The federal government’s Basic Health Care Provision Fund (BHCPF) has recorded some successes with a high enrolment rate in Gombe State. Despite the feats, the sustenance of the scheme remains shaky as staff shortages, and inadequate facilities among other challenges remain.
Zainab Babangida, a housewife from Sansani quarters in Billiri Local Government Area of Gombe State, was diagnosed in June this year with an ectopic pregnancy at the Kekkel Primary Healthcare Centre (PHC). Zainab’s life was in danger, and she needed urgent medical attention.
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An ectopic pregnancy is a life-threatening condition that requires emergency treatment, and this condition can lead to bleeding because the baby is growing outside the womb.
But due to lack of equipment and qualified personnel to handle her complicated case, she was referred to the General Hospital, Kaltungo, a distance of 10 kilometres.
But there was no ambulance at the Kekkel PHC, so Zainab’s husband, Babangida Aliyu, arranged for a commercial vehicle, to convey her to Kaltungo General Hospital.
While at the General Hospital, doctors discovered that Zainab had another life-threatening ailment – an inflammation of the appendix. Thankfully, the doctors successfully conducted a laparotomy for both conditions.
Aliyu, a peasant farmer in Billiri, was happy when he learnt that the operation was successful and the bill was taken care of by a Federal Government initiative, the Basic Health Care Provision Fund (BHCPF).
“I was scared of losing my wife because of the pregnancy and the fact that we didn’t have money to undergo proper medical examination and treatment,” an elated Aliyu said.
How BHCPF rescued peasants, pregnant women
The Federal Government created the BHCPF under Section 11 of the National Health Act as catalytic funding to improve access to primary health care.
According to the government’s official document on the programme, the BHCPF funds a Basic Minimum Package of Health Services (BMPHS) and increases the fiscal space for health, strengthening the national health system, particularly at the primary health care (PHC) level.
The scheme provides for routine daily operation costs to PHCs and ensures access to health care for citizens, particularly the poor, thereby contributing to overall national productivity. In addition, the government aims to use the scheme to achieve the universal health coverage goal.
Aliyu and his wife, Zainab, have taken advantage of the scheme through the surgery, which they ordinarily would not have been able to afford.
Gombe State launched the BHCPF scheme in 2021. Many vulnerable people in the state have enrolled and are already enjoying the benefits.
Like Zainab, Ezekiel Jummai, a resident of Dongol village in Billiri North of Billiri LGA, was also due for childbirth and reported to the Sansani PHC. She was attending her antenatal care service at the PHC.
It was her sixth pregnancy, and the five previous experiences, especially during childbirth, were characterised by severe pain.
Jummai required an emergency Caesarean Section (CS) because she had a long labour and could not give birth unassisted.
However, there were no qualified midwives or medical doctors at Sansani PHC that could attend to her case. So, she was rushed to the General Hospital Kaltungo, for surgery, where she successfully delivered her baby.
Some primary healthcare centres in Gombe State have no qualified midwives or medical doctors that could attend to emergencies despite being under the Federal Government’s intervention, the BHCPF.
Shortage of medical personnel, including doctors and nurses, has been a significant challenge to public health facilities in Nigeria. A report by The Guardian in 2021 said the country had only 99,120 doctors and 333,494 nurses and would need 149,852 doctors and 471,353 nurses by 2030.
Meanwhile, in the neighbouring Kaltungo LGA, Sunday John, 65, was diagnosed with an ailment at the Gwandun PHC but was also referred to the General Hospital, Kaltungo, for treatment.
“Upon arrival, doctors informed me that I must undergo three surgeries. I became depressed because I didn’t have money to pay for the surgeries,” John told this reporter.
“I have been living with the same ailment for over seven years because I could not afford to pay for the medical procedures.”
“But through the BHCPF, the surgery was conducted free of charge. Even the doctors were surprised that I survived those years without being treated,” he added.
Also, at Bambam in Balanga LGA, 35-year-old Audu Esther had not been feeling well since she conceived some months ago. She attended a PHC in Bambam for her ante-natal care services and did not spend any money.
“However, during delivery, I developed a problem that required me to be referred to the General Hospital Talasse, which is a whole day’s journey,” Esther recalled.
On arrival after the hectic trip, doctors at the hospital recommended surgery. But, according to them, they suspected that the baby was already dead.”
