About 10 years ago, a consortium of non profit organisations mounted pressure on Kaduna state government to make progress on its commitment to provide free maternal and child health services (FMCH), following a law establishing Primary Health Care Development and Drug Management Agencies seeking to tackle some health issues in the state. With support from the Department of International Development (DFDI)-funded State Accountability and Voice Initiative (SAVI), the state government scaled up its commitment to provide FMCH services by increasing primary health care centres from 115 to 255. In 2015, the government awarded contracts for 255 primary health centres to be renovated or newly built. RUTH OLUROUNBI brings findings from three local government areas captured in the government documents for new centres and renovation.
An abandoned Doka Primary Health Care (PHC) centre in Kachia local government area of Kaduna state, located off Kilometre 60, Kaduna – Abuja Expressway, is now a sweet spot for bandits, who are seen as a security threat to residents of the area, Facility Health Committee Chairman in the area, Sadiq Hamza, who doubles as ward head in the community tells Per Second News (PSN).
The N16.64 million centre meant to help reduce maternal and under-five mortality, as well as provide healthcare in the area is meant to complement an existing ill-equipped and battered centre with leaky roofs and visible cracks on the wall. The problem is, the project, started a little over three years ago, remains abandoned at below 50 percent completion for more than two years per residents’ accounts, with exposure to various weather conditions wrecking damage to the structure and wood used in the roofing, which are seen rotting.
According to Hamza, the abandoned centre does not only pose security challenge to people who live in the area, it poses a greater risk for pregnant women and children who are unable to access health facilities quickly enough.
Unsafe public centres pose significant danger to patients and healthcare professionals whose job it is to provide life-saving services to their patients, Damilola Lewis, a public/family health doctor. “They are a good breeding place for rodents who are vectors for viral haemorrhagic fevers, especially Lassa fever. Malaria fever will thrive here because of the decrepit condition of these facilities,” Lewis said commenting on the state of infrastructure decay in the three local government areas.
Currently, Nigeria is the highest contributor to maternal mortality in Central and Western Africa and contributes 14 percent to the global maternal mortality rate, according to the United Nations Children’s Fund. The ratio of 576 maternal deaths per 100,000 live births has not improved over the last decade. Most of these deaths occur in northern Nigeria where health indices are poorer, according to the UNICEF which stipulates Nigeria being among the world’s highest mortality rates for women and children.
The PHC building meant to be complemented by the abandoned centre is a two room apartment constructed in 2002 that runs seven hours a day for seven days a week, and caters to the health needs of about 300 patients monthly. The centre, lacking adequate space to cater for the number of people accessing healthcare services at the facility, causes a situation where women who put to bed at the centre are often discharged immediately without lying-in-section for observation, in order to create room for other deliveries or emergencies that often arise.
Kaduna state government’s documents show that contract for the abandoned centre was initially awarded to M/S Olimax International Limited, but was later revoked for non-performance and was re-awarded to M/S ABC Salico Resources Nig. Ltd. A public search of the country’s Corporate Affairs Commission (CAC) failed to turn up M/S ABC Salico Resources Nig. Ltd as a registered company and no evidence on the internet search showed a company website or physical address for the firm. Same for the two other firms contracted to renovate and build primary healthcare centre in the two other local government areas visited. An Abuja based lawyer said even if the companies were going through registration process as of the time of awarding the contracts, company names would and should still be on the CAC portal.
Innocent Sarki, Village Head of the local government area told Per Second News that the key contact person representing the contractor for the project has repeatedly pleaded for patience during their communications, stating that the State Government is yet to provide funding for work to continue on building the PHC as agreed in the contract.
Kaduna state government, in response to pressure from civil society groups to make progress on its commitment to provide free maternal and child health services (FMCH), in 2011 committed to scaling up provision of FMCH services from 115 to 255 facilities, a year later, it transferred management of the FMCH programme from the governor’s office to the Ministry of Health, under the supervision of the Permanent Secretary, according to a government document cited by PSN.
Multiple data from the United Nations Children’s Fund and World and the Health Organisation (WHO) show that over one third of Nigeria’s pregnant women do not attend antenatal care services during pregnancy, and barriers such as infrastructure decay as well as inadequate healthcare systems for communities members in Kachi, Kajuru and Kaduna South local government areas are preventing women’s and children’s access to quality healthcare, residents in those areas told Per Second News.
“Nigeria’s mortality rates for women and children are among the world’s highest. The ratio of 576 maternal deaths per 100,000 live births has not improved over the last decade. Most of these deaths occur in northern Nigeria where health indices are poorer” – UNICEF
Unsafe primary healthcare centres prevent women’s and children’s access to “basic health care parameters that serve as indicators to the fact of their wellbeing,” according to Lewis, who said: “in the absence of adequate primary health care centre facilities, they would be at the mercy of traditional birth attendants who are not skilled in the art of health care delivery, especially as concerns pregnant women.”
Unskilled traditional birth attendants pose greater risk to significant risks to pregnant women who would be “denied access to basic information which is shared on ante – natal days. This information helps them to take adequate precaution against diseases, malnutrition, and the likes that will affect growth, and development. The information helps them to space their children for better quality of life. The children will also have access to quick intervention, in cases of disease, and infirmity. There will be prompt diagnosis and early treatment.”
An existing Doka PHC for instance has no source of water, with the only water point within the facility damaged for a while now, according to a staffer who did not want to be identified in print. PSN observed that centre is not connected to the national electricity grid and it has no supplementary source of light; lacks laboratory equipment, storage equipment for vaccines and medications as well as enough beds to cater for women who come to access ANC and maternity services.
