Lagos primary health centres in disrepair, distress

We Are Refurbishing All PHCs—Lagos Govt

Saving mothers and their babies from needless death may remain a herculean task in Lagos State due to poorly functioning Primary Health Centres (PHCs). Investigations revealed that some of the PHCs in Lagos State are in deplorable conditions and affecting uptake of family planning, maternal and child health services.

Itire-Ijesha PHC
Along Ijesha Road, Mushin Lagos, a dilapidated structure stands half hidden and enclosed by a weathered and dusty yellow wall. But for a white metallic signpost by the wall with the inscription-Itire-Ijesha Primary Health Centre (PHC), it is easy to mistake the centre for an abandoned building. This is the PHC that serves Itire community situated at the boundary between Mushin Local Government Area and Itire-Ikate Local Government and home to over 1, 000, 000 people.
 
On entering the facility, the sight of stained yellow paints peeling off the exterior, the torn roof, incomplete glass louvered windows, perforated and dusty window nets, are enough to worsen a patient’s condition.This is a far cry from the standard set for PHCs in the country by the National Primary Health Care Development Agency (NPHCDA).

One of the required standards, according to the NPHCDA, is that the facility must be in good condition, with functional doors, roof, walls, equipment and netted windows.But Itire-Ijesha PHC lacks all these basic conditions. In addition, it has damaged floor, door handles and toilet. Health workers there also complained of constant lack of electricity, and there is no stand-by generator. Surprisingly, even in the midst of this rot, health activities are carried out daily at the centre.

Said a staff: “We offer child health services, where we take care of children from age zero to five years. We give immunisation to babies from age zero to one year, while others above one year are given vitamin supplements. We also register pregnant women for antenatal, and give them TT, as well. Offering HIV counselling and testing and PMTCT are all part of our services here. These services are free. We operate Monday to Friday, from 8am to 4pm daily.”

Information gathered from the hospital record showed that about 5, 000 pregnant women received service last year, while about 4, 058 children of less than one year and 20, 300 children under-five received services from the PHC in a year.

Mrs. Omosola Santos, the principal nursing officer, was busy attending to a crowd of people- mostly nursing mothers and pregnant women. Inadequate staff seemed to be a problem on this day.

Tired of waiting, a young woman with a child on her back got up to leave. When The Guardian accosted her, she lamented bitterly: “I have been waiting here for hours, but it’s not yet my turn. I came here for FP counseling, but I can’t wait any more.” Another woman also got up and left.

After exhausting hours of attending to patients all by herself, the nursing officer sat down with The Guardian for a chat. “I’m the only nurse on duty here. We are short of staff. Although we have one mama that is helping us here, but she is a junior community officer. She cannot counsel patients on family planning or antenatal care. We also have a recorder here, who helps us take records and an attendant.

“Our child health services are usually on Mondays to Wednesday,” she said, adding, “When you come here on these days, you will see the crowd. We usually have over 100 people here, and I’m the only one that will collect their BP, as well as undertake physical examination.”

According to the NPHCDA prescription, every PHC should have at least one doctor, a pharmacist, two midwives or nurse midwife and other paramedical support staff. There should be sufficient staffing to conduct outreach services, such as, immunisation, basic curative care services, and maternal and child health services, preventive services, and monitoring and evaluation.

Investigation at the Itire-Ijesha PHC revealed that it lacks most of these prescribed personnel, as it has just one nurse midwife, one JCHEW and two support staff.

The family planning section is a tiny room with a few old equipment, a door with broken handle, an old patient bed without bedding, stained broken concrete floor and rusted instrument.

Despite this limitation, however, Mrs. Santos said she still manages to give family planning services.She said: “On Thursday and Friday, we have antenatal and family planning services. Usually, people come for FP services on these days. While some come to collect condom, others come for implant. Many of them need counselling because they don’t know the type of family planning to go for. We have people coming for implant just because their friends did it, and not that they really knowing whether it is suitable for them or not.

“We have just one room for FP procedure and none for counselling. We don’t have adequate instruments; the ones we have for IUD insertion are rusted, but we manage them like that. Lack of electricity also hampers services because we have no generator.”

Family planning services are supposed to be free at all PHCs nationwide. Santos said FP consumables are not always available at Itire- Ijesha PHC. She explained that they advise clients to buy them from pharmacies outside in times like that.

It was observed that the facility does not have steriliser for infection prevention, as recommended by NPHCDA. So they have to make do with boiling the equipment on a stove. But the pertinent question is: for how long do they boil and how do they measure the degree of boiling?

