INVESTIGATION: Leaking Roofs, Inadequate Equipment and Drugs… Many Loopholes In Niger Primary Healthcare Centres
Some primary healthcare centres in Niger State are yet to feel the impact of the Federal Government’s Basic Health Care Provision Fund (BHCPF), which seeks to improve Nigeria’s health care coverage, especially for the vulnerable.
By Hamzat Ibrahim Abaga
Twice, Mahamud Adamu and his wife, Aisha, had to contend with miscarriages because they could not afford to visit a nearby primary health care facility.
The couple lives in Jiko, a community on the outskirts of Maikunkele in the Bosso Local Government Area, LGA, of Niger State.
Aisha had two miscarriages and gave birth to her other children at home with the help of traditional birth attendants.
Jiko settlement is six kilometres away and a 20-minute ride to Maikunkele Primary Healthcare Centre at the headquarters of Bosso LGA. However, the Adamu do not have access to medical care because of funds.
“I have a wife and seven children, and my wife gave birth to all the children at home with the help of traditional birth attendants,” Adamu said.
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But he rues how his wife suffered miscarriage twice and could not visit a health care facility for proper medical examination and treatment.
Adamu and his wife have never heard about the Federal Government’s Basic Health Care Provision Fund (BHCPF), which should make healthcare accessible to vulnerable people at the grassroots like them.
Nigeria remains the second largest contributor to maternal and child mortality globally, losing an estimated 2,300 children and 145 women daily.
For years, the father of seven said his family had lived on herbs rather than visiting a health care facility whenever the need arose.
Their inability to be part of the scheme is limiting the minimal gains that the government set to attain universal health coverage.
According to a document obtained from the office of the Director, Health Planning Research & Statistics (DHPRS) for Executive Director, Niger State Primary Healthcare Development Agency, Maikunkele Primary Health Centre is one of the facilities captured under BHCPF. Still, Adamu and his wife, who are marginal farmers, did not know of the free services offered by the facility.
An understaffed facility, high cost of drugs, treatment
No official was willing to volunteer information about the health centre’s operations.
The BHCPF utilises two approaches to improve service delivery in at least one Primary Health Care Center (PHC) per ward in Nigeria: through direct financial investments that fund critical upgrades for PHC infrastructure, improving availability of skilled staff and assuring the stock of medicines and health commodities; and through the purchase of a Basic Minimum Package of Health Services (BMPHS) from PHC providers at no cost to Nigerians.
Only three workers were on duty and some interns during this reporter’s visit to the Maikunlele PHC. Under the BHCPF, a benefiting PHC is supposed to have at least five health workers, including two midwives.
Despite being understaffed, many residents still access healthcare services at the Maikunlele health centre. Health workers struggle to service a large number of patients daily.
Manta Maimuna, a resident at the health centre, said it takes hours for her and others to see health workers.
“That is not encouraging at all. There is a need to strengthen the staff strength of the facility to make their service easier and stress-free,” said Maimuna, who came to treat malaria at the centre.
Following the BHCPF intervention at the facility, which changed its face, residents complained about the cost of drugs and treatments at the centre.
“This Maikunkele health care centre was not as standard as it is now as before,” said another resident, Dauda Abu.
“We have seen a lot of renovations and repairs around the facility, and many were hoping that the cost of treatment and drugs would be affordable for us after the renovation and re-equipping of the facility, but nothing has changed so far.”
Nigeria’s weak health financing system has been a significant driver of poor health outcomes. The reality gave rise to a scheme that provides the Basic Minimum Package of Health Services (BMPHS) freely to the members of the public.
A dive into Basic Health Care Provision Fund
In December 2014, Nigeria’s former President, Goodluck Jonathan, signed the National Health Care Bill to achieve the Basic Health Care Provision Fund (BHCPF) goals. The scheme was established under section 11 of the National Health Act as an avenue for funding, improving access to healthcare, and heading Nigeria toward achieving Universal Health Coverage (UHC).
The Nigerian Government under President Mohammadu Buhari in 2018 made a budgetary provision of N55.1 billion for the scheme, about one per cent of the government’s consolidated revenue assigned to BHCPF.
According to the National Primary Health Care Development Agency (NPHCDA), BHCPF serves to fund a Basic Minimum Package of Health Services (BMPHS), increase the fiscal space for health, strengthen the national health system, particularly in the primary health care (PHC) level by making provision for routine daily operation cost of PHCs, and ensure access to health care for all, particularly the poor, thus contributing to overall national productivity.
