they gave me my result and that is what I am using to work here.”
A young woman who works in the PHC, Amuche Okonkwo, told the reporter that she was “a volunteer nurse.” She said that after she was through with secondary school, she enrolled as an apprentice in a ‘chemist’ shop for three years to learn how to sell drugs.
In Nigeria, ‘chemist’ is used to refer to a person who runs a medicine store; and not necessarily a person whose occupation specialises in the science of chemistry, especially at a professional level.
Okonkwo said that patients come to the PHC once in a while and that she partakes in their treatments.
“Pregnant women do not come here. But we handled one case last year. They don’t come because we are not always here. They usually put to bed at night and we don’t stay here at night,” Okonkwo revealed.
Asked what her responsibilities in the PHC were, Okonkwo, who said that she had been in the facility for about a year, said: “I treat patients. I give them injections. Whenever there is an immunisation programme, I take part in it.”
Some residents of the community told Saturday Sun that due to the dilapidated condition of their health centre, they prefer patronising ‘chemists’ instead.
Mrs Ebere Iyama who hails from Mgbagbuowa, Eziagu in Enugu State but resides in Awba Ofemmili told the reporter that she gave birth to her child in April 2022 in her mother-in-law’s place.
“And that is where I did my antenatal too. The day I went to the PHC, that place was very bad and because of that I didn’t go there again”, Iyama said.
Another resident, Mrs Blessing Onwuzuka, told Saturday Sun that some people had died in the town during health emergencies due to lack of a functional healthcare system.
“More than 20 casualties have been recorded. Personally, I have had a miscarriage. And that was because there was no doctor here. Had a doctor been here, it would have been prevented.
“That day, before we reached Ebenebe it was late. The child died in my womb. It was four months old at the time. So, many people have died in this community under such circumstances”, she lamented.
A 25-year-old mother, Chinecherem Chinwuko, told the reporter that she attended her antenatal care at a ‘chemist’ shop in the Oye Agu area of the community.
“What they do is that after examining us, they give us drugs sometimes, capsules”, she said.
On her part, Uju Nweke told the reporter that “two of my children were born in Lagos while one was born here in Awba. The one born here was delivered at the ‘chemist’ shop. The woman there is good at what she is doing.”
Augustina Chukwura gave birth to her baby on July 31, 2022. That was her first pregnancy. “It was at the chemist shop that I gave birth to her. And I went there because we don’t have a hospital in this community.”
In Ugbene community, the situation is not so different. When the reporter visited the PHC, it was locked but its annex at another location was open. One of the buildings in the main compound was razed down about two years ago. It was an MDG project of 2011.
A volunteer nurse in the facility, Ogechi Agba, told the reporter that there were three officials in the health centre – two volunteers and one Officer-in-Charge.
“We don’t have everything we need here. For example, our delivery table is not padded. We need some medical equipment like medical trepan, PB apparatus, weighing scale and so many other things”, she said.
Agba, who said that she had been there for the past 10 months, told the reporter that she attended the School of Health Technology, Oji River where she obtained a JCHEW – Junior Community Health Extension Worker certificate. She said that it was a two-year course.
The second volunteer said that she was an “auxiliary nurse” and that she was still learning how to do the job at the health centre.
Ogechi said she’s not allowed to treat patients. She said that her job is to pen down medical records of their patients.
The nurse in charge of the PHC, Helen Ibe, was not in the health centre when the reporter visited but she told him on phone that she received the money from the BHCPF just as others did and that she used it to work.
Mrs Agnes Okafor, Mrs Patience Agbatuo and others who spoke with Saturday Sun asked the government to send more health workers, including doctors, to the PHC.
In Ugbenu, the building was better off. The only nurse in the PHC, Loretta Okoye, told the reporter that UNICEF renovated the building recently and also supplied the PHC with some equipment such as beds, foams, delivery coach and other instruments.
Okoye, however, made stunning revelations about the spread of HIV in those three communities based on her findings. She said that pregnant women in those areas patronised traditional birth attendants who used unsterilised objects on them during child delivery.
The nurse, who is also the Manager, Local Action Committee on AIDS (LACA) in that area, said that based on her findings, the activities of these TBAs aid the spread of HIV, hepatitis and others.
Okoye narrated thus: “In these areas, pregnant women here prefer to go to their relatives who are traditional birth attendants. But as a LACA manager for Awka North together with the officials of the FHI, we are making efforts to explain to them the risks involved.