An FP expert with the Nigeria Urban Reproductive Health Initiative (NURHI) Dr. Duduyemi Adeola, explained that this method of sterilisation puts the clients at risk of contracting HIV, Hepatitis B and other infectious disease, as they are not even sure the equipment are actually sterilised properly.
 
Alli-Daodu PHC
The situation at Alli-Daodu PHC is not much different from that of Itire-Ijesha PHC. Located at 4, Akinshola Street, Abule Ijesha, Yaba Local Council Development Area (LCDA), a suburb in Lagos, this PHC exhibits every sign of neglect. Notwithstanding, it caters to the medical needs of women and children in this very large and populated community.

The Guardian observed that a very large part of this PHC has been taken over by Rubaan Nursery and Primary School-a private nursery and primary school. According to Mrs. Biodun Grace, the nurse on duty, the hall used by the school is meant for child services, but the local government gave it to the school.

Like the Itire-Ijesha PHC, Alli-Daodu PHC does not undertake delivery, but undertakes child services, immunisation, antenatal, PMTCT, HIV services and Family Planning.

The PHC’s waiting room leaves a striking impression with its bare windows and unpainted walls. Presently, the PHC is without steady electrical power supply, a generator and no potable water, and the borehole needs to be fixed.  

The nurse on duty explained that the number of people coming for family planning have improved at the facility. “About 50 clients came for FP service last month. Many usually ask for IUD, but because we have no kit presently, we refer them to either Kolaoso PHC in Abule-Ojo or Simpson PHC in Ebute-meta,” she said.The Guardian observed that there is no privacy for family planning sessions, due to the lack of curtains on the windows of the PHC.

Oloja PHC
LOCATED at Akinsola Street off Olaja Street in Bariga Shomolu, Lagos, this flagship PHC operates 24 hours a day and takes deliveries.
Despite the seeming high standard observed at the PHC, however, the family planning service lacks what NPHCDA prescribes. The FP room is a tiny and stuffy space taken up mostly by staff’s clothes scattered around.     
 
According to experts, increased uptake of FP can help avert 30 per cent of maternal deaths. However, The Guardian investigations revealed that this PHC lacks FP equipment and consumables. Mrs. Oginni, the Nursing Officer in Charge (OIC), said the fan in the FP room is not functioning and needs repair. “We are also in need of IUD instrument, as we don’t have implanol- an FP commodity, sphygmanometre, and consumables like Providone (disinfectant), Lidocaine injections, plasters, gloves, cotton wool, needles, 5ml syringe, water for injection, soap for hand wash and Jik,” she said.

Just as is the case in Alli-Daodu, due to lack of consumables, clients are told to buy some of these consumables before they can be given FP service. The Guardian learned that about 10 clients come for FP service at the PHC weekly.

Dr. Veronica Vaughan-Iwayemi, the Reproductive Health Programme Officer with the Lagos State Primary Health Care Board (LSPHCB), said The LSPHCB has included FP consumable in the 2017 Lagos Health budget. “It is now left for it to be implemented. We are also trying to renovate the PHCs,” she explained.

Vaughan-Iwayemi, who spoke during the inter-faith forum by Nigerian Urban Reproductive Health Initiatives (NURHI), said family planning would help prevent unwanted pregnancies.

Dr. Omosanjuwa Edun, NURHI-2 Lagos team leader, said FP has not been integrated properly in maternal health services in Lagos State, even though it’s part of the Lagos State medium term health development plan. “We all know that FP is one of the key interventions for averting maternal death. Our target is to achieve 74 percent contraceptive prevalence (CP) use by 2018,” he said.

According to him, NURHI has selected 50 PHCs in Lagos for refurbishing. He explained that they have already started a 72-hour make over to give the facilities a new look and make FP services more appealing to clients. He called on the state, local government and Lagos State Primary Health Care Board (LSPHCB) to also look into these issues.

Reacting to the poor state of Lagos PHCs, while speaking with journalists earlier this year, the Special Adviser to The Governor on Primary Health Care, Dr. Olufemi Onanuga, said the state has started renovating some of the PHCs.

He said: “We have started renovating 35 PHCs and we are building two new ones. They are ongoing. His Excellency has approved the money, so it is as good as done, because the money has been committed and the contractors are working.

“The additional two new PHCs would make the PHCs in our invent to be 290. Out of that, some have been renovated before, but we have started renovating 35 others, and will continue to do so. This depends on their condition, so, I cannot tell you the extent of this renovation. But if we meet a run-down primary health care centre, we must rebuild and renovate it. What is important is that the PHCs infrastructure must be in good condition,” he said.