As of February 2021, 13,388 people in Niger State registered for the BHCPF, according to Adelaja Adereoran, the North Central Zonal Coordinator for National Health Insurance Scheme (NHIS).
Adamu and Aisha represent many residents who are not under the BHCPF due mainly to a poor awareness campaign for the program.
Findings by Result for Development revealed that 8.9 million Nigerians had been captured under the BHCPF, targeting 1,300 facilities nationwide.
The Federal Ministry of Health (FMOH) says it has disbursed N28.59 billion across the 36 states in Nigeria and the FCT, as its 2022 Basic Healthcare Provision Fund (BHCPF) allocation, according to a Business Day report.
How health workers contribute money to renovate MDGs PHC
The infrastructural decay at the Millennium Development Goals (MDGs) Primary Healthcare Centre (PHC), at the headquarters of the Shiroro local government area, is problematic. But workers are the ones making donations to fund the health care centre.
Joy Baba Joshua, the officer in charge of the facility, who received this reporter, disclosed that workers are using part of their monthly salary to repair the roof and provide other necessary items at the centre.
While the BHCPF also facilitates direct financial upgrade of PHC infrastructure and employment of skilled staff and ensures the availability of drugs, the MDGs PHC at Shiroro Local Government is yet to enjoy these interventions.
The roofs are half gone, and the entire facility becomes pools of water whenever it rains.
There are no beds and mattresses at the facility, the staff strength is very minimal, and no supply of electricity, water, drugs, and other medical needs.
Joshua said the government seems to have forgotten about the facility in its programs.
“We also outreach on immunisation to some settlements as far as 10 to 15 kilometres, and it is all self-sponsored. No single support from the local government, state or federal government,” she said.
The facility receives over 200 patients monthly.
“I went to the village head complaining about the condition of the facility, and he assured us of amplifying our complaint to the local government authorities, but we are not seeing anything,” Joshua added.
She continued, “the last time the windstorm affected the roof, community members contributed to replacing it. However, when it happened again, I called the Local Government Director, and he said they would see what they could do, and up till this moment, they have done nothing.
“No single vaccine or immunisation supply is given to us by the government, and we used to receive 70 to 100 children for immunisation every month. We buy the little we can buy from our pocket, and when we exhaust the vaccine, the immunisation ends. ”
A nursing mother at the healthcare facility, identified as Mary, decried the facility’s state and pleaded for government intervention regarding basic needs and staff strength.
“Let the government help us to renovate this facility so that we can enjoy, and the staff also enjoy doing their work,” Mary said.
Sunday, Jumai, another nursing mother at the facility, lamented that the facility is not receiving any intervention from the government. “Nothing seems to work,” Jumai said in the Hausa language.
“Anyone who visits the healthcare centre should thank God and the staff’s effort to ensure that some needed items are available at the facility from their pocket, but that is not enough. The government needs to come to their rescue.”
Lack of power supply and source of clean water at Bonu Basic Health Care Centre
Despite accessing about N1.3million from the BHCPF intervention, the Bonu Basic Health Centre, Gurara LGA, still does not look habitable for human beings.
Yahaya Jibrin, who heads the facility, said under the BHCPF, the health centre had received the sum of N200,000, N500,000, and N600,000 in the last three quarters , but it is never enough to put the facility in good shape.
This reporter observed that the facility needs general renovation, as it does not have adequate medical equipment, bed space, and drugs. In addition, no access to running water, and the toilets are in terrible shape.
“The funds we have received so far were used to replace broken doors, bought plastic chairs, mattresses, and rubber buckets,” Jibrin said.” (This is an investigation. Did the reporter see these items? Cos, that is the only way he can account for even the little he collected.
About seven communities are connected to the facility: Bonu l, Bonu Tikai, Dagibge, Londan, Chepkeji, Danga, and Paita. Two thousand residents from those communities depend on the facility, while 200 people visit the health care centre every month, according to records obtained at the facility.
Jibrin was the only available staff at the facility at the time of this report. He was attending to children brought by their parents for treatment.
Amina Ladi, a Bonu Tikai resident who often visits Bonu PHC centre for immunisation and treatment, lamented how bad the facility is and pleaded for government intervention.
“Look at the way the building is; the ceilings are already gone, no source of water, no access road, and no means of power supply,” Ladi said.
Ladi also complained about the lack of drugs and other essential medical needs at the facility, adding that “whenever a drug is prescribed to me, my husband has to go to a nearby medicine store to buy them at an exorbitant rate”.
Yakubu Danjuma, a resident with two wives, corroborated that the PHC lacks adequate personnel.
