Multi-million naira SouthEast hospitals in tatters
In mid-July, the Federal Government announced plans to revamp 10,000 primary healthcare centres across the country to provide quality health service delivery, particularly to rural dwellers. Three months after, Yekeen Akinwale embarks on a fact-finding to
Continued from last week
Elsewhere in Okposi Umuoghara, Ezza North Local Government, Ebonyi State, it is a tale of lamentation for parents who, after taking their sick children to the only healthcare centre in the area, cannot get them treated.
It is known as Comprehensive Health Centre, but nothing is as depleted and “uncomprehensive” as the facility. At 9am, no one is at the centre. But as soon as a lady steps down from a motorbike and unlocks the main entrance to what appears a town hall, parents with their kids come in droves. By 9:29 am when a fat woman who would later turn out to be the officer in charge of the centre climbs down from another bike, there are more than 10 children in the hall awaiting treatment.
On the day, seven children test positive to malaria. Their fate hangs in the balance, as there is no drug to treat them, except injection which, according to Peace Ohike, the officer in charge of the centre, is the last resort.
Okoposi is ravaged by malaria; the centre records more than 40 cases daily. Yet, there are no drugs to treat them.
Nwane Virgilus, a father of four, is at the former development centre now designated Pilot Model Health Centre by the State government with two of his children who are down with malaria. Victory Nwane, three years old, and Shedrach Nwane, five years old, look pale and weak. Both, like Nweze Kosarachi (six) and Nweze Ifesinachi (five), rest on the wooden benches at the centre.
“Malaria is reigning here. It is a major challenge here. Many people burnt their mosquito nets when they were given during the governorship tenure of Elechi Martins, thinking it was a political gift. Now, we don’t have enough nets,” Ohike says as she takes the blood sample of a sick kid.
When women go into labour at night, lantern and torch come to the rescue as the centre was long disconnected from the power source due to an undisclosed amount of debt. The labour room that has no light is also where women for family planning insertion are attended to.
But while parents and their wards struggle to get healthcare at the former development centre, now Pilot Primary Centre in Okposi Umuoghara, the N21.9million National Primary Healthcare Centre that ought to bring relief to people of the area wastes away under lock and key near Nwuomah Primary School.
It was awarded in 2014 and handled by Stephanie Michael Nigeria Limited. Overtaken by weeds, the well-painted and fenced facility from appearance could be ready for use. But the reason it has remained locked is not known. The contractor, Stephanie Michael Nigeria Limited, is apparently not registered, as it has no records with the CAC.
In a clear case of disconnect between politicians and their constituents, residents of Okposi Umuoghara do not even know that the facility is meant to serve them.
Even where the abandoned healthcare centre is located, nobody knows that it is meant to serve them. The construction signpost that should provide information about it was on the ground, taken over by weeds and used as food by termites feed on it.
Victoria Chinedu, a pregnant housewife whose house is adjacent the facility, does not know what the building is meant for. But for her antenatal care, she pays N50 for a tricycle ride to the development centre. “We go to the development centre for antenatal and immunisation,” she said.
After his kids were given injection instead of malaria drugs, a disappointed Virgilus said that many people in the community thought the abandoned primary healthcare centre was a political project sponsored by Peter Edeh, a former member of House Representatives representing Ezza North and Ishielu Federal Constituency. Yes, it is actually a constituency project. However, since he lost his reelection bid, the project has been neglected.
“We don’t know that place is a primary health centre,” he says. “We only know that Honourable Peter is the one behind it.” Like Okposi, like Nkalaha At Nkalaha, Ishielu Local Government, Ebonyi, nursing mothers such as Ada Ugochukwu prefer to take their babies or themselves to Amofun community in distant Enugu State. Holding her sick son to her chest and trying to maneuver her way round the bad road, Ugochukwu says she is taking her son to Amofun for treatment because the health centre at Nkalaha has no doctor or qualified nurse.
They have enough reasons. From Gedegede village to Nkaleha, it is easier for a horse to pass the eye of a needle than for human beings to navigate the road to the village. It is deplorable. Then, a newly constructed model primary healthcare is also under lock and keys. It has been taken over by bushes.
