How Akwa Ibom health workers struggle to keep PHCs afloat

Many Primary Health Centres (PHCs) in Akwa Ibom State have deteriorated over the years due to neglect, but the Basic Health Care Provision Fund (BHCPF) has brought hope to the otherwise hopeless state of the sector. Daily Trust on Sunday writes on the disbursement of the fund and its effect on the health facilities.

A lot of community health workers in primary health centres in Akwa Ibom State are forced to keep their jobs running by using their salaries to keep the facilities afloat owing to many years of neglect by the government, Daily Trust on Sunday has learnt.

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Many of them battle with challenges such as poor working conditions, inadequate tools, shortage of personnel and insecurity, as well as infrastructural decay, while providing services to members of the public.

More than 461 primary health centres across the state have stories of rot and decay.

Findings revealed that over the years, many of such centres have had little or no funding, but health workers are expected to report to duty on a daily basis. This is in addition to the hostility of some community members, who also steal from the already deteriorated facilities.

Investigations across five local government areas of Uyo, Ikot Ekpene, Ikono, Oron and Ikot Abasi outlined various challenges faced by the health centres and how workers have fared over the years, especially with the implementation of the Basic Health Care Provision Fund, which is composed of one per cent Consolidated Revenue Fund (CRF) of the federal government and contributions from other sources, including donors, to salvage the primary health sector.

At the Community Health Centre, Atan Offot in Uyo Local Government Area, where Blessing Udo Albert is a community health extension worker, the environment is serene and very welcoming. A first-time visitor would feel at ease and happy with the ambience, which elicits hope, but beyond the physical outlook, the facility lacks basic amenities, as confirmed by Albert.

“The pump in our borehole was stolen two years ago. We have not been able to replace it because there is no fund to run the facility. We go to nearby boreholes to fetch water.

“We don’t get funding from anywhere; rather, we pay revenue to the local government every month, which depends on the number of patients we have,” she said.

According to her, since the health facility operates without electricity, they make use of lanterns to sometimes deliver pregnant women of their babies.

“There is no power supply here, so we use lanterns. In cases of emergency, we refer complications to the teaching hospital,” she said.

Albert, who said she was not aware of the existence of the BHCPF, also complained of inadequate number of staff, noting that the facility operates with three community health workers and an unpaid casual security man, who is not equipped in case of any attack.

“We don’t have midwives here; however, the community health extension worker can take delivery, but it must be with the assistance of a midwife. So, we need a midwife.

“We have three community health extension workers. We have only casual security men, and they are not paid. So we need security men because insecurity is serious,” she said.

Unfortunately, the health centre, which was said to have been built by a community member and handed over to the government, operates without a signpost, making it difficult for a first-time visitor to even identify the facility.

Albert said, “We don’t have a signpost, so people find it difficult to locate this place. Such funds will assist us to put things in place.”

At the primary health centre in Idoro, the officer-in-charge, Mary Victor Edem, who took our correspondent round the facility, said although the facility witnessed a lot of patronage, especially on Wednesdays, the place is small; therefore, there’s the need for expansion. She said the delivery room was so small that there’s no place to keep a newborn baby after delivery.

“When we had delivery here in the night, the woman’s mother-in-law had to hold the baby because there was no place to keep it. She sat here with the baby while her daughter-in-law remained on the bed for over an hour before she left for home. I want another building that would accommodate the maternity section so that women can deliver their babies and sleep. We have land for expansion,” she said.

She said the facility operated without power supply and water, adding that they make use of lanterns for any delivery that happened at night.

“The generator we had was stolen two days after I resumed work here. The solar we have is for the solar fridge used for immunisation. We don’t work at night. If we have delivery, we use lanterns. We buy water worth about N500 daily. We need water here,” Edem added.

Speaking on why the BHCPF she collected was not used to sort out the problems, she said the money was used for utility and maintenance as directed.

“I collected the money this year, and that was the first time. I collected N601,500. The money was divided into utility and maintenance. Under utility, I did painting, renovation of windows, bought long span zinc and ceiling boards, benches, table cloths, and fixed the sit-out extension you see,” she also said.

On staff strength and the midwives’ scheme, Edem said, “We have two community health workers and two midwives. I am a staff nurse midwife but we do not benefit from the midwife scheme. I employed additional two persons and paid them from what we make here. We need more hands.”

One of the patients, Mrs Mary John said, “The service here is good, but I want improvement. I want an antenatal room to be built so that when pregnant women come for maternity check-ups they can stay and be comfortable.

“I would also want a place for women who come with their babies for post-natal check-ups. The staff members have social life, they make us comfortable.”

A nurse in the University of Uyo Teaching Hospital (UUTH), Kufre Inwang, said she came to the facility for treatment because of their services.

At the Primary Health Centre, Ikot Ebo, where a visitor would feel happy to be treated after overcoming the hurdle of locating the facility, the officer-in-charge, Mrs Mandu Samuel, revealed that before now, community members stayed away from the facility because it was unkempt.

