IN 2010, Rivers State government launched a Strategic Health Programme under which it planned to bring healthcare to the doorstep of every resident of the state.
To drive that programme was the primary healthcare scheme, which would ensure that there was a health facility within 20 minutes’ walk from everybody or at most, a five-kilometre distance from the next health facility.
From 2010 to 2015, the state government committed to building ultramodern primary health centres, setting aside the sum of N21 billion. The money was to include the construction of 160 ultramodern heath centres fully equip with cold chain facilities, electricity, solar/diesel generator sets, doctors, nurses and midwives quarters.
The essence was to keep the doors open for the people to access medical services 24 hours and seven days a week. In addition to previously existing health centres and health posts, the total number of primary health centres in the state came to 344, outnumbering the 319 electoral wards in the state. In fact, the government policy had said it was going to ensure that every electoral ward had a health centre.
All the 160 modern health centres were built and commissioned for use across the state by 2014. With the comprehensive health centre in every electoral ward, Rivers State became the envy of other states in the area of grassroots healthcare delivery.
But a few years down the road, many of the facilities have gone into disuse. In some cases the structures have been abandoned and are overgrown and dangerous reptiles have made them their homes.
Contrary to the plan of government that every of the centres would have doctors, nurses and midwives, many of the centres had just a midwife or a community health worker instead. This situation has also adversely affected the functioning of the centres and the consequent delivery of health services to the grassroots.
Some that are still functional, are grossly underused. Where medics and paramedics still come to work, the locals, for who the facilities were built, hardly patronize them. Nevertheless, there are a few centres that are still functioning optimally and meeting up with the purpose for which they were set up.
When National Point went round Eleme Government Area of Rivers State to find out the state of the primary health centres, it was found that the health centres were plagued by a number of challenges that have put some of them in disuse, while some were grossly underutilised. There were one or two centres were fully functional and meeting the demands of the community.
Between 2014 and 2019, Ebubu, one of the ten wards in the local government area was engulfed in a serious security crisis that sent many residents evacuating the town with their families. Criminals and cult members took virtual control of the town and unleashed a reign of terror.
One of the casualties of the crisis was the ultramodern health centre located on the old Port Harcourt – Bori road, Ebubu. While the crisis lasted, people packed out of the town. Workers at the health centre for security and safety reasons also left. The centre was then left at the mercy of hoodlums, vandals and scavengers. They looted the centre and carried away everything that could be cannibalized from the centre.
When National Point visited the centre, the building was in complete ruins while its premises had been converted to a cassava farm. Ebubu Health Centre was said to be one of the best equipped centres before it was abandoned.
Benjamin Ngongwia, a resident of the community told National Point that the whole thing happened a few years ago when the community was invaded by criminals and cult members that sent residents packing. “Scavengers took advantage of the evacuation of the community to loot the health centre and cleared it of whatever equipment that were left there,” Benjamin said.
The Model Health Centre at Onne was commissioned for use on November 15, 2010 by former governor, Rotimi Amaechi. It is located on the outskirts of the town. The approach to the gate is flooded, while the main gate is almost permanently locked. Visitors as well as staff are not able to access the yard with their cars. They have to drive to the side of the centre’s fence through the neighbouring private diagnostic facility.
When National Pont visited the centre at 3pm, the place was already deserted. There was no health worker available to take enquiries. The person on duty was the guard, who said the doctor did not come on that day. He said with the deplorable state of the road from Port Harcourt to Onne, he could not say if the doctor who he said resided in Port Harcourt, about 35 kilometres away, would come the following day.
Mighty Ogor, a commercial motorcycle operator, who took the reporter to the centre, said he often brought his wife to the centre. He said the main reason why people hardly went to the health centre was that the doctor was not regular. “When he comes he leaves very early because there are very few people to attend to,” Ogor said.
He also pointed out that because of the distance from the town to the health centre, many residents of Onne would rather go to private clinics in the community.