The only primary healthcare centre serving the whole community exists just in name. It has no doctor; instead, it relies on stream water for treatment of patients. Pregnant women in the village make use of birth attendants when in labour rather than the centre, even if they had sought antenatal care there.
Ebe Rosemary, who heads the centre, says there is no visiting or resident doctor at the centre. The shelves are filled with expired drugs.
Speaking on why the centre has not been opened for public use, the contractor, Status Global Services Limited, who handled the N21.9million project awarded in 2014, claims he uses his personal money to undertake the project.
His words: “Most of the projects are constituency projects. Most of them are not backed by cash and that is what led to the collapse of the job. Why this one is done is that I used my personal money and I’m using my contacts to recover my money.
“The project was awarded in 2014 but the letter of award was collected almost about May 2015 and it was already 2016 when we finished the signing of relevant documents; we finished the whole job by 2016.”
Nothing model about Orogwe Model Primary Health Centre
Despite her old age and a threatening high blood pressure, Madam Abigail manages to cross the waterlogged roads to the health centre. She has high hopes that her rising blood pressure would be lowered once she gets to Orogwe Primary Healthcare Centre in Owerri West Local Government of Imo State. She comes to the centre on a regular basis for
check-up. But the 80-year-old mother of four would later be disappointed - indeed she sits with dejection in a white plastic chair as Onogbo Augustina, an environmental health officer in charge of the centre, breaks the news to her. The equipment to measure her blood pressure, sphygmomanometer, had broken down the previous night, so there was no way she could be attended to.
Revealing her total grey hair after removing her headscarf, Madam Abigail, as she is fondly addressed by people in the community, speaks in Igbo of her frustrations about the clinic.
“Please tell them [the Federal Government] that there are old people here. They should bring plenty medicine,” she says, facing the journalist.
Her fate at the clinic is a daily occurrence that many endure due to apparent lack of facilities and tools to work with by the health workers. But that is not the only thing that is not working at the centre. Everything about it is not right.
Orogwe Primary Healthcare Centre was among the 120 primary healthcare centres awarded in 2004 by the Federal Government for construction as part of measures to address the healthcare needs of Nigerians at the grassroots.
But 13 years after, the centre remains an uncompleted facility. Awarded at the cost of N16millon to Crossland, an unregistered company, it was not occupied until 2015 when authorities at Owerri West Local Government closed down what was known as the temporary health centre. It was later converted to a Customary Court.
“We were using the temporary site before we moved here. In 2015, we were told that government wanted to use the place, so they pushed us to this permanent site but nothing is working here,” says Augustina as she conducts the ICIR reporter around the facility.
They were forced to occupy the new healthcare centre despite lacking doors, electricity, water and other essential facilities. Visitors are welcome to the centre by broken floors devoid of tiles, non-functioning electrical installations and security attachment.
“There is no water at the centre; there is no electricity, the generator is faulty and the plumbing system is not good. The injection room has no light, dispensary room has no light and we use candle and lantern at night to deliver women who are in labour,” she laments.
Findings revealed that all the electrical installations have not functioned since 2015 when the centre became operational because the project was never completed. The security house, which is just by the main gate to the centre, has neither door nor window. By the contract details and specifications, the centre ought to have doors and windows, and tiled floors. All these were conspicuously not there. The mattresses are with no cover or bed spread.
“Only the labour room and the adjoining room have tiles, but they were done by the community. None of the rooms has doors,” Augustina reveals.
There are only 10 workers at the centre: community health extension workers headed by a Principal Extension Health Worker. The workers’ morale is dead. They are owed salaries by the local government. In 2015, they were owed for eight months.
However, this is not an isolated case; the situation is not different elsewhere in Omuma, Oru East Local Government, Imo State where rainfall is the main source of water at the healthcare centre. Pipes are channeled from the roofs to storage tank to get water for the health centre’s use. The motorised borehole is not functioning. Pregnant women and nursing mothers, whom the facility is meant to serve, don’t usually patronise it.
ICIR gathered that pregnant women who attend the health centre for antenatal prefer to deliver elsewhere for security reason.
“This place is not secured and for security reason, when they go into labour at night, they go elsewhere,” says Ugoeze Ebighi Euharia who heads the centre.
