Ebonyi: Umahi’s legacies include dilapidated health centres

…child, maternal mortality high

Immediate past governor of Ebonyi State, Engineer Dave Umahi, may have performed well on infrastructure, but he left behind broken healthcare centres in various parts of the state.

In Nigeria, state governments manage general hospitals while local governments are in charge of primary healthcare centres (PHCs), with the supervision of the National Primary Health Care Development Agency (NPHCDA).

Due to lack of local government autonomy under Umahi as reported by a research report and other groups, the state government controlled all the activities of the third tier of government, including managing the PHCs.

Umahi, who is now Nigeria’s Minister of Works, did not pay attention to the health sector as much as he did to works and infrastructure. He left as governor on May 29, 2023 after serving for eight years.

In 2022, Ebonyi State Ministry of Works and Transport got 16.74 percent of the N145 billion annual state budget, while health received only 5.72 percent. In 2020, works and infrastructure got 30.8 percent of the N178 billion budget, whereas health got 8.6 percent. In the previous year, infrastructure had got 28 percent of the N188 billion total budget whereas health received only 7.22 percent share.

Dilapidated PHCs

The result of low funding of the health sector in Ebonyi is a litany of dilapidated health centres across the state. Ebonyi has 417 PHCs.

The reporter visited various PHCs in Ebonyi and found that they were simply glorified stables. At Ndingele Primary Healthcare Centre, only one bed was seen at the delivery room. The PHC neither had essential drugs for babies and women nor did it have water. Ndingele PHC

Only one nurse was on duty. The nurse, Ms Ruth Uguru, told the reporter that gloves were lacking, stressing that she and her senior colleague, Ms Ogbangba Grace (absent at that time), were doing their best to ensure that no life would be lost.

The reporter found that basic facilities for childbirth, including ambu bags used in resuscitating babies, were lacking. Important drugs like Oxytocin, used in bringing on contraction in pregnant mothers during labour, were absent.

A 71-year-old man was referred to Iboko for medical attention owing to lack of drugs.

“We have no water here. We do not have borehole, so it is a major problem,” Ms Uguru said.

Ms Uguru and her colleague, Ms Ogbangba, were both nurses and doctors at the same time. They both performed the roles of both due to the absence of a qualified doctor. It was found that the health centre was abandoned for many years and only started operations a year earlier.

Iboko PHC

At Iboko Primary Healthcare Centre, the reporter found that critical facilities were also 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.Iboko PHC

“We need clean water here and hospital beds,” said Assistant Officer-in-Charge, Ms Precious Nkwo.

“We can do more with more facilities,” she added.

Amananta PHC with leaky roofs

At Ohaukwu, one of the local government areas in Ebonyi, 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.

Amananta PHC

The leaky roofs and broken windows betrayed lack of maintenance of the facility. Doors were always ajar due to damage. There was an acute lack of water as well as facilities for blood pressure and malarial tests. Staff would often buy basic drugs such as Paracetamol and Flagyl for use by patients. Antenatal activities went on every Wednesday but without a doctor.

The reporter found that the health centre was neither getting drugs from the local government nor the state. As of early August when the reporter visited, staff salaries had not been paid for three months. The reporter was told by an Ebonyi State government official that it was due to the transition in government, which started on May 29.Amananta staff

A child patient was seen on the floor. On enquiry, the reporter was told that “he prefers to lie on the floor.” Staff quarters were as decrepit as the health centre -with leaky roofs.

“The government is doing its best, but we need drugs, water, weighing scale, electricity,” Officer-in-Charge, Ms Ngozi Agbo, said. “We want rehabilitation of our roofs. We need beds, chairs and table,” she added.

Like Ndingele Health Centre, no doctor was attached to the Amananta facility. Nurses were totally in charge, even of emergency cases. Ms Agbo, however, said she often referred complicated cases to general or tertiary hospitals.

Ezza North was worse

The reporter moved to Umuoghara-Ogharaugo Primary Healthcare Centre in Ezza North Local Government and saw that patients were going through a tough condition. Rooms were unventilated and a man whose leg was amputated, Mr Simon Nkome, sat on the bed hoping for the best. By Nkome’s countenance, it was easy to decipher his despondency.

A woman lying helplessly in bed at Umuoghara PHC

Nkome bemoaned the state of the facilities but expressed satisfaction with the staff who he said were doing their best.Simon Nkome

A helpless woman was also seen lying in bed in a one of the rooms at the facility. Ventilation was a major problem, and mosquito bites could be felt even in a hot afternoon while the reporter was there. The floors were without carpets, rugs or any other covering, betraying the extent of neglect of the centre.

Nurse Rosemary told the reporter that she and her colleagues were always attending to children and pregnant women and there had been no record of maternal mortality there. It was easy to believe her until anyone began to ask for certain drugs or items. No serious item used by pregnant mothers or even children was available when a skeptical pregnant woman enquired. From folic acid to anti-hypertensive drugs, none was available. Basic drugs for children such as paracetamol, antimalarial drugs and cough syrup were absent.

Nurse Rosemary, however, assured the woman that a doctor often visited the facility with drugs with which the staff attended to the patients, including pregnant women and children.

Mortality is high

Mortality is high in Ebonyi. In 2018 and 2019, it was one of the three high burdened states with frequent occurrences of Lassa Fever. In February this year, 17 people died of cholera in Ezza South Local Government Area of the state.

