THE Ministry of Health and Social Welfare has budgeted N300 million for ministerial retreat just as the National Primary Health Care Development Agency (NPHCDA) earmarked N938.403 million for the monitoring and evaluation of primary healthcare centres (PHCs) in the 2024 budget.
The NPHCDA, an agency under the Ministry of Health and Social Welfare, has also set aside N173.027 million for “PHC project/programme planning, review and operational research.”
The agency is yet budgeting N259.576 million for “PHC ICT including development of e-learning systems for sustainable PHCs,” including N106.633 million for “budget monitoring and expenditure tracking” for 2024.
Analysts say these line items are misplaced priorities, as the most critical issue is the rehabilitation of abandoned PHCs across the country to provide them with drugs, equipment and medical personnel.
“When I see this kind of budgeting, I feel so sad,” said an Ebonyi State-based physician, Dr Amos Ida.
“In Ebonyi State alone, hundreds of PHCs are dilapidated, and without drugs, equipment and medical personnel. Only nurses attend to patients, including pregnant women, because doctors aren’t coming,” he said.
Chasing shadows
The Ministry of Health and Social Welfare is spending N300 million to organise a mere retreat when the Nigeria’s health sector is looking bleak, with 2,000 doctors emigrating yearly to the United States, the United Kingdom, and Canada, according to the World Health Organization (WHO).
The National Cancer Control Plan (2018–2022) says cancer kills 72,000 people in Nigeria every year, with an estimated 102,000 new cases annually.
A report by the Nigerian Institute of Medical Research (NIMR) says high blood pressure (HBP) accounts for 52 percent of deaths in the country. However, the WHO’s report notes that 10,692 persons die of hypertension in Nigeria annually.
Malaria affects 68 million Nigerians annually and kills 194,000 out of the number, according to the WHO.
“Nigeria has the highest burden of malaria globally, accounting for nearly 27% of the global malaria burden. The risk of transmission exists throughout the country, all year round,” the WHO said in its 2021 malaria report.
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About 100,000 to 300,000 infections of Lassa fever occur annually in Nigeria, with about 5,000 deaths reported yearly, according to the Centers for Disease Control and Prevention (CDC) of the United States of America.
No fewer than 70,000 Nigerians die from preventable waterborne diseases a year, says the United Nations Children’s Fund (UNICEF).
Also, the WHO’s report said that out of 467,000 tuberculosis cases recorded in Nigeria in 2021, 125,000 died.
Similarly, around 162,000 pneumonia deaths occurred in Nigeria in 2018. The UNICEF says that “Nigeria contributes highest number to global pneumonia child deaths.”
In spite of these damning statistics, the Ministry of Health is budgeting N300 million for a retreat that will have no impact on the people, say health experts.
“It is unfortunate that our budgeting system is getting worse yearly,” said a United Kingdom-based nurse, Ms Clementina Oke.
“We put the cart before the horse and then drag the horse along the way,” she noted.
PHCs are glorified mortuaries
Only few of Nigeria’s 30,000 PHCs are operational, with the majority of them looking like glorified mortuaries.
A former Minister of Science and Technology, Senator Olorunnimbe Mamora, said in May 2023 that only 10 percent of PHCs across Nigeria’s 36 states were functional and operational.
“When I was the Minister of State for Health, we could establish 30,000 primary healthcare centres through the last audit that we had across the federation. But less than 10 per cent of the primary healthcare centres are functional,” he had said.
“The centres are not functional, either the buildings have become dilapidated or they cannot be accessed. When we talk about functionality, it entails uninterrupted power supply, but it is not stable. It also entails constant water supply, but it is not available. It equally involves medical personnel, but they are not adequate,” he had noted.
With Dr Mamora’s statement, it means that there were recent audits of PHCs in the nation. In spite of that, the NPHCDA is still spending money on “ongoing” projects that focus on “operational research. monitoring and evaluation of PHCs.”
Ebonyi, a special case
In Ebonyi State, southeastern Nigeria, the situation is dire.
At Ndingele Primary Healthcare Centre in Izzi Local Government Area, the reporter saw only one bed at the delivery room, meaning that it could not handle more than one pregnant woman due for child delivery at the same time.
The reporter found that basic facilities for childbirth, including ambu bags used in resuscitating babies, were lacking. Important drugs like Oxytocin, used in inducing contraction in pregnant mothers during labour, were absent.
At Iboko Primary Healthcare Centre, headquarters of Izzi Local Government Area, the reporter found that critical facilities were lacking. Only one bed was found in the general hall. There was, however, one other room with two small beds for patients, but their mattresses/foams were old and dirty. Another room had only one bed with an old mattress. Two other rooms were locked and unused. Water was also visibly a challenge as there was neither a borehole nor a tap water.
Amananta PHC
At Ohaukwu, one of the local government areas in Ebonyi State, the reporter visited Amananta Primary Healthcare Centre located at Ishi-Iziah community. Lack of care for both the facility and the staff was written all over the health centre.
In spite of these, the NPHCDA is budgeting millions of naira on line items that have no bearing with the upgrade of PHCs in the country. Even though the agency’s budget contains some upgrade and rehabilitations of some PHCs, it does not show any sense of urgency, especially as tens of children and pregnant women die annually.
The Nigerian government records show that 80 percent of the 2,500 Nigerian under-five children who die every day occur at PHCs.
Way forward
Ananda Marga Universal Relief Team (AMURT), an international health non-governmental organisation (NGO), said there was a need to ensure that PHCs were properly equipped and open for 24 hours of the day.
“There is a need for primary health centres to be open 24/7 in order to help emergency situations at late hours,” he said, adding that doing that would save a lot of women and children in rural areas.
A lawyer and associate at an NGO named Centre for Health, Ethics, Law and Development (CHELD), Ms Chioma Ejimofor, said there was a need for primary health centres to have good synergy with tertiary health institutions.
“The referral pathways are often terrible at primary health centres. When you do not have a proper referral pathway, your patients will suffer. Also, there is a need for the government to equip the primary health centres as many of them lack facilities with which to attend to patients,” she said.
For an economist, Mr Joel Abiaka, there was a need to change the budgeting system of Nigeria’s ministries, departments and agencies (MDAs), including that of the health ministry, noting that more money should be voted for capital projects and less on items that had little bearing on development.
“There are too many repetitions in the 2024 budget, which is visible in the budgets of the health MDAs. Money should go to prevention and treatment of diseases as well as rehabilitations of PHCs, rather than on ambiguous items involving ‘monitoring’, ‘evaluation’ and ‘recalibration.’ “
An email sent to the Ministry of Health and Social Welfare was not replied. Also, text and WhatsApp messages sent to the NPHCDA were not responded to as at the time of going to the press.
