By Juliet Ochenje Jacob
It is usually a beehive of activities at the modest 8-room Primary Healthcare Centre (PHC), Dutse-Makaranta, a shouting distance from the bustling Kubwa. Kubwa is one of the biggest satellite towns to Abuja metropolis, home to the seat of the federal government of Nigeria.
Its only 9.00 am on this day, and nearly all the available standing spaces within the PHC has been taken by various categories of patients, seeking attention.
All available seats had been taken by mothers clutching their babies to their chests or strapped on their backs. Then there are scores of pregnant women holding red and blue hospital cards. All are waiting to hear the call of their names, to step forward to the table in front of the row to be examined.
It’s unbelievable how the four nurses on duty – a matron, two nurse midwives and a laboratory attendant – manage to remember the sequence of the order or non-order at play at the PHC. To a non-staff of the PHC, everything at the Centre spell chaos.
A baby cries there; a nurse shouts the name of a patient above the cry; a bellow of a beckon there. But things manage to move on. That is the state of everyday work at the Dutse-Makaranta PHC centre daily. Atop this bedlam is the intensity of heat within the centre.
There is no electricity to power two ceiling fans spotted at the centre. Maybe with that, mothers at the centre would not be sweating the way they are, even at 9 O’clock in the morning.
Mrs. Lilian Thompson is one of the patients at the PHC on the day our correspondent visited the centre. She says she had spent about two hours at the hospital without being attended to.
Thompson who is pregnant with her second baby said she delivered her first baby at the PHC some years ago. According to her each time she visits the centre, her experience is almost the same.
Thompsom says the nurses at the centre are doing their best. The problem responsible for the long stay at the centre to get treatment is inadequate manpower, she adds. In her words: “The nurses are not enough and the equipment are not enough too.” Patients also wait for long hours to be given their drugs, she further says.
“They will say no vitamin A and the rest but everything is supposed to be here. But they will say, you should come back next week or upper week,” she rues.
Mrs. Anabelle Peter was also at the PHC on the morning our correspondent visited. She agrees that lack of adequate number of staff needed at the PHC is responsible for the long time patients spend at the centre before receiving treatment.
According to her, the PHC is “short of staff, equipment and they are short of things used to treat children”. She says she has been using the centre in the last five years. In fact, she said she attended her antenatal and delivered her baby at the centre. Even after delivery she said she continued using the centre for the immunization of her baby.
“Sometimes they will say “no card and sometimes they will say no drugs”. Sometimes we will suffer and come and will join a long queue and they will tell us “vitamin A has finished”, go and come next week. Now speaking in pidgin English she said “sufferness dey for here oo!!, Make una help us abeg!”, meaning its tough accessing care here, we need help”.
At inception of the PHC 24 years ago, the plan was for a quick and easily accessible health facility close to the people at the grassroot, it was aimed to encourage rural patients especially pregnant and expectant mothers to reach care easily within their neighbourhood.
But Mrs Maria Shiva, the health information officer at the Dutse – Makaranta PHC sees the challenge at the centre differently,
She said sometimes the delay is manmade. “Some of these mothers do not come when they are scheduled to come, they come whenever is convenient for them, so in situations like that, we attend to those on schedule first and attend to others afterwards”
As a result, she said they get agitated and begin to “rush for hospital card, some lack patience and get annoyed and leave while some exercise patience and get their card and get treated”. Mrs Shiva however admitted that if they had more staff, the speed of delivery would have been faster.
Shiva says there are “one midwife and she is a volunteer, and the matron is also a midwife and that they have only two nurses, nurse midwife and nursing officer”, admitting you cannot do so much with the number. “We need a bigger facility and better equipment” she further said adding “there is a big space here (pointing at a big unbuilt space in front of the centre) for expansion, it will really help us”
According to Shiva, “like me I have just one assistant and she is a volunteer”. She says the centre can do with more staff to be able to fulfil the intention of government in setting up the centre.
Provide however a more vivid picture of the challenges facing the centre, Mrs Amarachi Okereke, who is a nurse at the centre said “materials to use are not always available”. As a result, they frequently refer patients to secondary hospitals around, especially the Kubwa General Hospital.
When this occur she says the patients feel bad “and sometimes even fight and destroy chairs all in the name of they want to be attended too” adding “it’s frustrating trying and failing in getting the patients to understand this place is only a PHC some patients feel that everything can be done here.”
According to Professor Bolaji Aregbesola of the community and primary healthcare Unit, University of Lagos and one other, 24 years after the PHC system was set up in the country under the tenure of Professor Olikoye Ransome-Kuti as Minister of Health, the need to strengthen the PHC in Nigeria is relevant as ever before.
The scholars in an essay published in the Frontiers of Public health, “the current state of PHC system in Nigeria is appalling with only about 20% of the 30,000 PHC facilities across Nigeria working” at full intended capacity.
According to them, “most of the PHC facilities in Nigeria lack the capacity to provide essential health-care services, in addition to having issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, poor condition of infrastructure, and lack of essential drug supply”.
They also concluded that “in part, problems with the implementation of PHC in Nigeria are related to the hand over in 1980s to the local government administration, which is the weakest level of government”.
It was apparently to address some of these identified failings, that the federal government approved the PHC under one roof (PHCUOR) policy in 2011. Mainly the policy was to address the problem of fragmentation in PHC and ensure the integration of PHC services under one authority.
But Prof Aregbeshola et al, say the impact of the policy is yet to be felt on health status and utilization of PHC in Nigeria. They however agree that maybe the policy should be given more time to fully impact on the health sector, since policy is only few years old.
At the Dutse Makaranta PHC the long line of women and patients waiting to be treated seems never ending. After waiting for nearly three and a half hours, Mrs Lillian Thompson says she will have to go home and return another day.