“I have two wives, and both of them visit Bonu PHC for antenatal whenever they are pregnant. They complain of a lack of qualified staff at the PHC centre, but what can I do. As an average Nigerian who doesn’t have any means of livelihood except farming,” Danjuma said.
“I have to persuade my wives to continue visiting the health care centre because I don’t have any other option.”
Residents don’t use Dubbo/Birgi PHC due to the cost of drugs
One of the cardinal goals of the BHCPF is to make health care accessible to the vulnerable at little or no cost. But residents of Dubbo/Birgi in the Bosso Local Government Area are not enjoying this benefit. The facility has only three workers and is not under the BHCPF.
The cost of drugs at the Dubbo/Birgi Primary Health Care centre is one of the reasons they seek medical attention elsewhere or choose to use herbs.
According to Zubairu Mulikat, the wife of the District Head of Dubbo/Birgi, many women in the community now resort to seeking medical attention elsewhere because of the cost of drugs and other medical items at the Dubbo/Birgi PHC.
“If the woman in charge of the facility did not buy drugs with her money, you wouldn’t get any drugs for use; many people have stopped visiting the healthcare facility because of the cost of drugs and treatment,” Mulikat said.
Alhaji Yusuf Shabba, the District Head of Dubbo/Birgi, said that the situation had gotten out of hand as he had sought government intervention, ‘but no one is willing to help’.
Workers at the Dubbo PHC facility work from 9 a.m to 6 p.m. Shabba attributed this to a lack of adequate staffing.
The District Head narrated how his wife was taken to the general hospital at midnight, about 30 kilometres from Birgi, because the PHC centre in the community was under lock and key.
“There was a certain time my wife started labour at about 2 a.m. The facility was already under lock and key. I had to take her to Minna general hospital, about 30 kilometres drive from my home, and we arrived at the hospital one hour later.”
But Inuwa Mohammed Fatima, a midwife and the officer in charge of Dubbo/Birgi PHC, said that since she started working at the facility, she has witnessed no intervention from the local government or state to re-equip the facility with the needed equipment.
“There is no drug provision; we use our money to buy and sell drugs to patients. We receive 250 to 300 patients every month, and about three settlements are attached to the facility, including Lapai Gwari, Dukuchi, and Fimba, among other settlements,” Fatima told this reporter.
Anguwan Tudu PHC Suleja in need of more personnel
Residents have seen the transformation of Anguwan Tudu Primary Health Care (PHC) due to the government’s intervention through the BHCPF. But they are yet to see the recruitment of more hands to boost the current workforce at the facility.
Findings by our reporter revealed that Anguwan Tudu Primary Healthcare (PHC) has benefited from the first, second, and third phases of BHCFP. The facility has received N1 million from the BHCPF.
Despite benefiting from the scheme, at exactly 2:00 pm on the day our reporter arrived at the facility, the PHC was under lock and key. Reason: There are only two workers there.
Haruna Sani, who superintends over the health care facility, told this reporter that there is a shortage of qualified health workers at the facility.
According to him, there are only two permanent staff who five volunteers support.
“There are not enough qualified medical personnel at the facility. So we have to seek the service of volunteers under the payroll of the BHCPF. Now, there are five volunteers here at this facility who we pay N20 000 monthly,” Sani lamented.
According to Sani, the fund is still insufficient to solve all the facility’s problems. For example, the hospital depends on water from vendors as it does not have running water, enough beds, and mattresses.
“Yes. Our facility has received N200,000, N500,000, and N300,000 for the program’s first, second, and third quarters. We use the fund for maintaining the facility, paying volunteers working in the centre, and buying drugs,” he explained.
However, a resident in the community, Hassan Hawwa, pointed out that the facility has ‘helped the community so well.’
“The government intervention is truly showing. As a result, other community women and I no longer go to Suleja general hospital for medical treatment,” Hawwa said.
“I have been sick and admitted to this facility several times, and their services are okay. They give required drugs and treat me how they are supposed to,” said Habila, 28, a resident of Anguwan Tudu.
Habila said more staff is required to make the facility perform optimally. “I think there is a need for more hands at the hospital.”
Like Anguwan Tudu Primary Health Care, after accessing N1 million from the BHCPF, the primary health centre at Etsugaie in Agaie local government is yet to perform optimally. There are not enough qualified community health care workers to service the residents.
This reporter found out there is also a shortage of drugs at the health centre.
Mohammed T. Mohammed, the officer in charge of Etsugaie PHC, said the centre had received N600,000, N200,000, and N200,000 for the first, second and third quarters.