“Some of them contract HIV when they patronise the traditional birth attendants. This is because at times, tests are not carried out on them before the processes begin.
“But when they go to the PHCs or any government hospital, tests must be conducted. You will be tested for hepatitis B, C and A. But because the traditional birth attendants don’t conduct such tests, they like to go there.
“At times when they come here and we discover that they are HIV positive, we give them drugs. But still, they prefer going to the traditional birth attendants because they feel that the tests expose their HIV status.
“We discovered that the women usually contract HIV from these traditional birth attendants because when you test them and their husbands, you discover that their husbands are usually negative while their wives will be positive.
“These birth attendants usually don’t sterilise their instruments. Sometimes as soon as one pregnant woman finishes giving birth, another person comes on almost immediately, using the same instrument without sterilisation. That’s why they contract HIV. The sad thing is that it is rampant here. But now, the FHI has stepped in, trying to assist. Once we detect HIV in any pregnant woman, we contact the FHI which supplies them with nevirapine.
“Once they give birth, the newborn is given the nevirapine before 72 hours so that the virus will not disturb the child. So, that way, the number of those who contact HIV here is reducing.
“Before, when they were not using the drugs, the newborn would contract the HIV, suffer ailments and die; and then the people would say that the child was possessed by evil spirits.
“Some would say that whenever they give birth, the child will suffer a sickness and die. Some would say that the death of their newborns might have been caused by bitter breast milk. They tell a lot of stories.
“But we keep enlightening them on the causes of such conditions and all they need to know concerning pregnancy and childbirth. We also counsel them.
“Again, when we test them here and tell them the result of their tests, they disagree with you when it is HIV positive. They tell you that they don’t have the virus.
“For example, there was one girl we tested here and she was HIV positive. She rejected the result and started arguing. She said that a certain woman somewhere had examined her and told her the same thing.She said that the church she attended rejected it. She stopped going to the woman. When she came here, I tested her and saw the same thing. I started treating her, giving her drugs.
“But when she wanted to give birth, she went elsewhere. I contacted the FHI and the team went to her house and gave her drugs. Sadly, she didn’t take the drugs.
“When the FHI team checked on her one month after, she gave them back their drugs, telling them that the God she served would not allow her to contact HIV. Till today, she has refused to take the drugs and she is still living with the virus. This happened last year.”
Meanwhile, efforts to speak with the Executive Secretary of the Anambra State Primary Health Care Development Agency (ASPHCDA), Chisom Uchem, proved abortive as she declined to speak on the matter when contacted on phone.
Uchem, a pharmacist, said that she was newly appointed into the position and as such did not know much about the condition of PHCs in the state. She also did not grant the reporter audience when he visited her office.
However, an account rendered by her predecessor, Chioma Ezenyimulu, to the Anambra State House of Assembly in 2022 showed that the agency disbursed a total of N357,952,281 to the 332 PHCs enrolled under BHCPF.
“Each political ward has a functional primary health care facility and the primary healthcare centres have been renovated with the money from the Basic Healthcare Provision Fund,” Ezenyimulu had said.
“The total expenditures from the report are N357,952,281 while the balance in the bank is N455,055,207.79.”
Signatories to the account, according to her, were chairmen of the ward development committees and the officers in charge of the PHCs.
But the lawmakers who had earlier visited some of the PHCs in the state to assess the implementation of BHCPF were not impressed with what they saw on ground considering the amount of money already spent by the agency.
They bewailed that despite accessing over N800 million in funding between 2020 and 2022, they were yet to see the impact of the expenditure on the lives of their constituents.
Chairman of the House Committee on Health, Carter Dike-Umeh, lamented that the lawmakers did not see any PHC that was refurbished in all that they visited.
Dike-Umeh, representing Aguata 1 Constituency, said that 30 members of the state legislature, the Speaker inclusive, could not find any functional PHC in their respective constituencies.
“Some primary healthcare centres in my constituency, Umuchu Ward 2 and Akpukpa, are made functional through community efforts. There is no reflection of the Basic Healthcare Provision Funds in the facilities,” he had lamented.
Meanwhile, efforts to get relevant information from Achieving Health Nigeria Initiative (AHNI) on the spread of HIV in the three communities proved abortive.
Senior Programme Officer of the organisation, Henry Udenenwu, told the reporter that he would need to get clearance from higher authorities before granting him an interview on their activities in those communities.
AHNI, it was gathered, works closely with the Family Health International (FHI) to prevent the spread of HIV in the state.