The centre has not seen electricity since it was opened. “For more than four years, there has been no light here. In fact, since this place was opened there has never been a light.”
Like the Orogwe Health Centre, Omuma’s electricity bulbs and ceiling fans are also mere cosmetics; they have never worked. The outpatient ward floor and those of toilets were also not tiled. The generating set meant to power the 12-bed centre is not working. It has unoccupied quarters for nurses and doctors, but Eucharia says the size of the quarters could not accommodate married health workers ought to be resident at the centre.
“As you can see, we don’t have security, we don’t have accommodation here. If we have accommodation, people will be trooping here,” she says. But despite Orogwe and Omuma having no required facilities to function well, they still serve the people of the community.
Government not unaware of abandoned projects nationwide
The Federal Government is notorious for awarding contracts without cash backing or what is known in legislative parlance as budgetary allocation. From 1998 till date, there have been several abandoned projects nationwide due to lack of budgetary allocation.
The health sector is not an exemption. Disregard for due process in contract award, violation of the 2007 Procurement Act and misdemeanour by contractors are reasons contracts for healthcare centres are either untraceable, abandoned or haphazardly done.
There are 805 abandoned primary healthcare centres across the 36 states of the federation and the Federal Capital Territory, which were awarded between 2004 and 2015. These projects have gulped N25.2billion, out of which the south-east region accounts for N5.8billion (23percent of the total). In southeast alone, there are 98 of these projects, which are either abandoned or untraceable.
A Freedom of Information (FOI) request to the Executive Director of NPHCDA on the status of the contracts and procurement details was not responded to before the end of the statutory seven days. However, an official of the agency says government is unaware of many abandoned projects across the country.
The top official, who asked not to be named, speaks on the failure of government to back up many contracts awarded with budget.
“We are not unaware of abandoned health centres nationwide. Based on many newspaper reports and security reports, everybody knows about 1001 abandoned projects by the government all over the federation not only in the health sector,” he says.
“A lot of NGOs are working with the National Assembly to amend appropriation in such a way that projects that you have awarded, for instance in 2016, and are not completed, how do you include them in 2017 budget?
“If you don’t include them in 2017 budget, how do you get them completed? Those you awarded in 2017, maybe the Federal Government is just releasing fresh capital allocation now. This is what accounts for most of the abandoned projects nationwide.”
“If you look at 2017 now, 2017 budget, how many times has the Federal Government released the capital vote for the 2017 budget? Maybe they are just releasing the first one, maybe not yet cash-backed and we are going to October. So, in three months, the year will end. Consider yourself a contractor; maybe you are awarded a contract in October or November and before you know it the year ended and they say no money and then you are talking of 2018 budget.
“You now have a situation spiraling that, in 2018, the contract that you are doing, you have not collected your money but it gets transferred in 2018 appropriation. That is part of what is responsible for most of the abandoned projects.”
Sampson Parker, a former Commissioner of Health in Rivers State, shares the same view. According to Parker, government awards contract without following through.
“Government needs to appoint management committee at the local government level to oversee these projects. People award contracts here in Abuja without following through. If there is a policy and we follow through with proper funding, there won’t be the problem of abandoning of projects.”
He laments that award of contracts has been politicised by political office holders, who site contracts in their localities without the political will to execute it.
Placement of projects has been politicised. Before they were criticising it and later it became a political thing that if you don’t have it in your area, you are not a big man.”
But he adds that the governments at the three tiers need political will and political leadership to bring the nation’s health sector out of the woods, because “Nigeria’s health indices are worrisome and among the worst in the world”.
In July 2016, the Federal Government said it secured a loan of $500 million (N180billion) to bring the 10,000 primary healthcare centres in the country back to life in order to meet the health needs of rural communities.
Osagie Ehanire, Minister of State for Health, had said every state in the country would receive the sum of $1.5 million (N540million) to kickstart the revamp of the critical health sector.
The south-east states comprising Enugu, Imo, Ebonyi, Abia and Anambra were to get N2.7billion for the rehabilitation of primary health care centres in their respective domain. The loan was sourced from the World Bank under its ‘Saving One Million Lives’ programmes. Unfortunately, if you ask one million people in that region today, they will tell you they haven’t been saved!
Concluded
This investigation is supported by the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting.