Most Primary Healthcare Centres (PHCs) in Imo State have less than half of the basic utilities needed to run a primary healthcare facility, a recent survey of PHCs in Nigeria has revealed.
The survey conducted by Connected Development (CODE) sought to assess the readiness of PHCs in Nigeria to administer the COVID-19 vaccine.
The project sampled a total of 90 primary health care centres in 15 states across the six geopolitical zones of Nigeria. Six primary health care centres were inspected in each state.
The report of the survey showed that PHCs in Imo state, south-east Nigeria, have the lowest set of required facilities and utilities, compared to the other 14 states.
The criteria used to measure these requirements are the minimum standard infrastructural requirements for PHCs outlined by the National Primary Health Development Agency.
The primary healthcare facilities were measured based on their access to clean water, connection to grid electricity, availability of sanitary waste collection points, availability of separate toilet facilities for males and females, and availability of appropriate staff accommodation within the facility premises, among others.
According to the data, 5 out of 6 (or 83% of) PHC’s in Imo state are clearly signposted. This percentage appears satisfactory only when compared with states like Abia, Ebonyi, Kebbi and Kogi, which have lower figures in this regard.
On the other hand, only 1 out of the 6 primary healthcare centres that were sampled in Imo state is a detached building. The other 5 were attached to building structures serving other purposes.
Having only 1 in 6 (or 17% of) PHCs in Imo State being in its own separate hospital building is the poorest estimate among all the 15 states, followed by that of Benue state, which is 33% of the state’s PHC’s surveyed.
Similarly, only 33%, that is, only 2 out of the 6 primary health care centres sampled in Imo have access to clean water. Imo has the lowest percentage in this regard among other states.
Although 50% of Imo healthcare facilities are connected to the national grid, it has one of the lowest percentages alongside Ebonyi, Taraba, and Yobe states. This means that 3 out of 6 healthcare facilities do not have the main electricity connection, a critical need for effective healthcare service.
Also, just 50%, that is, 3 in 6 primary healthcare centres have a sanitary waste disposal point. Imo state surpasses only Osun state in this category, the latter having the lowest percentage of 33%.
In addition, only 1 healthcare facility in Imo state has a separate toilet for males and females. The 17% figure is the lowest among other states. In the other 5 PHCs, males and females share the same toilet, giving rise to many safety and privacy concerns.
Lastly, only 2 out of the 6 (or 33% of) healthcare facilities in Imo state have appropriate staff accommodation provided within the hospital premises. Imo state PHCs fare better in this regard than those in Benue, Ebonyi, Plateau, and Kebbi states, which have no staff accommodation within the PHC facility premises.
Details of each of the Primary Healthcare Centres surveyed in Imo
The Primary health care survey was conducted in three local government areas (LGA) of Imo state, namely, Owerri North LGA, Ohaji/Egbema LGA, and Ehime Mbano LGA. The PHCs surveyed in these local governments were in six communities: Okwu, Ohoba, Umuchima, Umuanunu, Umuome/Umuokem, and Owalla.
Umunomo Ibenkwo primary health care facility at Umuanunu, Ehima Mbano, appears to be in the worst condition among all the sampled PHC’s in Imo state. Out of the 6 attributes for attaining minimum standard infrastructure in PHCs, Umunomo failed to meet four.
The Umunomo Ibenkwo health centre is neither clearly signposted, nor connected to the national grid. Likewise, this PHC does not have a waste collection point. Neither does it have a separate toilet facility for males and females.
However, Ekeobi, Owalla, Owerri North is in the best conditions among the sampled primary healthcare centres in Imo state. It has a signpost for easy location, a separate toilet for females and males, access to clean water, connection to the national electricity grid, a sanitary waste collection point, is situated on a detached building, and has appropriate accommodation for the staff, within the premises of the healthcare centre.
The implication of the low level of required PHC utilities in Imo State and others
The poor quality of infrastructure in primary healthcare of Imo state also depicts the wide gap the state’s leadership has to fill to achieve goal 3 of the Sustainable Development Goals (SDGs). This goal is to ensure healthy lives and promote well-being for all ages.
Over the years, the Nigerian government has promulgated some acts and made efforts to improve the state of primary health care in the country. Some of these acts include the National Health Act (2014), the National Human Resources for Health Policy (2015), the National Health Policy (2016), the Second National Strategic Health Development Plan (2018-2022), Ward Minimum Health Care Package (2007), and the National Healthcare Development Agency (2004).
In terms of funds, the National Health Act holds that primary health care is entitled to 45% of the basic healthcare provision fund, of which 20% will be used to provide essential drugs, vaccines, and consumables for the centres, 15% will be used for provision and maintenance of pieces of equipment and facilities, and 5% is disbursed for the development of human resources in the primary health care centres.
The question is, why do we have the conditions in Imo State if funds are truly allocated to PHCs as the National Health Act stipulates?
At the federal level, in the 2021 appropriation bill, 35 billion was appropriated for the basic health fund, which is to be shared equally among states, based on the number of PHCs in the state.
For Imo State, as of 2018, a total of 16.7 million was budgeted to finance revitalization and equipping of PHC’s in Ohaji/Egbema local government, one of the LGAs included in the primary healthcare centres survey.
The PHCs in Ohaji/Egbema local government were also meant to benefit from the 6.2 million budgeted to be shared equally between Ohaji/Egbema and Awara local governments.
Besides, Ehime Mbano local government, another local government included in the PHC survey, was also to receive 26.7 million to revitalize and equip 7 PHC’s in the local government.
In 2019, a budget of 25 million was made to finance the supply of medical and hospital equipment in Ehime Mbano.
Taking examples of the funding of these two aforementioned local governments, it is uncertain whether the problem bedevilling PHCs in Imo State, and indeed the nation as a whole, is inadequate funding or the misappropriation of funds meant for the maintenance and upgrade of these health facilities.
Whatever the case, for the people of Imo state to have improved access to quality primary healthcare facilities, including access to vaccinations such as the COVID 19 vaccine programme, the state of the primary healthcare centres in the state needs to be reviewed.
Turning around the state of the primary healthcare centres in Imo State, and other parts of the country may require adequate funding and the efficient management of those funds. This is important for the achievement of the sustainable development goals for Nigeria’s health sector.