Mrs Samuel said patients had been trooping to the facility since she collected the BHCPF in February 2022 and used it to give the facility a face-lift. 

“We used the fund to paint the health centre, fix iron doors and make benches. I also bought two mattresses for the ward.

“I received N601,500 for two quarters. This is the first time I received the money. I was happy to receive the money because I was able to make the place neat. When I was posted here in September 2021, the place was dirty and unkempt. So, the money has helped us a lot. When people saw that the place became clean they started coming for treatment,” she said.

It was gathered that the increased patronage has helped the facility to function well as it makes use of the little funds generated from services to buy drugs, which are sold to patients, as well as pay local government revenue agents when they come.

At the Mbiabong Primary Health Centre, it was gathered that the BHCPF has given a boost to services rendered and increased patronage.

The officer-in-charge of the facility, Emem Umoren, said the money was used to purchase equipment for the laboratory, genotype and blood grouping machines, not for renovation.

“In our lab now, we have a genotype machine and one for blood grouping. We now have a laptop in the data unit from that same money. We also acquired syringes and instruments like delivery kits, rubber tables and chairs,” she added.

Umoren, a midwife, said the health centre had an urgent need for specialised hands, adding that the facility has only two midwives.

Bank frustrates access to funds in Oron

In Oron Local Government Area, it was gathered that none of the 10 primary health care facilities has been able to access the BHCPF due to the inability of the Community Development Association (CDA) to fulfill some of the conditions required by the United Bank for Africa (UBA), where the money is domiciled.

It was learnt that the primary health director in Oron met with the chairman, Akwa Ibom State Primary Health Care Development Agency, Dr Martins Akpan, to request that the money be moved to another bank that would not have stringent conditions for accessing it.

An authoritative source who preferred to remain unnamed said that even without the bank hitch, only two out of the four health centres qualified to access the funds would get it owing to the rule that only facilities domiciled in their own properties and not in rented apartments qualify.

The source revealed that unfortunately, most of the health centres in Oron operate from rented apartments due to the unwillingness of the local government authorities and leadership of communities to get permanent properties for them.

The assistant to the officer-in-charge in Uya Oron Primary Health Centre, Atim Usanga, said the hope of the facility benefiting from the BHCPF was slim as it is operating from one of the classrooms in Uya Oron Primary School.

Usanga explained that the permanent facility built for the health centre was under contention as Eiyetung community is laying claim to the property because it was built by a former local government chairman, who is an in-law in that community.

She lamented that the water pump installed in the facility was stolen since it has remained unoccupied due to the contention, and there is no hope in sight for a quick resolution of the matter.

“Among the 10 health facilities in Oron, none has received the fund. Our primary health care director is aware. We learnt that some health care facilities in other parts of the state have collected the money.

“The officer-in-charge here has spent a lot of money going back and forth to the bank to process the funds but without success,” she said.

The Esin Ufot Primary Health Centre borders the sea, and as such, the area, according to the officer-in-charge, Mrs Arit Victor Ntekim, is susceptible to a lot of health challenges.

Fortunately, in addition to building the health centre and handing over to the government, the community also supports the facility financially.

However, Ntekim believes that receiving the BHCPF will be a big relief to the facility as it will help in meeting so many needs. According to her, to keep the facility running, she uses her salaries to buy drugs that are administered on patients.

“The community gave us N30,000 to run this place and I used N10,000 to open an account for the BHCPF. The remaining amount was used to buy some materials for the laboratory for tests. When the community learnt of the BHCPF, they were happy, but we are still expecting the money,” she said.

Mrs Ntekim said the health centre made use of water from a borehole erected by a community member close to the facility. She noted that the centre operated without electricity owing to over N100,000 debt to the power distribution company in charge of the area.

“We rely on the solar power installed by the federal government for the antigen, but someone in the community bought us a generator, which we normally fuel for use. 

“The BHCPF would have been used to employ and pay some ad hoc staff like the security man who keeps the environment clean. I paid the security man N2,000 to clear this place. We have not seen the BHCPF,” she said.

Speaking on maternal health care, the officer-in-charge said, “We don’t take delivery of babies here, but we have a lot of traditional birth attendants around who were trained by the government and given kits and certificates.

“So, pregnant women just come here for antenatal but go to traditional birth attendants for delivery. We have a safe motherhood unit in the Operational Base, but we don’t have such units here because we don’t have space. We have three staff.”

At the Primary Health Care Operational Base in Ikot Ekpene, it was gathered that the facilities that benefitted from the BHCPF judiciously made use of the fund.

Janet Orok, a community health officer at the Operational Base and former officer-in-charge in Itu Local Government Area, said the facility was one of the beneficiaries of the BHCPF.

“We were trained intensively for four days on how to utilise the money. Village people like chairmen and treasurers were also involved because these facilities are in people’s communities, so they must know what is being done. You cannot do it on your own. The community people were involved so that the money would be used wisely,” she explained.

