How ‘One PHC Per Ward’ Policy Threatens Lives Of Rural Dwellers In Oyo State

Since the day Oluchi Chioma, 35, started attending antenatal care at Awotan Orisun Healthcare Centre, Onigbaketun Awotan, in Ido Local Government Area (LGA) of Oyo state, she had never missed her appointment, not just because she wants to know the condition of her unborn baby, but also because the health facility is the best one in Apete-Awotan-Ayegun and environs.

“Who won’t love this clinic? To start with, the environment is serene, the health facility is spacious and there is never a time when there is no bed space, because the health facility has a lot of beds”, Chioma said.

She added, “As for the health workers, they take good care of the community members, especially pregnant women. Drugs are never out of stock and the nurses are very friendly. So you can see the reason why I am eager to attend my antenatal and looking forward to giving birth to my bundle of joy at this PHC.”

However, Chioma’s joy was recently cut short. Two months ago, the PHC was closed by the Oyo state government. The health facility, one of the best in Apete-Awotan-Ayegun, was ruled as not conducive to run as a health facility.

The reason for the shutdown of the health facility is not far-fetched. “For years, there was no maintenance of the facility and with the heavy downpour that was accompanied with strong wind recently, the roof was blown away and the rain freely entered into the facility, destroying all the equipment, including the beds.

“Instead of fixing it, the Oyo state government decided to close the health facility about two months ago and ever since then, my people have been finding it difficult to access healthcare services,” the chairman of Onigbaketun community, Ido Local Government Area (LGA), Oyo state, Kola Ola, told LEADERSHIP.

“We cannot continue to live like this. Our children and pregnant women in this community need adequate healthcare services, which was provided to us at Awotan Orisun Healthcare Centre. Now that the government has shut down the facility, we are helpless,” a trader at Onigbaketun community, Mrs Balikis Adeyemi, said in an interview with LEADERSHIP.

Mrs Adeyemi who has five children, said she used to patronise herbal medicine sellers, but she got to hear of Awotan Orisun Healthcare Centre from her friend. “Ever since I have been attending the PHC, my children have been healthy and okay. The cost of treatment at the PHC is even cheaper and more effective than herb treatment. Now that the government has closed the facility, we will have no other choice than to go back to using herbal drugs, because the nearest PHC (Apkete PHC) is far from where I live,” she explained.

The community chairman said he wanted to renovate the health facility but he does not have the financial muscle to do it.  “We do not like the state of this PHC. We are helpless, however, because we do not have the financial muscle to renovate it. We are pleading with the government to put this place in order, so that our women and children can start accessing quality healthcare services,” he pleaded.

Ola added that he does not know what government has in mind for the PHC. “We have not been able to sit with the commissioner for health or the Primary Health Care Board, (PHCB), Oyo state, to discuss this issue, but we are trying to see a way to book appointment with the agency.”

The journey towards ‘health for all’

The poor health outcomes experienced by the people living in places like Onigbaketun Awotan was the main reason the federal government sets up the Primary Health Care Provision Fund (PHCPF) and the Midwives Service Scheme (MSS) in Nigeria.

It would be recalled that President Muhammadu Buhari launched the BHCPF appropriated by the National Assembly for the first time in the 2018 budget since the National Health Act (NHAct) was enacted in 2014.

The NHAct sets out the important drivers to guide disbursement of the BHCPF. These “Payment Gateways” are in three-fold and the Act states that 50 per cent (one half) of the Fund shall be disbursed through the National Health Insurance Scheme (NHIS) and deployed towards the provision of the Basic Minimum Package Health Scheme (BMPHS) in eligible primary or secondary health care facilities.

Forty-five per cent of the Fund is meant to be disbursed through the National Primary Health Care Development Agency (NPHCDA) and deployed to strengthening Primary Healthcare Centres (PHCs) in eligible PHC facilities for the provision of essential drugs, vaccines and consumables; provision and maintenance of facilities, equipment and transport; and development of human resources: while five per cent shall be disbursed through a committee appointed by the National Council on Health (NCH) and deployed towards emergency medical treatment.

Current contributions into the basket fund of the BHCPF includes N86 billion, of which about N56 billion has been disbursed to states as at June 2022, the secretary of the oversight committee of the Federal Ministry of Health, Dr Chris Isokpunwu, disclosed.

To access the Fund, a section of the Act makes it clear that states have to pay 25 per cent, while the federal government pays 75 per cent.

