Patients, community leaders and health workers in some rural communities in Enugu State have raised concern over the pitiable condition of primary healthcare facilities in their areas and appeal for urgent government attention.

The people made the appeal when Radio Nigeria visited some primary healthcare centres and health posts in Udenu, Aniri, Isi-uzo, Eziagu, Nsukka and Enugu East Local Government Areas.

In this special report, observations made and information gathered by Radio Nigeria during the visit were quite shocking and revealing.

In Nigeria, there are three levels of healthcare delivery, namely: primary, secondary and tertiary healthcare.

According to the World Health organisation (WHO), primary healthcare is “the first level of contact for individuals, families and communities and enables healthcare to be delivered as close as possible to where people live and work.”

Part of the main features of the primary healthcare system is its accessibility and affordability, with focus on preventive than curative medicine, which is why in Enugu State primary health centres and or health posts exist in almost every community.

However, the condition of many of the primary health facilities leaves much to be desired as they are in dilapidation, poorly equipped and with workers accused of not being committed to duty.

One of such facilities is the Comprehensive Health Centre Amalla Orba in Udenu Local Government, established in 1976.

Observations by Radio Nigeria showed that the facility was not only dirty and old, but looked like a ghost house with faded paint; leaking roof; obsolete bedding with cobwebs, a sign that they had not been put to use for some time; no public power supply; no water, except from the rain; no functional toilet facility; dilapidated staff quarters and bushy environment, a situation that scared patients away.

Though the facility had five registered nurses, it lacked a doctor and a lab technician.

This is in addition to alleged poor attitude to duty by the workers as lamented by some members of the community interviewed during the visit.

“Many of the workers do not even come to work and again many of them have nonchalant attitude to work, they hardly stay in the health centre, they need to sit up very well,” one of them lamented without mentioning her name.

Another male community member said “It’s only the poor ones that come here because even the staff, sometimes if you come here, you will not even meet them; sometimes two years ago, there was a woman that delivered at the steps there because she came there was nobody there, so she couldn’t go back, she had to (be) deliver(ed) (of her baby) there.”

The Youth President of Amalla Orba Community, Mr. Godfrey Onah, added that the sorry condition of the facility and the poor attitude of the workers had far reaching implications to the health needs of the people.

According to Mr. Onah, “the entire Amalla people, before now do go for ante natal, safe delivery and every other infant health services and treatment but because of the nature of the whole system now, the women that make use of that place now go to quacks and traditional health (birth) attendants; they are the people that our people now patronize in our community and we are not happy about it”.

“The experiences and what has happened before now that the staff, the former matron of that health centre, the behavior she portrayed that time; in the night if a woman is in labour, she will not attend to the person, she will tell you that she has gone to sleep; any emergency in the night she will just arrogantly talk to you; she doesn’t have that customer relationship in her”.

“Also, there is no facility, the whole roof of the buildings are (sic) leaking, some of the windows and doors are not in good condition, so nothing is there, so nobody will like to go and risk his or her life in such health centre so that is the reason our people don’t talk about the health centre, nobody attends there.”

Mr. Onah also alleged that the selfishness and politics affected government’s earlier proposed renovation and upgrade of the health facility.

“The Governor of Enugu State, Ifeanyi Ugwuanyi, the first project he wanted to carry out in Enugu State was to turn that health centre to district hospital; 350 bed space hospital that will serve as an extension of ESUT Teaching Hospital but political interest and greediness by the community members that call themselves Igwe-In-Council with the Ichies betrayed the whole programme so the Governor changed his mind and took it down to Awhum Orba.

“The government came and surveyed the place, they quantified the houses that were involved, whose property will be affected in the expansion, get the appropriate compensation that will be paid but the Igwe-In-Council together with the Ichies they went and  tried to hype (inflated) the cost so that they will enrich themselves after the programme.

“They told the villagers to fill forms and after filling forms, they will tell you that when you build your house is not worth up to one million naira and government said they would pay you one-point-five million because of that after filling forms they will tell you that your house is worth ₦800 thousand.

“They wanted to go and collect money from governor, then come back and pay them with those files they have created for them locally, not working with what government quantity surveyor has quantified and that was what the problem that erupted so they shifted the hospital to Awhum-Igboano,” Mr. Onah alleged.