“We used the fund to make provisions for portable drinking water, mattresses, and the installation of solar panels,” Mohammed said in an interview.
“Also, we used part of the fund to print patients’ cards, which are issued to the patients for free to motivate the people to visit the clinic. We bought drugs and employed two security personnel to guide the facility to avoid theft and vandalism.”
There are only two community health extension workers at the health centre. According to Mohammed, residents cannot access the facility if the two staff are not around.
“We only have two CHEW, and if we are not around, the facility will be closed down,” Mohammed said. “We need nurses and midwives to take charge of delivery and other services. We receive not less than 200 patients every month.”
Ndanusa Halima, a resident of the Etsugaie community, commended the services rendered at the facility and the state-of-the-art equipment provided through BHCPF intervention despite the lack of personnel.
“Whenever I visit the clinic for any treatment, staff are always on the ground to attend to people, and drugs are available at a very subsidised rate,” Halima said.
“The major problem I will point out and the centre is lack of enough staff, no single nurse or midwife, be it male or female. In rural communities, female nurses and midwives are needed so that the female gender can visit the clinic for childbirth and other treatments.”
Halima wants more government intervention in the facility, noting that the beautiful facility will be wasted if not enough qualified staff are present at the centre.
However, when contacted to comment on the various challenges plaguing the BHCPF in Niger State, authorities were not forthcoming with a response.
Dr Ibrahim Dangana, the Director Niger State Primary Health Care Development Agency (PHCDA), was unavailable all the time this reporter visited his office in Minna, the state capital.
Similarly, a FOIA request sent to his office on August 8, 2022, was not responded to a month after it was submitted. The agency did not explain why the FOIA was not responded to.
When a Whatsapp message was sent to him on September 15, he responded with “Good Evening Mr Hamzat. Apologies, the officers are yet to get back to you. Please, you’re welcome to interview me.”
“Are you in Minna… So can we schedule an interview session sometime next week if my busy itinerary allows me? Kind regards, ED,” he concluded the response.
But the interview couldn’t hold because Dr Dangana did not state the exact interview date and did not respond to further chats by this report to confirm the date and time.
His mobile phone number was not reachable on September 18, 20 and 21 when this reporter attempted to reach out again for his comments.
On September 23, 2022, the reporter further suggested they have an interview via the phone because of his busy schedule, which he agreed to, but his phone was switched off when it was time for the interview.
However, at a previous conference, Dangana had told reporters that 274 focal primary healthcare facilities across the 25 local government areas in the state benefit from the BHCPF. He disclosed that each facility receives N300,750 every quarter, and the disbursement started in 2021. Only 274 PHCs out of over 2,000 PHCs in the state.
He explained that BHCPF is used to settle the salary of medical personnel and attend to the needs of the facilities across the state. He said the PHCs use part of the fund to procure drugs and pay an allowance for ad hoc staff.
“We ensure that any PHC who is a beneficiary of BHCPF buys genuine and not counterfeit drugs,” he said. Part of the funds, Dr Dangana added, goes to the procurement of stationery for the facilities and “fuel to power motorcycles we use to conduct outreaches to difficult-to-reach communities”.
In the state, the government ensures a priority development plan for each facility. The PHCDA director explained that this is to ensure that the fund is judiciously allocated and used for the priority needs of the facilities.
Government will not spare any erring official- Commissioner for Health
When contacted for comments on the challenges confronting the implementation of BHCPF, Dr Mohammad Makusidi, the Commissioner for Health Niger State, said the state government would leave no stone unturned to ensure that officials caught sabotaging the scheme are dealt with within the ambit of the law.
“We all know that in Nigeria, people will always find ways to shortchange the system, so we need to get information from where all this is happening through the help of the press to allow the agency in charge to verify, and those found wanting will be dealt with,” Dr Makusidi said in an interview.
He also clarified the criteria for selecting the beneficial PHC in the state. According to him, one primary healthcare facility is considered from a political ward of the state. In addition, the centre must have good physical infrastructure and a minimum of two midwives before selecting it.
“Oversight functions are put in place by the Niger State Ministry of Health and other agencies in the state to checkmate any illegal or fraudulent activities in the scheme,” he added.
“Out of over 2000 accredited PHCs in Niger State, 303 have been enrolled on the BHCPF, and 274 have started receiving their funds directly from the Central Bank.”
This report is supported by the International Budget Partnership and the International Centre for Investigative Reporting (ICIR).
NOTE: This investigation was first published by WikkiWimes.