The health centre was one of the centres that were generously equipped, complete with cold-chain facilities and quarters for doctors and nurses. But, the quarters National Point gathered is used as Corpers’ Lodge for National Youth Service Corps (NYSC) members.
There was a giant diesel generator and accessories of solar generated power. But the guard said there was no power supply to the health centre. He said thieves in the past had broken into the centre and carted away electrical facilities and air-conditioners.
He added that he was alone in the facility after former National Youth Service Corps (NYSC) members that stayed the quarters finished their programmes and left.
Mr. Peter Okon, who spoke to National Point about his experience at the health centre at Onne, said his wife, who was a regular attendant at the centre’s antenatal clinics fell into labour and he decided to take her to the centre for delivery. As part of the incentives for expectant mothers to attend antenatal sessions, they are promised free deliveries when they are due.
That incentive was the window that Mr. Okon wanted to activate and save his family the huge sum that it would cost them to have their baby in a private hospital in town. Normal delivery in a private hospital costs between N70,000 and N100,000 depending on the hospital, while delivery by caesarian session goes for as high as N250,000. It was the high cost of delivery in private hospitals that Okon was running away from when he took his wife to the model health centre for delivery.
At the model health centre, Mr. Okon was lucky to have run into the matron that was just rounding off to leave. He said he noticed that there was no functional electricity. “There was a huge diesel generator outside. But it was not in use,” he said. The health centre had long been disconnected from public power supply following failure by the management of the hospital to offset accumulated bills.
Still wondering how his baby could be delivered in that situation, Okon said he asked to see the doctor and was shocked when the nurse told him that the doctor was not available. At this point, he took the hard decision to leave immediately despite assurances from the matron that she could handle the delivery being a certified and experienced midwife herself.
Apart from the model health centre, there is a health post inside the town within the compound of the Lutheran Church. But the health post was closed when National Point visited. A resident of the compound said the health post opens on Mondays, Wednesdays and Fridays.
A community leader in Onne, Chief Paul Nkpornwi, blamed the low patronage of the centre on charges, the cost of services. H said the poor people were still charged fees for cards and medicine at rates even higher than in the open market.
He also said doctors in public hospitals were fond of diverting drugs from government hospitals to their own hospitals or pharmacies of their cronies thereby making drugs scarce in government hospitals or expensive. “Such doctors pray that people do not come to government hospitals so that they can easily convert the drugs and facilities provided by government to their own private uses,” he said.
Chief Npornwi also blamed a mentality among women and indigenes that take their children to private hospitals and schools. This affects the turnout at the health centres “Most of those who benefit from government facilities are non-indigenes. They take advantage of government policies on free hospitals and school services. But the indigenes tend more to go to private hospitals. The women collect more money from their husbands that way,” he added.
The model primary health centre at Agbonchia had just concluded an antenatal session when this publication arrived the centre. Only six women attended the session, which hold once in a week. The midwife that conducted the session said sometimes, fewer than six expectant mothers attend the session. She said any expectant mother that attends antenatal session four times would be entitled to free delivery services at the health centre.
But, she said somehow after the women had come for antenatal sessions and even qualified for free deliveries, they would rather go to traditional birth attendants to be delivered where they pay from about N30,000 and above.
She also said other services were also rendered free of charge to HIV positive and tuberculosis patients, whose treatments and drugs are sponsored by an NGO, the Institute of Human Virology of Nigeria. She said what scared people from coming to the hospital in the past was menace of miscreants and robbers that ambushed both patients and medical personnel.
She said the last doctor that served in the place was robbed on the road to the centre, and he never came back. “For two years now, Agbonchia health centre has run without a doctor. “With doctors around, people will come,” the midwife said.
She recalled one patient that came with his child to see a doctor. “He left when I told him that there was no doctor,” the midwife said. Another woman due for delivery was taken away, according to her because there was no electricity in the place. She said deliveries could be taken in the centre however. Though she said patients could be admitted, they are only kept for observation before they are referred to a general hospital.
She identified electricity as another major problem confronting the health centre. “NEPA (public power supplier) charges exorbitant bills and the centre couldn’t pay. So, they cut us off long ago,” she lamented.
The major issues noted with Agbonchia primary health centre was that it did not have a doctor, only one nurse/midwife, lack of power supply, location (its location off the major road and close to the creek made it easy for miscreant to confront people going to the facility), and poor sensitization.
The health has long been overdue for renovation but nothing yet has been done in that direction. National Point was informed an inspection team had visited the facility from the Ministry of Health, Port Harcourt in respect of the renovation but that was all that had happened.
The traditional ruler of Agbonchia, HRH Joseph Ngeto, in an interview with this reporter confirmed that the management of the health centre had approached him with their complaints and demands. In response, he said he had put a call through to the management of the electricity distribution company in Afam to restore electricity to the health centre.
On the patronage of the health centre by the people, HRH Ngeto said he has summoned the town crier to go round periodically to mobilize the people to take advantage of the services available at the health centre and use them.
The neighbouring community, Aleto does not have a model health centre but a health post, located in the community’s town hall. There was no doctor at the health post, the health officer seen at the table told National Point. He said if there were serious cases, the patients were referred to nearby Agbonchia health centres, for which it is an outpost.
The problem he said they now have is the absence of a consultant at Agbonchia health centre, which he said compounded with the story of the recent insecurity the town. “The health centre at Agbonchia is threatened. Thieves have broken into the place and carted away facilities,” he said.
A women leader in Aleto, Chief (Mrs.) Martha Egbe, told National Point that though a lot of sensitisation needs to be done, it was also important that the people of Eleme show more seriousness in embracing facilities sited in their communities.
She however commended Aleto community for providing accommodation for the health post and ensuring that the necessary personnel expected from the community were deployed to work at health post.
The officer said services rendered at the post include immunization of children and birth and death registration. He said the post was about being upgraded to handle antenatal services.
At Alesa, because there was no building to house a health post, the town hall is used to hold clinics on special days. And those days were quite infrequent until when a community crisis engulfed the community and the sessions stopped holding. Those needing medical care at that level had to go to health facilities in neighbouring communities or to the general hospital at Ogale.
Alode Health centre was built, equipped and donated by Port Harcourt Refinery Company Limited as a corporate social responsibility project. A look at the attendance ledger at the centre showed that for the month of January, 2023 no patient was registered at the centre. In February, only four people were to the centre.
Mrs. Mercy John was at Alode Primary Health Centre to attend an eye clinic by a visiting medical mission. The night before, the town crier had gone round the community to invite people with issues with their sights to be at the health centre for free eye tests.
It was that invitation that drew Mrs. John to the health centre for the first time despite the fact that she lived in that community. She told National Point that she had never visited the health centre before the eye mission. She said he had most of the times bought drugs she and her family needed at the local chemists in the town or the one at the market. When cases were severe, she went to private clinics, she said.
Chief Emmanuel Ochen, who was also at the clinic said he had not been to the centre even though his place of business was not far away from it. He said it could be because of the location obscured from the main road in the community.
Chairman of the Community Development Committee of Alode, Chief Emmanuel Saloka, said the matron at the health centre has not been very helpful with her attitude to work. But Hon. Jerry Nwolu, the councillor representing the community, said efforts were on to sensitise the people to use the health centre. “We cannot have such a facility here and our women and our people are not taking advantage of it.
By far the most functional model primary health centre in the local government is the one at Akpajo, which was commissioned in 2014 by former President Olusegun Obasanjo. There is always a doctor on duty to see patients.
When this reporter visited the centre, it was brimming with patients, nursing mothers and children. The pharmacy was open and attending to patients, the diagnostic laboratory upstairs was also functional with staff taking samples from patients and analyzing them.