The traditional ruler of the community could not be reached for his reaction to the allegation as he was said to have traveled out of the country as at the time of the visit.

In the meantime, a new Officer-In-Charge (OIC) of Comprehensive Health Centre Amalla Orba, Mrs. Josphine Ngwoke, said she had intensified efforts to revive the health centre and restore the confidence of the villagers in the service delivery at the centre, through house to house sensitization for immunization, child birth, and antenatal care with a team of community people.

Mrs. Ngwoke however identified issues of poor work environment and poor motivation of the health personnel as a major challenge.

“This place is dead already we are trying to revive it. We don’t have water, we have only one tank, which we connected to the roof for rain water and during dry season we use to contribute money to buy water from outside.

“We don’t have toilet here, go outside and look at our roof and see how old the zinc is; and even they were telling us they will renovate and build staff quarters but no way; look at my office and see how bad it is.

“They are not paying our promotion allowances, like my own they are owing two grade levels of promotion and before our leave allowance is equivalent to our salary but now they pay us any amount they like,” Mrs. Ngwoke lamented.

Efforts by Radio Nigeria to get the reaction of the Chairman, Udenu Local Government Area, Mr. Frank Ugwu on the complaints failed as he was not in the office when visited and he neither picked calls nor responded to our text messages.

Meanwhile, the Head of Department, Health, in the Local Government, Mr. Silas Ekwueme blamed indiscipline and poor attitude of workers to duty in the Local Government System in the state partly on political interference.

Mr. Ekwueme suggested institution of monitoring and technical units to address issues of truancy and faulty equipment at the health centres.

“The government should have a monitoring unit in Enugu with functional vehicles that will be going to health facilities from time to time because why instrument of discipline is poor is that the civil service has degraded to the extent that they do not know the meaning of query, they only know that they are being punished when their salary is stopped and that one is in the extreme and it should be the last resort in disciplining of staff.

“Politics has spoilt everything. There is no instrument of discipline, a kind of saying your salary has been suspended this month or this month you will receive half salary and all that and even the chairman runs away from such discipline because so many persons that matter will be calling him.”

“People should be made to render their service irrespective of who they are. They should not just employ people but they should subject people to pre-qualification test before they are employed.

“Most of these people, they come to the health facility without knowing anything but because they belong to the power that be they must be there and the moment they are deployed to a health facility, off they go. And their political backbones determines what health facility they will be posted.

“And people want you as the HOD to write a report and furnish them with names and numbers of people that are not coming to work. Some of us have been threatened for trying to take certain steps,” Mr. Ekwueme narrated.

Mr. Ekwueme also advised that “we should have a maintenance unit that technicians should be employed that will be going to our health centres to repair their solar freezers and generators. Like the solar freezers, solar panels, these things will get spoilt, no one will repair them.

“You even see the water that is being constructed by UNICEF, they use solar panels to power it but when it spoils nobody will be there to repair it but if these type of artisans are employed by the Enugu State Primary Healthcare Development Agency, once you have this issue you call them, they will come and repair them and things will be going well.”

The tales of woes continued at the Comprehensive Health Centre Mpu, Aninri Local Government Area.

Though the facility was relatively new and large enough with staff quarters, lack of maintenance had left the buildings with cracked walls, abandoned beddings with cobwebs, no light and bushy environment.

Also, a modern ambulance parked there had long been left to rot away with deflected tyres and its white colour dented with black patches.

Just like the others, the health centre had no doctor, no trained nurse and lab technician but had four permanent and four adhoc Community Health Extension Workers (CHEW).

When Radio Nigeria visited the facility around 10am only a female adhoc staff was on duty with no patient.

The health worker pleaded anonymity as she spoke alongside a resident of the community, Mr. Godwin Nwonye, on the lackluster attitude of the workers and the situation of the health centre.

“We don’t have the equipment that this health centre use, including the drugs that we use to treat people and as for the staff, they come they will travel again; they travel to where their husbands stay but sometimes they come to work.

“Sometimes in a whole week, we may not see a single patient here,” she stated anonymously.