Orok said the Operational Base dealt with a lot of referral cases, and as such, the patronage is high. She lamented that some of the facilities had only one staff because many workers had retired.

At Etip Ediene in Ikono Local Government Area, it was observed that the once thriving health centre was neglected and left to deteriorate.

Except the main building where health officials operate from, three other structures within the premises have been abandoned, while the water tank is not functioning.

A faded signpost welcomes visitors to the facility that has become overgrown with grass, and without power supply. Also, the rooms where drugs are kept and patients are supposed to be treated have their windows and ceiling boards broken.

The officer-in-charge of the facility, Christiana Christopher Ekpo, who said the centre was supposed to serve 9 villages in the area, lamented that its deteriorating condition did not encourage patronage.

Ekpo said, “Since I was posted here in March 2022, no money has been received from the government. I just manage the place myself. I buy the disposables myself. JEPAGO helps us with syringes.

“There is no light here (though we have solar), as such, no night services are held. The generator is bad and our water facility is not functioning. I pay N6,000 for people to cut the grass. We cannot take delivery of pregnant women because the place is not good. We refer them to other health centres. We give our phone numbers to them in case of any problem as many of them prefer traditional birth attendants who are trained.”

However, the officer-in-charge of the health centre in Ibiaku Ntok Okpo in the same local government area, Emem Michael Uko, said the facility enjoyed patronage from the community and recorded about 30 patients daily.

Uko explained that the centre benefitted from the BHCPF, and the money was used to provide security, among other things.

Speaking on the challenges confronting the facility, she said, “We don’t have electricity supply, no generator. The one we had was stolen. We reported it to the village head, even the council was aware of it, but they didn’t do anything. If we have delivery, we use rechargeable torches. There is no water here. We buy water from the borehole nearest to the facility and fill our jerry-cans to use.”

At the Primary Health Centre, Ukpon Ikono, the facility was recently given a face-lift.

A volunteer community health worker who said she had been doing the job since 2018, added that the facility benefitted from the BHCPF.

She also said, “We want the government to provide essential drugs because we pay tax to the local government council. And we don’t have support from the community. We have one midwife. We are community health workers, so we stay here.” 

In Ikot Abasi, only three primary health centres – Ikot Usop, Ikot Akan and Edemaya 1 – have benefited from the BHCPF.

The one at Ikot Akan is said to be one of the busiest facilities in the area with an average of 10 patients a day. It also records a lot of patronage from pregnant women. The receipt of the fund was a great relief and encouragement to the officer-in-charge, Mrs Patience James.

 “We collected the funds in April. There are times we would attend to pregnant women about to deliver without electricity.

“If you check our windows you would discover that some of the louvers are out, so we discovered that one of our pressing needs is security. To make sure the place is secure, we fixed burglary in most of the windows,” she said.

At Ikot Usop, Mrs Christiana Udo, the now retired officer-in-charge who collected the BHCPF, said it was used in painting and repairing the facility. But it was observed that the painting job was halfway completed and possibly abandoned.

It was learnt that despite the repairs, whenever it rains, the halls are flooded due to leakages on the roof. But defending the use of the fund, Udo said the leakages were a recent discovery.

She added, “I employed one ad hoc staff to work with me. We had three workers and one attaché.” 

In Edemaya 1 Primary Health Centre, the officer-in-charge, Mrs Imoh Umoren, who said the facility took care of 9 villages, adding that they recorded average patronage.

Umoren said she had not received any money from the BHCPF, but added that her predecessor must have received it and used in renovating the facility.

Reacting to the primary health centres in Akwa Ibom State, Dr Martins Akpan, the chairman, Akwa Ibom State Primary Health Care Development Agency (AKSPHCDA), attributed the deteriorating state of many of the facilities to long time of neglect.

Akpan said the health centres were in shambles before the National Health Act came on board and shifted the responsibility to the state. He said the state government was still in the process of migration, and it involves a lot.

He said the National Health Care Development Agency selected primary health care centres to benefit from the BHCPF, noting that out of the 461 in the state, only 231 were selected.

He lamented that the selection process was not carried out in partnership with the AKSPHCDA, which would have ensured that the worst affected health centres were selected.

He also said, “The problem with the BHCPF is that the amount given to primary health centres is too small. If the money was to come in bulk, it would have made a lot of sense. However, the good thing is that they are coming for a second phase.

“The issue of the BHCPF being trapped in a bank in Oron is about to be resolved.” 

Akpan further said the state government was aware of the shortage of staff in the health centres, noting that time is needed to engage quality personnel. He, however, said plans were underway to employ midwives, even if it is on part time basis.

Akpan said the state government was not aware of the alleged levies paid by the health centres to revenue agents, noting that poor policies is the major challenge of the health sector, and called for more partnership with interested organisations.   

This report was supported by the International Budget Partnership and the International Centre for Investigative Reporting.