Fatima Mohammed, a mother who is resident in the community, and who was just delivered a baby at the PHC, said there was only one bed that caters for women who access ANC services and those who come to deliver their babies. As such women have to take turns to use the single bed. She also reported that when mothers bring children for treatment at the PHC there is usually no bed to admit them. She sat on the single bed when PSN visited the centre and interviewed her for this story.
Staffer said medications are occasionally supplied by the government, while at other times, they’ve had to source for more from the General Hospital at Doka , often using commercial motorcycles to pick the medications up. The centre according to staffers does not have an ambulance and commercial motorcycles are used in cases of emergency.
In a bid to revamp primary health care delivery in the state, the government awarded contracts for building/renovating 255 primary health care centres across the state in 2015. According to data obtained from the Kaduna State Primary Health Care Agency, out of the 255 contracts were awarded for renovation/construction of PHCs, 183 PHCs have been completed on paper, while 62 and 10 centres are respectively at the stage of 50 to 94 percent completion and below 50 percent completion. Site visits show that the centres do not reflect the realities of the people.
Although government records show that these contracts were awarded through tenders in line with procurement guidelines, claims that these contracts were awarded through friends and families acting through legally registered firms that served as fronts, have largely gone uninvestigated. Added to that are the reports that construction and/or renovation of these 255 PHCs were carried out with little supervision from line ministries.
A primary health care centre in Iri Gari community of Kajuru local government serves as a case in point for residents who say they are unable to access healthcare services. The centre, contracted to M/S Edi-Jen Company Ltd at N16.84 million, hasn’t moved past “under construction” in the past three years, forcing residents to rely on the old PHC building, which currently is in a dilapidated state. The old centre caters to the health needs of about 100 patients monthly, like two other centres in other local government areas meant to be renovated, has been in its state of disrepair for more than 10 years, the Village Head of Iri Gari, Sani Bature, told PSN. A staffer who didn’t want to be on camera told PSN that the entire PHC has been infested by bats and their droppings are seen all across the facility. Out of nine rooms in the centre, only one room is in use, serving as a consulting room, maternity room, lying-in-section area, antenatal services area, reception area, and child welfare clinic.
Again, multiple attempts to locate the company through a public search of the CAC as well as internet search yielded no results verifying whether M/S Edi-Jen Company Ltd as well as the other two contractors – M/S Sofi Et Ladi Nig. Ltd and M/S ABC Salico Resources Nig. Ltd – are legally registered companies or not. An email sent to the state agency seeking clarification on these issues and more returned with a failure delivery stating: “Your message wasn’t delivered to firstname.lastname@example.org because the domain smoh.kd.gov.ng couldn’t be found.” A Kaduna State Primary Health Care Agency document listed email@example.com its email address. A request for clarification sent to the state ministry of health has not been responded to as at the time of filing this report.
Following a rapid assessment checklist designed by NGOs in the state, Per Second News found that health care services for pregnant women and children were markedly subpar. For instance, the evaluated PHCs lacked the capability to provide specialized care for pediatrics, obstetrics and gynecology cases; and because all cases requiring specialized care are often referred to the nearest General Hospitals, this often elongates the period between diagnosis and treatment thereby putting women and children living in these communities at risk of further breakdown from diseases. An uncompleted borehole site can be seen in the centre which lacks any other source of water. There are no signs that the centre is connected to the national electricity grid or that it has any supplementary source of light.
In Hajia Amina Namadi Sambo Comprehensive Health Centre at Kaduna South local government, the N62.98 million facility contracted to M/S Sofi Et Ladi Nig. Ltd also lacked any source of water, given that the only water point within the facility is in disrepair. PSN’s visit showed that the design for the new PHC building is substandard, according to the rapid assessment checklist and a Akin Akintayo, a structural engineer who was shown photos of the building.
“The roofing structure and walls tell me for a fact the structural integrity of the entire building poor. It looks like a building on the verge of collapse or a really old building and this portends a significant risk to the users of these buildings. My assessment of these buildings is that they are life threatening unfit for use,” Akintayo said.
Three rooms in the makeshift health centre have been in use for the past 22 years, according to staffers, who say they utilise the first room as a consulting room, an ANC reception area, a child welfare clinic and for conducting minor procedures. The second room, they said is used as a delivery room and lying-in-section area, while the third room is used as an admission room.
Hajia Lado Umar, the women’s leader for Kaduna South LGA and practicing traditional birth attendant who volunteers at the centre said contract for the reconstruction and renovation of the old PHC has been underway for the past two years and is unsure when construction will be completed on the site. According to her, ambulance at the PHC remains nonfunctional “for a long time and staff often rely on the use of commercial cars and/or motorcycles in cases of emergency.”
The severely under-staffed centre only has no licensed doctor, three technical staff, an Officer in Charge (OIC), an Assistant Officer in Charge,and a nurse. At the time of Per Second New visit, there were two community health extension workers onsite. They said the centre has for the majority of its existence, depended on volunteers to run it.
While officers in charge at the PHCs visited declined to speak on the condition that they were not authorised to speak with the press and independent evaluators, they did say there were no record of maternal mortality in those centres in recent years. With the existing practice being to keep women who have successfully been delivered of babies in the lying-in-section for a period not exceeding 24 hours, record keeping for mortality becomes a herculean task.
Per Second News attempt to reach the upper echelon of the state ministry of health was unsuccessful as this newspaper was told the state governor has yet to form his cabinet; and the permanent secretary, Mohammed Mahmoud Shuaibu, was not on seat.