Mr. Nwonye corroborated what she said pointing out that “sometimes you come, this place will not be open; sometimes when you come, you cannot see people working here, that is why our people do not come here.”

However, another health centre in Mpu, which was smaller in size and with four permanent health workers and an adhoc staff, was said to have more patronage as expressed by one of the patients met at the facility, Mrs. Mercy Daniel.

“I come here often, sometimes I will for immunization, they are doing well, dedicated; every time you come here you must see somebody to attend to you but they don’t do test here, that is the problem,” She said.

In spite of the commitment of the personnel, a volunteer Community Extension Worker, Mrs. Scholastic Obaji, complained of poor equipment, work environment and motivation as the roof of the building leaks with no public water and power supply to the facility.

According to Mrs. Obaji, “labour ward is leaking and out-patient department is leaking too and if we are conducting delivery during rain, we move our patient to the palpation room and stay there to conduct the delivery; we don’t have enough equipment here, we don’t have light here because we are having NEPA (EEDC) problem, we don’t have even gen set; we don’t do night services here because of lack of security men.”

She appealed to the state and the local governments to regularize the appointment of volunteers in the state’s primary health centres, who she claimed were more dedicated to duty.

Efforts to speak with the Chairman, Aninri Local Government Area, Mr. Ezekiel Chukwu, on the disturbing issues observed in the health centres were not successful as he was not in the office when visited and, he did not honour appointment he booked with Radio Nigeria when he was seen in his private office Enugu.

Radio Nigeria also visited Neke Uno Primary Health Centre in Isi-uzo Local Government Area and was told that the facility had no doctor and trained nurses but had two community health workers, a lab technician, and six health attendants.

One of the female workers who pleaded anonymity said poor power supply and insecurity were major challenges affecting the facility.

“If we don’t have fuel, we use torch and lamp for delivery; most times we stay two days, three days, at times two months no light; the other time we stayed for four months without light and we don’t have vigilante for security,” she stated.

A patient at the facility, who didn’t want her name mentioned, corroborated the story on power challenge, saying “they don’t culture test here because of lack of light and necessary things involved in performing that (test).”

The health worker described as worrisome a recurring experience of how some expectant mothers who came for antenatal at the health centre often times ended up patronizing Traditional Birth Attendants (TBA) during delivery.

In an attempt to unravel the reason for such shocking development, some residents of the community attributed it to non availability of doctors and nurses.

One of them, who gave his name simply as Ifeanyi stated that “It’s just a glorified health centre because it needs proper staffing; nurses will be there and a resident doctor, then people will have the confidence to go there all the time and that is the problem.”

Another member of the community, Mr. Gabriel Eze said “our pregnant women use to go there for antenatal care but we need more of doctors and nurses there and then rehabilitate the facilities there because the facilities are dilapidated.”

Despite claims that maternal and child health care services were free in Enugu State, a lactating mother who didn’t want her name mentioned alleged that such services were paid for in the health centre.

“Like after immunization, they do collect some amount of money; like if they give your pikin (child) like two injections they collect, ₦100.00,” she alleged.

The scenario was even worse at the Primary Health Centre, Awha Ndiagu in Eziagu Local Government as the facility was under lock, though its main gate was wide open.

In fact, it looked deserted as the whole compound was thickly over grown by weeds, an indication that the health centre might not have been put to use for some time.

A member of the community, who gave his name as Sampson Eze decried the attitude of health workers in the facility and non-monitoring of their activities by their superiors.

“The locking of the health centre is not in the interest of the community. The pregnant women they suffer and sometimes before they could see even the workers, it takes them time and sometimes they have still birth as a result of non attendance to them.

“We don’t know what to do; we have reported to the appropriate authority, we have reported to the local government. What we are saying is let them try as much as they can to have routine-check on their staff, especially those posted to that health centre so that people will be coming.

“Sometimes people don’t patronize them because when they come, they will not see anybody and if they don’t see anybody, you see them going to quacks and traditional birth attendants,” Mr. Eze lamented.

The Head of Health Department in the Local Government, Mr. Celestine Ukwuani and the Chairman of the Council, Mr. Chukwudi Ezinwa both claimed ignorance of the development.

Mr. Ezinwa told our reporter, “please get to the HOD health, let him check from the record who is the OIC in Awha Ndiagu, to find out if there is any problem and why must that place be locked down because on my part as the Chairman of Local Government I am not aware that the place is locked and I know I do pay the person monthly; I am not owing them; I have done my beat; so if he is not there, he or she is defrauding the local government.”

When contacted, the HOD Health, Mr. Ukwuani said “I am not aware of that the place is locked, you don’t mean it, and now that you have said it, I will do all I could as the PHC coordinator /HOD to force the OIC who is supposed to be there to be showing her presence on a daily basis. I know I posted two staff there but one of the staff is not well.”

Then at the Health Centre Olo, still in Eziagu Local Government, it was the same story of no doctor but there were two nurses, a volunteer nurse and a lab technician.

However, it was observed that the health facility was a shadow of itself.

Though the three blocks of flats that served as staff quarters were in good condition, two other buildings that serve as wards were not.

While one of the buildings was still being renovated, the other had its roof totally removed and had been like that for one year.

One of the health workers, who also pleaded anonymity, said the situation of the health centre had affected patients’ patronage of the facility.

“They renovated this place putting only new zinc and ceiling, even painting they did not paint; they have not finished this one, they went and removed the roof of this other one, saying they will complete both of them but now they say they have no money to continue and it has been like this for one year now.

“Patients used to come here but since this hospital collapsed like this many of them have run away; there is a private hospital people are rushing there but sometimes they go there and come back here saying that their price (cost) is too high.”

Notwithstanding that the facility was fenced, the anonymous health worker raised alarm that the bushy environment posed security threat to them as they had to contend with presence of wild animals.

“Many bush animals live here; snakes, including cobra; there is a pit there, if it rains may be for two day it gets filled up and if you go there you see giant lizards that look like crocodile and even the fox that use to eat fowls all live in this compound,” she cried out.

Another port of call was Model Health Centre, Agbamere in Nsukka Local Government Area, which had eight health workers and a health attendant but without a doctor or trained nurse.

The Officer-In-Charge there, Mrs. Juliet Anenechukwu said lack of a doctor, power challenge and non availability of staff quarters were major issues that affected patronage and full functionality of the facility.

“Some people, especially in this village, they like a place where there is a doctor and there is no doctor here and some of them may think that health workers they do not know what to do; even the one we know, they think we don’t know but many of them come for antenatal, they come to deliver and they put to bed safely.

“Again, there is no light here and if there is light it will attract them; at least when somebody comes to deliver baby in the night the person is supposed to see light, even the health workers (are) supposed to use light to deliver babies but we use lanterns (kerosene lamp) sometimes or if you have rechargeable lamp, you come with it from your place. It is not easy for us, the only thing is that we manage it, it is not good but there is nothing you can do because we want to save life and we don’t have generator.

“Another thing that make people not to be here is that we don’t have lab. At least if there is a lab space here and somebody is working there and when you send somebody for test and the result is out the person will allow you to treat him or her but when you send the person to do the test outside, after everything, the person will not return but will buy drugs outside and go,” Mrs. Anenechukwu narrated in a sad mood.

She further complained about poor payment of promotion arrears and leave allowance saying “the recent Chairman is paying us our salary, the only problem we have is promotion arrears and leave allowance.”

Another Community Health Extension Worker in the health centre, Mrs. Esther Eze also alleged of poor salary scale in Nsukka, claiming that other Council Areas pay better.

“Nsukka Local Government is poor in salary, they are not paying us well; the other Local Governments are getting much more than us in their salary. Somebody in level six here is paid thirty-eight thousand and someone in level seven is forty-six thousand but in other local governments, someone in level seven is paid fifty thousand,” Mrs. Eze alleged.

They also urged the government to build staff quarters and employ a security personnel to encourage them to work at night.

In an interview, the President General of Agbamere Autonomous Community, Dr. Emmanuel Chukwuma Eze, described the functionality of the health centre as abnormal due to low cadre of personnel and poor equipment.

“What is going on there is not normal because we don’t have doctors, the nurses, what we have there is junior community workers, so that makes our people not to attend the clinic as supposed.