“But after several tests, it was discovered that the baby was still alive. Therefore, the doctors arranged an emergency CS, and I was delivered successfully, without paying a kobo.”
With 50 Primary Health Centres in five local governments in Gombe State, residents like Zainab, Jummai, Sunday and Esther have been enjoying the Basic Health Care Provision Fund (BHCPF) scheme. However, they are not paying to receive medical services.
About 25,000 vulnerable Nigerians are enrolled under the health intervention scheme and benefit from it across the 11 local governments in Gombe State.
Lack of qualified personnel threatens scheme
While beneficiaries are singing the praise of the scheme, the little gains recorded so far are under threat.
Before the scheme’s launch in the state, as required by the programme, the Gombe State government had renovated one PHC in each of the 114 political wards of the 11 local government councils of the state.
The PHCs now operate 24-hour to provide essential health services to people at the grassroots.
After the launching of the BHCPF, each of the 11 LGAs had a certain number of enrolled beneficiaries to benefit from the free healthcare services offered by the scheme.
Although the services are free, findings by Daily Trust on Sunday revealed that all the benefitting PHCs in the five LGAs visited lack qualified medical doctors and ancillary healthcare workers to provide healthcare services.
In Gombe State, PHCs receive funds quarterly through the Gombe State Contributory Health Management Agency (GoHealth). The fund, according to state authorities, is meant for purchasing the required drugs and essential operations of the facilities.
According to GoHealth desk officers at the respective LGAs, each PHC receives the sum of N300,750 every quarter to cater for running expenses.
Under the scheme, the government pays the sum of N570 for each beneficiary to purchase drugs.
“Before the release of the fund in each tranch, the facility has to send what we called a business plan detailing how they will spend the money. We will also monitor how they spend the previous fund before we can forward it to the GoHealth for the release of the money,” one of the desk officers said.
Beneficiaries under the BHCPF would be able to receive antenatal care. Other services include delivery and postnatal care for pregnant women, immunisations and treatment for malaria, pneumonia, measles, and dysentery for children under-5, malaria treatment, hypertension and diabetes screenings, and family planning for all adults.
Dilapidated structure, staff shortage, water shortage at Billiri PHCs
In Billiri LGA, 1,682 residents registered for the programme, and 203 of them were posted to Kelkel PHC to access services like immunisation, treatment of malaria, and typhoid, ante-natal care and family planning.
However, the Kelkel PHC is in a deplorable state, with some structures on the verge of collapsing. There is no running water. Officials said they rely on unclean water from water vendors for medical activities and personal use.
According to UNICEF, poor access to water, sanitation and hygiene (WASH) remains a significant challenge, contributing significantly to high levels of diarrhoea-related deaths. As of 2015, 57 million Nigerians were without access to improved water sources, while 130 million people were without access to improved sanitation, it said.
Only one midwife at the Kelkel facility attends to many pregnant women who come daily.
The facility also lacks electricity, and was in an unhygienic condition at the time of this report. Many residents say the poor state of the PHC discourages them from accessing healthcare services there.
Lilian Joshua, the officer-in-charge of the PHC, told Daily Trust on Sunday that there are only 16 health workers at the facility, whereas it needs at least 30 to run its three shifts effectively.
“We have all the essential drugs for the services we are rendering, but we lack the required number of qualified staff to operate the facility. Most of them are middle-class health workers,” Joshua explained.
“And despite the high number of pregnant women visiting for delivery, we have only one midwife, and most of our staff are either on contract or working voluntary, hoping to be employed,” she added.
Timothy Lakulde, Desk Officer of the programme in Billiri LGA, admitted that there was a shortage of the required personnel.
He said the BHCPF commenced in the LGA in April 2021. According to him, 1,682 vulnerable persons like widows, IDPs and the elderly have been accessing the services in the ten selected PHCs across the LGA.
At Kaltungo LGA, about 2,028 IDPs, including women, children and the elderly, were registered under the scheme at different PHCs. However, some local facilities do not have enough health workers to provide vital services to the residents.
In one of the PHCs in Kalargu, Talatu Fada Feson, the Facility Manager, said 473 beneficiaries are accessing free healthcare services at the PHC.