In Oyo state, for instance, LEADERSHIP findings showed that the state government paid a sum of N100 million as counterpart funding for the Basic Health Care Fund project and so far, about 351 PHCs, are eligible for BHCPF.

In Akinleye LGA for instance, Aroro PHC, Ojoo PHC, Iroko PHC, Ikereku PHC, Pade Maternity centre, Akinyele PHC, Iwokoto health center and Ijaye PHC are eligible for BHCPF; In Ogbomoso South LGA, Ilogbo PHC, Alapata health post, Adebayo Alata PHC, Isoko health post, Lagbedu health post and Okeolla health post are eligible for BHCPF; For Saki east, the eligible PHCs are Araromi PHC, Arolu PHC, Model Our Owode and Isale Ola PHC; In Ibadan South West, Agbokojo, Bode PHC, Isale Osi, Kokosi PHC and Molete PHC, among others are eligible for the BHCPF; In Ido LGA, Akinware PHC, Akufo Health centre, Elebu PHC, Ilaju health post, Ladunni health centre, Omi-Adio health center and Apete health centre.

Implementing PHCPF, MSS Scheme in Oyo State: Slow, but steady

So far, through the PHCPF, funds have been disbursed to over 100 primary health facilities in Oyo state, even as some facilities have received second disbursement of about N600,000, LEADERSHIP findings (as at 28th of June, 2022) showed.

A recent visit to primary health facilities like Isale-Osi PHC, Bode PHC, Molete PHC, Alata health center and Model Oje Owode PHC, (in July 2022) showed that N900,000 was paid to the PHC account as at November, 2021, and they have accessed about N600,000 of the BHCPF in June, 2022.

For instance, at Isale-Osi PHC, Ibadan South West LGA, community health officer and an assistant officer in charge of Isale-Osi primary healthcare centre, Ibadan South west, Oyo state, Olayinde Abass told LEADERSHIP that prior to the fund, the PHC faced challenges like inadequate provision of essential drugs and poor maintenance of the facility.

“So far, we have received from the BHCPF, N601,000 and we plan to use the funds to purchase essential drugs, to renovate the PHC, buy equipment like thermometer and stethoscope etc. We also need to print receipt and vouchers and carryout community mobilization/outreach programme.

“If the fund keeps coming, we believe that it will improve healthcare delivery in Ibadan South west LGA, in that more people will be accessing healthcare services at the PHC,” Abass said.

A visit to Molete PHC, Ibadan South West LGA, showed that the facility has received the sum of about N600,000 and part of the funds was used to fix the area for antenatal class and fix the beds, most of which were in bad shape.

The Matron of Molete PHC, Mrs Folashade Yinka, told LEADERSHIP that the PHC is faced with challenges ranging from inadequate beds, lack of hospital equipment like syringes, lack of potable water (as they fetch water from well) to inadequate chairs for antenatal and immunization class.

With the disbursement of the funds this year, the matron said parts of the N600,000 have been used to fix the bed springs, buy delivery couch, fix the antenatal area, buy chairs and bed lining, among others.

On the MSS, Yinka said the Oyo state government has assigned one midwife to the health facility, while assuring that it will assign more midwives to the PHC as soon as possible, to assist the four workers there.

She however appealed to government to provide borehole for them and put in more security in place to enable them work morning and night.

A visit to Akinyele PHC, AKinyele LGA, revealed that the facility is one of the best in the LGA as government has ensured that there are enough drugs in the hospital. According to the WDC Chairman, Akinyele PHC, Mr. Toogun Sunkanmi, the government is trying its best to make sure that the PHC is in perfect condition.

He told LEADERSHIP that his job is to take the needs of the PHC to the government and also to help educate the people (community) on the importance of using the facility for immunization of their children and other health care services.

In Ido LGA, the secretary and director of Ido Local government Head Authority, Dr. Olugbade Omotado, told LEADERSHIP that the LGA consists of 10 wards and each ward has more the one PHC, adding that the government decided to attend to one PHC per ward.

The others, including Awontan Orisun PHC, are not attended to and as a result are in bad state, a community member, in Ido LGA, Samson Amosun, told LEADERSHIP, while pleading with the government to renovate those centres as soon as possible, to save the lives of people living in those communities.

 

 

 

In Ogbomoso South LGA, a visit to Adebayo Amao Alata PHC, 2022, showed that while the health facility is selected as among those eligible to receive the PHCPF, it is yet to receive the fund as at 25th of July, 2022, when our correspondent visited the PHC.