“When this health centre was built our people welcomed it because there was no hospital around but for a while, the former nursing sister who was in charge, Mrs. Onu, was transferred and the whole place collapsed.

“Mrs. Onu when she was here made a personal arrangement with a doctor working in Parklane who attended to patients every Thursday; she made another arrangement with a doctor at Shanahan and a lab scientist and since she left, nothing is happening there again,” Dr. Eze stated.

He accused the Local Government of having contributed to poor service delivery and patronage of the health centre.

“There was a time the workers locked up the place, saying they go to the local government to thumb print and they didn’t go to work that time, that is why the place is bushy and as the President General, used I take my town union members to go and clean the place but since last year we have not done it because the workers stopped coming to work that time,” Dr. Eze said.

He appealed to the State and Nsukka Local Governments to resuscitate the health centre by providing doctors and qualified nurses to the facility and even upgrade it to a district hospital as the population of the community was over twenty thousand,

This he said would save their sick people from spending life savings patronizing private clinics and distant hospitals with the right medical personnel.

The Chairman of Nsukka Local Government, Mr. Patrick Omeje, was not in his office when visited, but when contacted on phone promised to book an appointment with our correspondent but later didn’t pick calls neither did he respond to text messages sent to him.

In a related development, Radio Nigeria visited Emene Community in Enugu East Local Government Area and discovered that the community, which is the main industrial layout in Enugu State, had no health centre but only Ujodo health post, situated in a rented apartment.

The health post had only one permanent health worker, a retired nurse on volunteer service, two volunteer auxiliary nurses, two volunteer health attendants and seven N-Power workers.

The health worker in charge of the post, Mrs. Victoria Ogbu, said they catered for the rent, water and electric bills as well as stipends to the volunteer workers from money generated from services, some of which should ordinarily be free of charge.

“We manage it from the finance we get from the patients, like some of these things that are supposed to be free, we don’t give them free so that we be able to pay for the rent and then satisfy some of the health workers that are taking care of the patients here and that is the same way we get money to pay the electricity and water bills,” Mrs. Ogbu explained.

In an interview, the Cabinet Secretary to the Traditional Ruler of Emene, Chief Fidelis Agbo, said the community made spirited attempt to build a health centre in Otukwu-Emene but had no funds to finish it for over six years and efforts to draw the Enugu East Local Government to complete the project did not yield any result.

“The present administration has no interest in the project; we have approached them, their response is it is in their plan,” Chief Agbo said.

He wondered why the government had not built a health centre in Emene despite the strategic position and population of the community with its attendant health challenges.

“Here you get Akanu Ibiam International Airport, here you get the industrial layout, there are some tertiary institutions here and many markets; it is thickly populated.

“We are having a lot of health challenges before you go to the town centre, you go to Parklane or you go to other health centres within the capital territory, it takes some people a lot of time but in the meantime, the private hospitals are benefitting immensely from the healthcare delivery in Emene,” the Cabinet scribe cried out.

Also at Nchatancha Nike Health Centre in Enugu East Local Government Area, it was observed that the structure was partly completed with only delivery room, post natal ward and reception in use.

The facility with no personal office for the Officer-In-Charge, had two permanent health workers and six volunteers.

It also lacked water, placenta pit, solar power for the vaccines, perimeter fence and lab equipment while some existing medical equipment, including delivery tools, were said to be obsolete.

Also, some of the maternal and child care services were offered at a fee as against the state government’s policy.

The Officer-In-Charge of the facility, Mrs. Christiana Enebe, explained that the fees were funds for payment of stipends to the volunteers.

“The volunteers, I find it difficult to pay them but anything we get, small, small money realized from those that come for antenatal and others, at the end of the month we give them ₦1,500 or ₦2,000,” Mrs. Enebe explained.

She also, said that lack of a doctor and nurses partly affected patronage of the facility but pointed out that the centre had appreciable patients.

When approached, the Head of Department, Health in Enugu East Local Government, whose name was given as Mrs. C.C. Anieme, declined formal interview even after scheduling appointment with Radio Nigeria on three occasions and referred our correspondent to the Chairman.