“We provide antenatal care services to pregnant women from conception to childbirth at zero cost,” Fada said in an interview.
“For the under-five, some of the diseases are being treated free of charge, and for the elderly and the IDPs, we referred cases we can’t handle here to the General Hospital Kaltungo.”
“There are all the essential drugs for the diseases that were identified before the takeoff of the programme and they are being given free of charge.”
Fada, however, identified some of the problems affecting the smooth running of the programme to include the absence of a perimeter fence and shortage of qualified health workers.
The facility manager said, “We have ten health workers, whereas the facility needs at least 19 permanent staff to perform its functions effectively.”
The Desk Officer for the BHCPF at Kaltungo LGA, Lynus Jonah, said there are over 50 healthcare centres in the LGA, but only ten were selected for the BHCPF.
“There is a need for more because of the difficulty of the terrain, which makes it difficult for some people to access the services,” Jonah said.
He added that “most facilities are not adequately staffed.”
Faulty ambulance, only two midwives at Filiya Cottage Hospital
In Filiya town in Shongom LGA, the healthcare facility selected for the programme was recently upgraded to a cottage hospital to serve as a referral centre for nine other PHCs running the BHCPF programme in the LGA.
Fatsuma Isa, the second officer-in-charge of the Filiya Cottage Hospital, said there are only 34 healthcare workers in the hospital, comprising a Community Health Officer (CHO), four Community Health Extension Workers (CHEWs), two junior CHEWs and others.
“But only two midwives in the hospital are posted specifically for the BHCPF programme. The hospital needs at least 50 health workers to work effectively,” Isa complained.
Ya’u Ahmad, the Desk Officer for the BHCPF in Shongom LGA, said the main challenge is inadequate personnel.
“Most basic illnesses like hypertension and diabetes, which are the common ailments reported by the elderly, are not covered by the programme. Most of them resort to out-of-pocket expenses to buy the drugs,” he said.
PHCs operating without a midwife in Balanga LGA
The PHC in Talasse, Balanga LGA, started with only 133 beneficiaries in June 2021.
According to the Facility Manager, Isa Buba, there are 22 trained staff at the PHC, out of which 17 are permanent. However, only two midwives are serving the hospital, despite the high number of pregnant women trooping to the centre due to its proximity to Talasse town.
“We need not less than 30 staff to run the three shifts effectively, including off days. There is also a need for pharmacists, laboratory scientists and at least one midwife on each shift. We manage the few numbers and place most of our staff on alert, even if they are not on duty,” Buba said.
“People have embraced the programme, but the staff challenges threaten the success earlier recorded. There is also no staff accommodation for the midwives and other workers. There is also no perimeter fence, hence the lives of the patients and the health workers are in danger.”
Idris Nuhu Ahmad, Desk Officer of the BHCPF in Balanga LGA, said 2,326 people are registered in the ten health facilities across the LGA, with one PHC per ward.
“There are 58 health centres in the whole LGA. But only ten facilities are running the programme, and we felt that the number is grossly inadequate, considering the large landmass of the LGA.”
The facilities are receiving funds on a monthly or quarterly basis. There are two midwives in all nine facilities, and some PHCs don’t even have a midwife. The midwives were specifically posted for the BHCPF.
The desk officer stated that there are no ambulances for the referral services, during which many women lost their lives while being conveyed to other referral centres.
While Nigeria represents 2.4 per cent of the world’s population, it currently contributes 10 per cent of global deaths for pregnant mothers, UNICEF said in a report.
Long distances discouraging beneficiaries from accessing PHCs
At the Gadawo Primary Healthcare Centre in Akko LGA, the facility registered 292 people from about 40 rural settlements surrounding the Gadawo village.
The Facility Manager, Aishatu Ya’u, lamented that most beneficiaries live far away from the facility. As such, transportation costs discourage many from visiting to access the services.
Sunday Bako, 74, was enrolled for the BHCPF under the Kekkel PHC, Billiri LGA.
He said the distance from the healthcare centre to his home makes it difficult for him to visit the PHC regularly for his follow-ups.
“Even though they don’t have an eye clinic in the PHC, I visit to get drugs for malaria and typhoid because most of the time, it is these ailments that trigger my eye problem,” Bako said.