New patients were being registered and given a hospital card at N500. Consultation was free. But laboratory tests attracted fees. For instance, test for malaria was charged N500 and under one hour, the result was ready.
There was a child delivery that morning in the delivery room, which attracted the doctor on duty. Though there was no public power supply, the diesel generator was working and there was electricity to support the operations of the centre. The centre also has a family planning centre, where couples referred to for family planning counseling.
The only odd looking item at Akpajo health centre is the demobilised ambulance that seems to have been parked in front of the centre for a very long time.
A nurse on duty confirmed that the health centre had two doctors and two NYSC doctors. The major issue she said was that patients rarely come early to the hospital.
The health centre at Ogale is one of the two most functional centres in the local government. Established by the former Eastern Nigeria government, the health centre is seen as the mother of all the medical facilities in the local government area. It used to be a dispensary and maternity many years ago. Located close to the Eleme main market, the health centre used to attend to more patients than any other health centre in Eleme before Akpajo health centre was established.
Somehow because of dispute over the land on which it is located, plans by government to expand it and build it into a model centre had failed. So, development oif the centre had stagnated. The Vice-Chairman of Eleme Local Government, Mrs. Virtue Ekee, told National Point that there was a plan to involve Shell Petroleum Development Company and a health management organization to run a health insurance scheme with Ogale health centre. But the plan has not materialised because Shell insisted that the land dispute be first sorted out.
Despite its prime position in the healthcare delivery at the grassroots in the area, services at the centre have dwindled because it does not run inpatient services. The doctor in charge of the health centre, Dr. Tonye Lawson-Jack had been posted out when National Point visited the centre. But he was still around.
Lawson-Jack, who also oversees the health institutions in the local government area, identified low staff morale as one of the factors the centres have to put up with. “There has not been any promotion for the last 15 years,” he said.
He said many rural dwellers are not willing to pay charges they were given in hospital even when the charges were very low. On power supply, he said the local government used to help supply diesel to the health centres us. But that support stop when the prices of diesel and other petroleum products went up. “Where we cannot maintain power supply, we cannot stay beyond 6pm,” Dr. Lawson-Jack said.
He pointed that Akpajo was able to maintain its generator and services because of the high number of people that patronise the hospital.
The Vice-chairman of Eleme Local Government, who is also the Supervisor for Health, Mrs. Virtue Ekee, admitted that the local government has a role to play in providing primary health care at the grassroots but said the council was hampered by funds.
She told National Point that the state government deducts five percent of the council’s financial allocation to plough into primary healthcare. This she said made he state government the major player in the sector, while the local government plays a supportive role.
However, Mrs. Ekee said the local government has a standing committee on health, oversees the ward community health committees. She said the duty of the community health committees include sensitisation, mobilisation and providing security for the health centres and workers.
The Director of Medical Services of Rivers State Primary Health Development Board, Dr Siyeofori Dede, told National Point that though some primary health centres had their challenges, a lot was being done to improve the situation.
He said many of the centres that were abandoned because of security issues have been recovered and are being renovated for use.
He said when the health centres were built, they were made into an integrated system where the chiefs, women and youths of the communities formed part of the project so that they could help with sensitisation, management and security of the facilities. It is called ward development committees.
He said every health centre has at least a midwife, that can attend to people in need of care. He explained that a doctor doesn’t have to deliver a baby as many patients think but a doctor could be on standby should there be complications arising out of the delivery procedure.
He said public power supply in the health centres could be problematic that’s why provisions were made for solar panels to provide alternative power supply at the centres
He admitted that inadequate personnel was an issue, but with the recent policy of the state government on employment provisions have been made for more doctors, nurses and midwives to be employed into the primary healthcare system.
The Director said funding is not a problem because the primary health care is funded by the state, local government, the federal government, UNICEF, Bill and Melinda Gates Foundation, Dangote Foundation and other intervention agencies so that the system would not suffer neglect.
