• Maternal, Child Mortality Figures Are Unaccounted For
Sidi, a resident of Ilaje community, in Gberefu area of Badagry, died from a boat accident, recently. Like many others in his community, he is a fisherman. But on the day he died, the tip of a boat hit him on the chest, which gave him a cut. He lost considerable blood in the process.

Some of the residents, who were by the shoreline, ran towards him to see if they could help to rescue the situation. The only place to take him for treatment was the Badagry General Hospital, which could be connected through the waterways or by road, which is not just a longer route, but also a difficult terrain to ride on because of the sandy nature of the community.

It is also pretty difficult taking him on bike on the sandy terrain to a point a vehicle or boat would convey him to the hospital in Badagry. His people said they decided to take him by boat to the hospital, but just as the boat was berthing at Badagry jetty, Sidi gave up the ghost.

Many residents of the community believed if the community’s Primary Healthcare Centre (PHC) built by government had been functional, Sidi would probably not have died from the incident, because he would have been stabilised by the doctor or nurse at the local facility, even if he would eventually end up at the General Hospital.

Yet, the Primary Healthcare Centre (PHC) in Gberefu, is one of the over 300 facilities that the state government put out as one of its PHCs.

But the PHC is just among the statistics, it has been under lock and key for many years now, forcing residents of the community of over 15,000 to rely on quacks and traditional birth attendants, among others, to access healthcare.

The community members said they have suffered unnecessary deaths including that of pregnant women and babies, just because they needed to travel long distance or take the alternatives to access care.

Surprisingly, in the September 2023 bulletin of the Lagos State Primary Healthcare Board (LSPHCB) sighted by The Guardian, the agency listed 320 functional primary healthcare facilities with 51 of them designated health post while others were categorised as Primary Healthcare Centres and Comprehensive Primary Healthcare Centres.

But a female resident of one of the sub-communities in Gberefu, Funmilayo Ebifemi, stated that almost all the pregnant members in the area rely on traditional birth attendants because going to the hospital is very expensive, as it requires going to town for delivery.

According to her, it means, arranging with a bike man and a boatman ahead of time when the due date is drawing close. She also said that the pains of commuting on the sandy road on motorcycles are also a huge challenge and dangerous at that hour; reason many women just invite traditional birth attendants to their homes when they go into labour to help take delivery of their babies or they take deliveries themselves.

Ebifemi talked about her sister, Mrs. Tanimola, who had a pretty difficult time giving birth to her baby, because she went into a prolonged labour. Ebifemi revealed that two traditional birth attendants tried to take delivery of her sister’s baby before she lost her baby, while her sister almost died too.

If Tanimola was lucky not to have died, this was not the case with Mrs. Bose Aiyeolowo, who lost her life and that of her child during childbirth following a prolonged labour. In the morning, a nurse was invited when the traditional birth attendant available that night could not help in delivering the baby. But at the end, she and her baby died.

One of the community leaders, the Chairman, of Temidire Village in Gberefu, Omowale Akingbemi, said generally it has been pretty difficult accessing public healthcare because of the abandoned PHC in the community and it becomes more precarious during emergency incidents.

Narrating an incident, he said that a boat hit a boy in the mouth, as a result, got a severe cut. Akingbemi said it was not easy to take him to the point where the vehicle would convey him to town for healthcare for onward journey to Badagry General Hospital, but if the PHC was functional, it would have been easier to take him there.

He said the available PHC became nonfunctional a long time ago, pleading with the government to come to the communities’ aid to make it functional for 24 hours.

There are other riverine and island communities in Ojo, Amuwo-Odofin, Kosofe, and Epe local councils to mention a few where residents depend on quacks for healthcare and traditional birth attendant for delivery of babies.

In the process, sometimes, pregnant mothers have lost their babies, while in other cases, both mother and child have died, residents of these communities said.

And findings revealed nobody in government or its representatives takes into account these deaths, especially since majority of them have little or no interaction with government owned facilities during pregnancy.

They even go to the traditional birth attendants and quacks for antenatal care and only visit government facilities after delivery because of vaccination, it was learnt.