“However, the location of the PHC is far away from my house and now that we are in the rainy season, the poor access road makes it difficult for me to visit as at when due for my follow-ups,” he added.
Amina Shuaibu, 42, was enrolled in the Filiya Cottage Hospital for the BHCPF, where she attended her antenatal care services from conception of her pregnancy until her delivery.
“I was getting all the required care, tests, counselling and the drugs free of charge at the Filiya Cottage Hospital, but during delivery, I was asked to go to Kaltungo General Hospital to avert any complication.
“I was already in labour, and because of the bad road to Kaltungo, I almost delivered inside the vehicle on our way to Kaltungo. Had there been enough staff and equipment at the hospital, I won’t have to go elsewhere to deliver,” she said.
Salamatu Ali Danburam, 72, is also registered at the Filiya Cottage Hospital. Most of her ailments are not being treated at the centre where she registered.
“I have typhoid, malaria, high blood pressure and ulcer. Unfortunately, they do not treat BP and ulcers at the facility, and I have to go to Kaltungo if I want to consult doctors and access the drugs,” Salamatu lamented.
“But the money I will spend on transport is enough for me to purchase the drugs at the medicine stores, even though it is much more like self-medication.”
We need more health workers – WDC chairman
Despite the challenges, Ward Development Committee chairmen in the five local government areas said the scheme is impactful.
While they praised the government for the initiative, they called for recruiting more qualified health workers to drive the project.
Mohammed Danladi Filiya, the WDC official for Filiya Cottage Hospital, said as the fourth tier in primary healthcare, they ensured that the PHCs are performing their functions satisfactorily.
“As representatives of our respective communities, we make the communities take ownership of the programme. We look at the issues at the respective PHCs, to ensure that the workers are doing their job,” Filiya said.
On his part, Paul Twaling Lakirya, chairman of WDC in Kaltungo LGA, said the less privileged and People Living with Disabilities (PLWDs) have benefitted from the programme.
According to him, before the programme came on board, people hardly visited healthcare centres because of financial constraints.
“Hitherto, people preferred taking herbal drugs, which greatly affected their health.
The BHCPF is attracting people to the hospitals, especially those enrolled for the scheme,” Lakirya said.
He appealed to the government for employment and deployment of more health workers to provide better services for the teeming people registered for the programme.
Despite the positive feedback, one Ward Development Committee Chairman faulted the scheme’s implementation.
Joshua Jerry, WDC chairman in Balanga LGA, said identifying only one PHC per ward was not enough considering the large size of the LGA. The cost of transport, he said, has been discouraging people from coming to the facilities.
According to him, even though the programme had immensely benefitted the people of their respective LGAs, the failure of the government to consult the right stakeholders before the PHCs were selected was ruining the programme.
We have enrolled over 25,000 beneficiaries – GoHealth
Currently, the Gombe State Contributory Healthcare Management Agency (GoHealth), the agency that oversees the implementation of the BHCPF programme, has enrolled 25,000 vulnerable and over 70,000 beneficiaries under the contribution scheme in the formal sector, a fraction of the 3,472,223 that is the current population of the state.
In an interview, Dr Abubakar Musa, the Executive Secretary of GoHealth, said there are plans to enrol about 40,000 poor, vulnerable, less privileged and Internally Displaced Persons (IDPs) in the second phase of the programme.
“Last year, when we implemented the first phase of the BHCPF, we were able to take 25,000 poor and vulnerable,” he said.
“For this year, we are targeting to enrol at least 40,000. We were able to identify over 100,000 potential beneficiaries.”
Government working to solve the challenges – Health Commissioner
Dr Habu Dahiru, the Gombe State Commissioner for Health, said the state government is aware of the problems confronting the implementation of the scheme and was already working to address them.
“We are looking into the human resource issue, focusing on the schools and colleges that produce the medical doctors and other health workers where the nurses, midwives and CHEWs were produced,” he told Daily Trust on Sunday.
“We will provide them with enough equipment to get accreditation and enrol more students. They will be subsequently posted to the healthcare facilities. So, that will solve the problem of shortage of human resources.”
Dr Dahiru added that existing staff would be sponsored for refresher training and re-training to enhance their skills and get better results in their respective places of work.
This report is published with support from the International Budget Partnership (IBP) , and the International Centre of investigative Reporting (ICIR).
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