By Sylvia Akpan
CrossRiverWatch visited Primary Healthcare Centers (PHCs) in Abi, Akamkpa, Akpabuyo, and Calabar South Local Government Area of Cross River State and found the conditions of the facilities generally disheartening.
The sun was still bright when this reporter arrived at Itigidi after a 55-minute ride on a motorcycle in search of Agba Health Post.
The first five people the reporter asked about the facility had no idea of its location. Finally, an elderly man returning from the farm said Agba is a nearby community and he was going there to grind his cassava. After a five-minute ride, our guide pointed at the facility.
It was locked but a neighbor called the officer in charge on the phone and Joy Erom Ekpo arrived about 30 minutes later.
Ekpo, 48, was posted to Agba in 2022 but discovered that the landlord had shut down the two-room apartment used by the facility because the rent had not been paid for a year. The landlord also confiscated most of the equipment. Mrs. Ekpo later secured a temporary place and moved the items she could retrieve there.
“This place is a temporary place, I pay N1,000 every month. Nobody supported me. But we are building a permanent place close to the Water Board office. We are still at the foundation stage. I have disturbed my clan head and they say they will do it. I told the clan head that I would transfer myself to Yakurr if they don’t keep to their promise,” she threatened.
The makeshift hospital has a tiny room under a leaky roof. Stones were placed on the roof to stop the wind from blowing it off.
Although it shares a fence with the local power station, the facility is not connected to public electricity. “We don’t have a power supply and toilet and no place to dump our waste,” she said.
We Are Unaware
In the 2020, 2021, and 2024 fiscal years, the Cross River State Government allocated a total of N2.2 billion for the construction and renovation of comprehensive health centers across the state.
Below are the 2020, 2021, and 2024 Cross River State Government Citizens Budget (N1,1 billion allocated for the construction and renovation of 10 Nos. Comprehensive Health Centres).
However, the expenditure does not reflect the conditions of the PHCs in the four LGAs visited by this reporter. These primary health centers are well below the standard set by the National Public Health Care Development Agency (NPHCDA) to enable them discharge their responsibility of processing immunization, reducing maternal and child deaths, helping towards achieving universal health coverage, and improving human capital development.
Most of the PHCs visited are housed in dilapidated buildings, lack basic equipment, power, and water supply, and do not have sufficient workers to deliver services to residents of the communities in which they are located.
When asked about the permanent facility being built for the Agba Health Post, the head of the Agba clan, Bassey Jonah Edu, said it had been difficult for the community to raise funds to build a new center. He said the community got the land and laid the foundation but needs the government to take over the project.
Mr. Edu said Mrs. Ekpo kept him abreast of developments in the facility. “The place that we were before had facilities but because we could not pay the rent, the man evicted us. The equipment are in different places because we can’t accommodate all in one place.”
When CrossRiverWatch visited the site, it was overgrown with shrubs with some concrete blocks heaped on one side.
A resident who demanded to speak off the record said during a meeting in 2012, the chiefs of Itigidi decided that accommodation be provided for the Agba Health Post since the main hospital in the LGA was far from Agba.
The resident said the chiefs paid the rent of the facility until 2022 when they stopped because the health post was not generating any revenue in return.
More Challenges
Speaking in an interview with CrossRiverWatch, a 56-year-old resident of Agba, Nkanu Ivara, said the abandonment of the health post has brought pain to the Agba community.
Mr. Ivara urged the government to look into the facility, saying it is not the workers that should carry the burden.
Same Story
In the neighboring communities of Anantigha in Calabar South and Aningeje in Akamkpa LGAs, the PHCs face the same problems but an additional one of security threats.
At Anantigha, the officer in charge, Glory Effiong Edet, told the reporter that the facility has had insecurity issues since its fence broke down some years back.
“For this reason, we can’t carry out night duty. We always close by 7:PM,” Mrs Edet said.
“Though delivery always comes at night, we always asked those pregnant women that anytime their belly pain starts, they should call us. So even in the night, we try to be protective and we lock ourselves inside.”
