By Hassan Zaggi
Two-years-old Safiya Salihu develops high fever. For three days, her parents have been managing her condition at home with harps because there was no money to take her to the hospital.
Little Safiya and her parent live at a Ungwan Katsinawa, a Fulani settlement at the extreme end of Jeun, a community in Masaka, Karu Local Government Area of Nasarawa State.
When Safiya’s parents discovered that the situation was getting worse, they sold one of their chickens for N3800 and took her to the hospital.
Because Safiya’s mother lost confidence on the only nearby government owned Primary Healthcare Centre at Jeun -a nearby community due to her previous unpleasant experience, she took the little girl to a privately-owned health clinic.
Findings showed that Safiya was diagnosed with high malaria and some elements of Typhoid.
The medical officer in-charge of the private clinic concluded to admit little Safiya so that she could receive comprehensive treatment under close monitoring and observation, but Safiya’s mother protested that she does not have the money to pay for hospital bed.
After heated argument with the medical personnel, she was charged N4600 for the treatment so that she could be given medicines to administer to little Safiya at home.
Unfortunately, however, out of the 3800 they sold their chicken, Safiya’s mother used N200 for transport from their settlement (unguwar Katsinawa) to Jeun where the hospital is located. She also bought N50 sachet water for herself and little Safiya. She was now left with 3550. She also needed N200 out of the money to transport herself back home.
Safiya’s mother handed over N3350 to the medical personnel and pleaded that she be given medicine commensurate with her money.
According to our findings, the medical personnel advised Safiya’s mother that the N3350 medicine cannot give her the needed result considering that the malaria was high.
He gave Safiya’s mother some drugs and told her to bring the balance of 1250 naira the following day and get the remaining drugs.
Safiya’ mother was not able to raise the N1250, hence, could not go to the hospital to collect the remaining medicines as directed by the medical personnel. Unfortunately, however, two days after, little Safiya died.
When our reporter visited Unguwan Katsinawa, Safiya’s mother explained that she could not go back to get the remaining drugs “because there was no money and our remaining chickens have not grown to the level that we can sell them to raise money”
She insisted that they will relocate to Bauchi, because, according to her, the incident was traumatic.
“We have left all that happened to God. But we are devastated that our daughter died in this circumstance. Definitely, this cannot be ordinary. We are going to relocate from this area any moment from now,” Safiya’s mother said.
When asked why she did not go to the government owned PHC which could be cheaper, Safiya’s mother disclosed that when her male child was sick, she took him to the PHC but the personnel that attended to him used the wrong medication on the child which compounded the problem. Since then, according to her, she vowed not to take her child to the PHC again.
All attempts to speak with Safiya’s father was resisted as he insisted that he will not speak about the incident.
The circumstance that led to little Safiya’s death may be emotional and annoying, but this is the reality most Nigerians at the rural areas face.
This has, however, exposed the twin issues of the out-of-pocked payment for health services and lack of confidence on government-owned PHCs across the country.
Reacting to the incident, an Abuja-based medical practitioner, Dr. Abdul Musa, called on the governments at all levels, especially, the states and local governments to take the issue of enrolment in health insurance of their people serious.
Dr. Musa who was feasibly angry about the circumstance that led to Safiya’s death, said: “This is annoying for a precious life to be wasted just because of less than two thousand naira. As a medical practitioner, I know that when a patient did not get the full dose of any medication, the treatment will not have the needed impact on him or her. The young girl died because the system failed her.
“The other most annoying aspect is the quality of staff and their dedication to service at our PHCs in the country. The cost of Safiya’s treatment could have been less if she was taken to a government owned PHC. The family’s previous encounter at the PHC made them loss confidence on the PHC.
“Our health system has myriads of challenges that need to be addressed quickly for us to save the lives of innocent citizens. Apart from infrastructure, we need to invest in the training and retraining of our health workers.”
He insisted on the need for state and local governments to mobilise communities to enroll in health insurance. This, according to him, will save most of these tragic situations.
Investigation by our correspondent in Karu, Keffi and Kokona local governments areas of Nasarawa State indicated that majority of the PHCs, especially, those located in the rural areas are in bad shape manned by incompetent staff and do not have equipment and consumables.
Responding to questions from our Correspondent, a top staff of the Nasarawa State Ministry of Health disclosed that though successive administrations in the state have tried to revamp the primary health care sector, but that their effort was only concentrated in PHCs located at the local government headquarters and some major towns.
The staff who pleaded not to be named because he was not authorize to speak said: “The truth is that our people at the rural areas do not have primary healthcare centres that are in good shape.
“One can only see well-staffed and standard primary healthcare centres at the urban and semi-urban areas but those at the rural areas have no competent manpower, no drugs, no consumables.
“Most of the workers posted to the PHCs at the rural areas are recruited base on political patronage not minding that they do not have the requisite training and capacity.”
He further lamented that: “Nasarawa State has never been lucky to have a very active Commissioner for health since after the time of the Aliyu Akwe Doma.
“In fact, the current one is even the worse. Since they brought him from the state health insurance agency, he seems confused and overwhelmed with the challenges of the sector.
“Until the government is able to get a competent health commissioner, the challenges facing the health sector, especially, the primary health care sector in Nasarawa State will persist and our people will continue to suffer for it.”
How to restore confidence of Nigerians on PHC
Responding to questions from our correspondent, the Acting Chairperson, Health Sector Reform Coalition (HSRC), Mrs. Chika Offor, said that most Nigerians are losing confidence on the PHCs because of the poor services and behaviour of the healthcare workers.
She explained that: “People are loosing confidence because when you go to the PHCs, you are not able to get the required service or you are being overcharged.
“In one of our communities, just about a month ago, we lost a girl because she actually went to the PHC and they could not attend to her.
“The girl started going to the Chemist with mis-diagnosis, by the time we found out and took the girl to the Maitama General Hospital, she died there.
“So, in a community where you have a primary healthcare centre and you have these kinds of cases, either they overcharge them or you don’t give them the treatment that they want or you tell them that the drug that they are supposed to get, they cant get it. They come today, come tomorrow and come next tomorrow. They wont come again and the mortality rate is increasing.”
While stressing that the governments at all levels should be held responsible for the current situation at the primary healthcare level, Mrs Chika said: “But the truth is that, when you talk of the government, there is this Basic Health Care Provision Fund (BHCPF) which is being led by the government, is it working well? Is it working as it should? But on our part as CSOs, we are supposed to be there to hold the government accountable and check those policies that are not working and what are they doing that is working and then recommend.
“The BHCPF is a template that if it is well utilized, UHC will truly be universal for all Nigerians.
She called for the expansion of the BHCPF, noting that: “Many Nigerians don’t have access to the BHCPF because of health insurance.
“The health insurance for the BHCPF is only for about 2 million Nigerians or so. The government promised that by the end of four years, 80 million Nigerians will be in health insurance. Now we have the NHIA which made health insurance compulsory.
“What we should do as CSOs, the media is to continue to shout about this health insurance so that the government can take it serious.
“We in the Health Sector Reform Coalition (HSRC) are ready to work with the current government, we have experts that are willing to support the government to achieve this goal.”
PHC gateway to UHC
On his part, the Yobe State Commissioner for Health, Dr. Mohammed Lawan Gana, noted that primary healthcare level is the gateway to universal health coverage.
Responding to a question raised by our Correspondent, he insisted that without the primary healthcare, “obviously, there is no way we can attain UHC. Primary health care system is the closet to the people.
“Majority of the people live in rural areas and of course, the whole idea of primary health care is getting healthcare to the door step of the people where they live and work.”
He, however, disclosed that in an effort to restore the confidence of the people on the PHC, “nationally, the primary healthcare has been prioritise as the bedrock of the healthcare system.
“With this new administration of President Bola Ahmed Tinubu, how he carefully selected the coordinating minister of health and the minister of state for health, what they have done and what they are doing is a paradigm shift towards making the system work.
“As such, a lot of work is currently being planned and is being done in some places already.”
On what the Yobe State Government is currently doing to improve the PHC, he revealed that, “we have 178 wards out of which 138 primary health care centres have been upgraded to standard.
“This is also putting in place drugs and consumables as well as health care financing system. All with the view of making the place functional and ensure that people access services in those locations.
“We do recognize the role of primary health care and we are working hard to ensure that we strengthen the primary healthcare system.”
Federal Government’s effort
On her part, responding to a question from our correspondent on the effort of the President Bola Ahmed Tinubu-led federal government to improve the primary health care sector and restore the confidence of Nigerians on PHC, the Special Adviser to the President on Health, Dr. Salma Anas, disclosed that primary health care is one of the key priority areas of this government for the provision of health services.
According to her: “The government intends to continue to improve the primary health care system and President Bola Ahmed Tinubu is working to ensure we have two PHCs that are functioning per ward and expand the existing Basic Health Care Provision Fund (BHCPF).
“You know we have the BHCPF which has started, this administration intends to scale it up and to also scale up the Universal Health Coverage (UHC).”
She recalled that: “Even at the recently concluded National Council on Health (NCH), this is the area they gave much attention on how to strengthen the primary health care and deliver quality health care to the people of Nigeria.
“A lot of effort is going on and also increasing financing and also provision of more skilled health workers, especially, nurses and midwives.
“So, we are thinking of how to increase capacity and production of our nurses and midwives so that they can be deployed to primary health care centres. These are some of the majors that have been proposed.”
On what per centage the government intends to scale up the BHCPF, Dr. Salma: “You know we already have one per cent consolidated revenue fund which we have not achieved the full release, this is part of what will happen and the Coordinating Minister of Health and Social Welfare is also thinking of how to find other innovative ways of financing.”