However, the state’s biggest challenge is maternal and infant mortality. In 2019, the National Population Commission (NPC) conducted the National Demographic Health Survey (NDHS) and identified Ebonyi as state with highest fertility rate in southeastern Nigeria.

According to the survey, the state also had the highest case of under-five mortality in the region with 91 deaths from 1,000 live births. In 2021, the State Manager of the United States Agency for International Development-Integrated Health Programme (USAID-IHP) in Ebonyi, Ms Gladys Olisaeke, disclosed that Ebonyi was a special interest state on infant and maternal mortality.

“The mortality and morbidity for mothers and children is higher in Ebonyi State compared to other eastern states. When you compare the statistics for women, for children, for adolescents, it is not as good as other states,” she noted.

In 2022, Ebonyi reported 7,014 maternal deaths from 40 healthcare centres. According to a new State Manager, USAID-IHP, Ms Augustina Otu, the deaths occurred between January and June, 2022.

“The record has it that Nigeria is among the worst hit in maternal mortality in the world and Ebonyi State is among the leading states that contributed to this record,” she said.

“We recorded 7,014 deaths in just 40 health facilities. Imagine if we had gathered reports from other health centres in the state,” she further said.

PHCs and investments

An Ebonyi State-based healthcare expert, Dr Okechukwu Egboluche, said more investments were needed to beef up PHCs in the state.

“If the healthcare centres are absent or not equipped, a pregnant mother who is bleeding or has complications may not survive it. This is worse if the distance between the health centres and communities is long,” he said.

On other reasons for high maternal and infant mortalities in Ebonyi, Dr Egboluche said, “Secondly, several Ebonyi women marry quite in their teens. This exposes mother and child to danger. Also, the state is still regarded as educationally less advanced, which is also a major setback. Lack of awareness makes mortality quite high.”

Another public health practitioner, Dr Jeffrey Ajoko, said the high child and maternal mortality rates witnessed in the state were not unconnected with the state of medicare in the communities.

“Yes, if you do not invest in primary health centres, you will have high child maternal mortality rates. Underdevelopment and lack of education in Ebonyi are issues driving infant and maternal mortality rates because the state is still poorly developed. If you do not build primary health centres in rural communities, pregnant women may have bleeding and die in the process,” he noted.

NGOs and child/maternal mortality

Ananda Marga Universal Relief Team (AMURT), an international non-governmental organisation (NGO), was launched in Nigeria in 2010. It selected Ebonyi State as its first project area owing to its high rates of maternal and infant mortality. The project is run in collaboration with the Ebonyi State government.

Country Director of AMURT, Mr Dada Daneshananda, acknowledged the inefficiencies of PHCs in Ebonyi State, noting that most of them were not providing 24-hour services. He noted that there was one health centre in one ward, stressing, however, that lack of doctors at the centres from time to time was also a big issue.

“We are in 10 local centres already. There is a need in the state, especially in rural communities such as Izzi. We are receiving applications from local governments regarding their needs and we are working on them,” he told the reporter.

On his part, the Director of Essential Health Network for Rural Dwellers in Ebonyi State, an NGO, Prof Henry Chukwuemeka Uro-Chukwu, refuted the report that Ebonyi was worse-off in health. According to the professor of medicine, successive governments in the state had done practical things to improve healthcare in the state.

“I have been practically part of several health sector in the state for a long time. There has been free maternal healthcare in the past, such that if a woman wanted to have a child, she could do it free of charge. A lot of things have been put in place to improve healthcare. Also, I do not think that Ebonyi is worse than Yobe, Borno and several other states on maternal and infant mortality based on recent data,” he said, stressing that there had been so much development on health infrastructure in the last 16 years.Dave Umahi

Ebonyi govt speaks

Newly appointed Commissioner of Health in Ebonyi State, Dr Daniel Umezuruike, told the reporter that he was touring all the PHCs in the state to ascertain their strength and level of facilities.

“We are just touring those facilities to ascertain the extent of things in those places. At this stage, we are assessing the extend of things,” Umezuruike, who was appointed commissioner in June this year, said.

“One of the things we have found is that manpower is a problem. Some people have just been posted to the facilities and they are just new. We are at a stage where we write to the governor for the employment of qualified personnel,” he added. He did not, however, say what he planned to do about the facilities and the rehabilitation of health centres in the state.

Similarly, a director at the state’s Ministry of Health, who did not want his name on print because he was not authorised to speak, refuted that Umahi failed in the health sector.

He cited the rehabilitation of general hospitals and other PHCs as examples, noting that the government “also, at various times, paid some money to rehabilitate PHCs.”

What is the way out of crisis?

According to Dr Ajoko, earlier cited, the state government must begin to invest heavily in primary health centres.

“There is a need for the government to build more health centres in places where there are none. They need to spend money to rehabilitate and equip health centres that are sited in rural communities. This is very important because you cannot have a significant reduction in mortality if you are not investing in primary health centres,” he explained.

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, which is what is happening over there. 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.

“Similarly, manpower is a challenge and efforts should be made to engage more workers at health centres in order to save lives,” she added.

For Mr Daneshananda of AMURT, Nigeria in general and Ebonyi in particular should endeavour to ensure that primary health centres in rural communities were open 24/7 in order to cater for issues that could occur during odd hours.

“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.

This longer form of this story was earlier published on www.dataphyte.com, which funded the investigation

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