According to one of the members of the WDC, who spoke with LEADERSHIP anonymously, “We have filled the form, signed it and opened an account with the bank, but we have not received any fund”.

He said they have gone to the Oyo state government House to discuss with the Commissioner for Information about the fund, and were assured that the money will soon be paid.

When asked what they will use the fund to, the WDC member said it will be used to fix what the PHC is lacking. “We are working with the matron and we will use the fund to fix what the matron said is lacking in the PHC.”

 

 

 

At Saki East LGA, Model Oje Owode PHC is one of the PHCs benefiting from the BHCPF, even as the Matron, Mrs Salam told LEADERSHIP that the facility has opened an account and government has credited it with the sum of N600,000 in June, 2022.

 

 

 

Salam disclosed that the fund will be used to purchase essential medical needs like drugs, maternity kits and hospital equipment. She disclosed that the community has no electricity, adding that parts of the funds will be used to purchase some lamps and fix the generator.

 

 

 

 

 

“We have asked the government to fix solar panel for us, but we are yet to get concrete response from them. We are renting generator, since the ones we have are bad. We cannot use the BHCPF to buy a new generator or to fix solar panel, hence the reason why we are calling to the government to come to our aids,” Mrs Salam said.

 

 

 

 

 

Assessing the implementation of BHCPF in Oyo State

 

 

 

From all indication, the BHCPF has the tendency to improve the health outcomes of the people at the grass roots, chairman, Public Health Sustainable Advocacy Initiative (PHSAI) Ayo Adebusoye told LEADERSHIP, while commending the state government for disbursing the funds to the PHCs. He urged the PHCs to ensure they use the funds judiciously.

Adebusoye, however, faulted the ‘One PHC per Ward policy’, adding that it may lead to the abandonment of some PHCs in various communities, as government may tend to focus more on PHCs selected to benefit from the PHCPF and abandon those not selected, which is a major problem.

He advised that, while other PHCs benefit from the PHCPF, government should set aside funds to maintain those like Awotan Orisun Healthcare Centre, which were not selected, thereby ensuring that no community is left behind or denied, access to quality healthcare services.

 

Oyo state Government reacts

 

Oyo state has over 730 PHCs, out of which, about 351 PHCs are accessing the BHCPF, the chairman, Primary Health Care Board (PHCB), Oyo state, Hon. Dada Awoleye told LEADERSHIP, adding that this is in line with the state government’s programme of one standard PHC per ward.

 

 

 

“We need to have a proper PHC; a PHC that is well staff and with equipment, in each ward. We need to optimize for now, due to the limited funds available to us. While other PHCs in a ward will not be totally neglected, what we are focusing now is to renovate the 351 PHCs first, (which are the PHCs selected for the BHCPF), build them to World Health Organisation’s (WHO) standard, before we consider the other PHCs. With the help of the funds from the BHCPF and what the Oyo state government is pumping into the renovation and upgrading of these PHCs, we have been able to renovate some of these PHCs to standard,”  Awoleye explained.

 

 

 

 

 

The PHCB’s chairman revealed that the Oyo state government cannot fix all the PHCs at the same time, considering the fact that nearly all the PHCs are in disrepair, while explaining further that, “We plan to consider those PHCs not selected for the BHCPF, after we must have finished with the 351 PHCs, which is close to 45 per cent of all PHCs in the state. We have selected 351 PHCs that this present administration have commenced renovation, upgrading, equipping and staffing them. We need to make sure drugs are available.”

 

 

 

 

 

For the meantime, Awoleye appealed to communities like Onigbaketun Awotan, to access quality healthcare services in the PHC selected for the BHCPF in their ward.

 

 

 

 

 

He however called on Onigbaketun Awotan, to write to the PHCB, stating what they want the government to do, while assuring that their proposal will be looked into. “We will look at their application and see how feasible it is for the government to consider their proposal. If the PHC falls within an area where there is good traffic, where a good number of lives are at risk, we will definitely consider their proposal. Our job at the board is to sit down with community members to discuss issues like this,” he added.

 

As for the MSS, the chairman said that in the last few months, about 100 midwives have been deployed to the 33 LGAs in Oyo state, representing three midwives per LGA, while assuring that more will be deployed soon.

 

This report is supported by the International Budget Partnership and the International Centre for Investigative Reporting (ICIR).

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