Mrs. Edet said when she arrived at the facility, she was afraid for her life because of frequent attacks by hoodlums on the facility. However, she said the threats had reduced since security guards were engaged in Anantigha council and Operation Akpakwu officers were stationed near the facility.
PHC Aningeje is located beside the community’s main market. But perhaps due to its location, it has become a den of thieves. The officer in charge, Nelly Adams, said workers and patients do not feel safe. She said the facility does not have a potable water supply since hoodlums stole its pumping machine.
She took the reporter around to see the damage caused by the hoodlums. The staff quarters were abandoned with the room littered with dirt.
The reporter visited a shallow stream from which the facility fetched its water. Some children were seen swimming in the stream.
At the Primary Health Post, Ekpene Ikot Umo in Akpabuyo Local Government Area, the CrossRiverWatch met two health workers on duty. Buckets were placed in some places to collect rainwater dripping from the leaking roof.
The principal Community Health Extension Worker (CHEW), Okon Nsagha Effiong, said during the rainy season, the facility was always cut off by flood which also brings out feces from its pit latrine.
On equipment, Mr. Nsagha disclosed “We don’t even have a stethoscope, the one we had has spoiled. Due to incessant rainfall, our weighing scale is bad, and other medical resources. No power supply and where we fetch our borehole water is a bit far from the facility.”
She said the health facility is short-staffed and uses a pit toilet located in the bush. When the reporter visited the latrine, she was greeted by flies. Floods had packed plastics and other particles into the pit toilet.
The leaking roof, inadequate staff, and absence of medical resources have hindered the operations of the health facility.
At PHC Adadama, Abi LGA, there was no perimeter fence and the facility did not have an ambulance. When the reporter tried to make a call, there was no service. “Sometimes, you have to enter into the bush or go far away from the premises for you to get a network,” a health extension worker, Felicia Aboh, said.
“If someone is in labor and wants to hear from the relative after delivery, you are at the mercy of the service provider because it doesn’t come by easily, Sometimes it takes about four or five hours,” she added.
The workforce had a principal CHEW, a doctor, ad-hoc staff members, volunteers and a pharmacist.
During an inspection in one of the rooms, there were five beds on the floor, with tables occupied by record books. The room was congested.
The Nigerian National Health Act proposes a radical shift in health financing in Nigeria through the establishment of a fund – the Basic Healthcare Provision Fund (BHCPF). This Fund is intended to improve the functioning of primary health care in Nigeria. To this effect, CrossRiverWatch raised concerns over the management of the BHCPF with respect to the roles of various stakeholders in ensuring accountability for its use, and the readiness of the implementers to manage this fund and achieve its objectives.
No Response
CrossRiverWatch visited the State Commissioner for Health, Dr. Henry Egbe Ayuk, in his office in Calabar, said he was not in the best position to speak on the issues observed at the health centers. He referred the reporter to the Director-General of Cross River State Primary Healthcare Development Agency, Vivian Mesembe.
But Mrs. Mesembe also refused to entertain any question from the reporter. When reached on the phone, she demanded to know how the reporter obtained her number. Told that the Health Commissioner referred the reporter to her, she said: “Why did he not speak on the issues when you met him? Why did he have to give you my number? Sorry, I can’t talk about anything,” she said and ended the call.
CSO: Government Neglecting Citizens’ Health Needs
A former chairperson of the Inter-Party Advisory Council (IPAC) in Cross River State, Anthony Bissong Attah, who is also the chairperson of the Young Progressives Party (YPP) in the state, told CrossRiverWatch that the issues at the PHCs are old and have persisted because the government was not paying due attention to the health care of citizens.
“Things are generally in a terrible state in the country and subnationals. Our health infrastructure is not being prioritized. Primary Healthcare is the worst hit due largely to neglect by successive administrations.
“We can situate the acute decay in health infrastructure to the absence of a functional local government system. The local government councils that should take charge of grassroots healthcare systems are in comatose, and the result is the total neglect of the local healthcare system. The Ministry of Health alone is not enough to maintain the primary healthcare system.”
He said the state government should conduct local government elections “in order to arrest the menace in our rural health infrastructure.”
The story was supported with funding from the Centre for Journalism Innovation and Development (CJID)
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