Similarly, the Chairman of the Council, Prince Alex Ugwu, declined granting an interview when met in his office but scheduled the interview for a later date, which he failed to honour.

A former Chairman, Medical Advisory Committee (CMD) at the Enugu State University Teaching Hospital, Parklane, Enugu, Dr. Wilfred Okenwa and a consultant in the hospital, Dr. Tony Ezinwa expressed confidence that the volume of complicated cases at the tertiary health facility would be reduced if the government addressed the issue of inadequate medical personnel and facilities at the primary health centres.

“At times we so much work and work and will be over burdened with patients and I can attribute it to the fact that enough is not being done in other sectors, especially at the primary health level, that should have alleviated the capacity of work we have here,” Dr. Okenwa stated.

According to Dr. Ezinwa, “if we improve the hospitals in the rural areas at the level of the primary healthcare that will help a lot because the hospital will be nearer to the people and it will cost the patients less and it now gives the tertiary health centres all the time to take care of all the complicated cases.”

However, the Executive Secretary, Enugu State Primary Healthcare Development Agency (PHCDA), Dr. George Ugwu, acknowledged there were infrastructural, equipment and manpower inadequacies in the state primary health system but said assured the people of government’s commitment to properly fund and revitalize the system.

Dr. Ugwu, said the State Government had recently, through a legislation, placed the issue of primary healthcare under one roof for efficient service delivery and to achieve universal health coverage.

“The challenge again is that are structural problem in the delivery of primary health services in the arrangement we had in the country before now. Various primary healthcare were run by different local government,; the staff of the primary healthcare were owned by different local governments and those different local governments were handling it with different approach, so there is no uniformity and there is clear set standard.

“Recently we have the policy of primary healthcare under one roof whereby all the primary healthcare in the state are going to be run by Enugu State Primary Healthcare Development Agency so that we can unify standards and make it more effective.

“His Excellency has signed the new Enugu State Health Law No 7 in which the Primary Health Care Development Agency has been established and the agency for universal health coverage has been established. These are specific agencies that are to supplement and work with and under the guidance of the Ministry of Health to ensure that health delivery improves and becomes better.

“There are funds we are expecting from the federal coffers called Basic Health Care Provision Fund, which is another huge effort by the Federal Government of Nigeria to also revitalize the primary healthcare as enshrined in the National Health Act.

“The state government has provided counterpart fund for the two agencies to participate in that Basic Health Care Provision Fund; that counterpart fund runs in the tune of ₦100 million to ensure good healthcare delivery at the primary healthcare setting and that fund is domiciled at the State Ministry of Health,” Dr. Ugwu stated.

Dr. said that the agency had taken over the role of deployment, supervision and discipline of the health workers at the local government level while making concrete plans to boost the number of health personnel at the health centres, including doctors, nurses and lab scientists.

“We have prepared about four different teams to ensure supervision and even the supervisors will be supervised themselves, so we are now at the verge of going into in-depth processes and already the processes of supervision have started and we are compiling challenges we noticed during our supervision.

“In terms of healthcare workers, we are compiling their names and discussing with the Government of Enugu State and His Excellency I’m sure is disposed to get us more nurses and doctors to strengthen the revitalization process.

The Enugu State PHCDA Executive Secretary also pointed out that the state government had recently re-positioned some health centres in the state as model primary facilities, including those in Abakpa, Uwani, Oji River and Nsukka urban as well as had plans to revitalize many others in phases.

“In the coming few months and in the coming year, we have concluded plans to escalate that process of revitalization so that in every local government there will at least three to five refurbished and revitalized primary health centres so as to be models and take care of primary healthcare needs of the people.

“That means each local government will have at least three doctors and apart from working in that key one that has been revitalized the doctors will take turn to visit other PHCs in that local government.

“We are also planning to have at least one standard primary healthcare centre in each ward of Enugu State and it is going to be in a phased fashion. So in 2020 we expect that over 50 to 60 PHCs will be revitalized and we can even surpass that,” Dr. Ugwu boasted.

Dr. Ugwu called on the community leaders to help in assisting and supervising activities of health personnel in primary health facilities in their areas for optimal performance.



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