Some residents said they are not deterred by the negative outcomes of visiting quacks and traditional birth attendants, as they are consoled by the fact that not all the cases taken to the hospitals come out successful too.

Also, in Ojo Local Council, there is a PHC in Irewe. Not abandoned like that of Gberefu, but the nurse comes once in a week, mainly for both ante and post-natal care, while there is a health volunteer, a secondary school graduate, who fully mans the PHC, when the nurse is not around for six days.

Speaking on the structures and operations of PHCs in Lagos, the Permanent Secretary, LSPHCB, Dr Ibrahim Mustapha, said the state has a new prototype for PHCs in the state. “There are two prototypes. We have primary health centers, health posts and comprehensive health centres. Functionally, what we currently have are health posts in some of the wards in the local councils in the state and they operate for eight hours majorly, and a number of them are manned by community health extension workers or nurses. Most of these health posts don’t have doctors covering them.

“Beyond the health posts, we have the eight hours primary health centres that run only morning and afternoon shifts. Then the 24- hour PHCs that run seven days a week, they are the flagship comprehensive primary health centres and have doctors and nurses on-call, as well as, all other cadres of staff,” Mustapha stated.

Yet, about 25 riverine communities categorised politically into two wards within the Ojo Local Council are expected to see the PHC in Irewe as their source of access to public healthcare. These communities include Irewe, Taffin, Ojota, Itogbesa, Origele, Igamo, Igboja Kekere and Igboka Nla, Agonu, Petepete, Egira, Olomometa, Sodanu and Okolundun. With government’s policy of a PHC per ward, these communities ought to have at least two health facilities. It was also gathered that there are not less than 30,000 residents spread across these communities but there is no official doctor in the community’s PHC, yet the World Health Organisation’s doctor to patients’ ratio recommended a doctor to 600 patients.

For some of the communities, the pains and cost of visiting the PHC in Irewe is hurting, both physically and financially, even when the nurse is around, due to the distance. “Let alone where the nurse only comes ones in a week and sometimes do not even show up in a week,” a resident of Taffin said.

As a result, many of the residents have taken to alternatives that include patronising traditional birth attendants, quack doctors, nurses and drug hawkers.

During a visit by The Guardian, Mrs. Rukayat Saheed, a resident of Irewe, who gave birth three days earlier, said she went into labour at night and had to go to the community’s Iya Abiye (traditional birth attendant) to help deliver her baby, because at that time of the day, the community health centre was already closed, with nobody available to attend to patients.

Saheed added that if the PHC was functional at that time of the day with health personnel around to attend to her, she would have gladly gone there to deliver her baby.

Similarly, another resident, Mrs. Gloria Temitope, said her ante-natal and delivery were carried out by a traditional birth attendant. She knew it would be difficult for her to visit the PHC to deliver her baby since no medical personnel was available to attend to her that time.

She wondered why with no appropriate health facilities; she should not allow traditional birth attendant to take charge from the beginning to the end.

On her part, Mrs. Sophiat Yussuf delivered one of her babies at the PHC in Irewe in 2013, because she went into labour during the day.

She, nonetheless, revealed that hours after she delivered her baby, she was discharged from the health centre because the only nurse on duty then wanted to close for the day.

She revealed that the nurse just asked her if she was feeling good and since she replied positively, she was discharged to go home despite it was just hours earlier she gave birth.

Recounting an earlier incident too, Yussuf said in 2009, when she wanted to deliver her first child, it was a nurse, who came visiting to the community that took delivery of the baby because it was at night.

One of the communities whose residents are expected to visit Irewe PHC is Taffin. But it takes about 20 minutes by boat to connect the PHC, with the alternative being trekking for at least an hour.

A community leader in Taffin, Musa Gbadamosi, emphatically said government has abandoned members of the community, revealing that it takes averagely about N6,000 to get to the Badagry General Hospital when they needed to visit the facility, especially as there is no General Hospital in Ojo Local Council.

He disclosed that owing to the cost and pains of accessing healthcare, many residents patronise drug hawkers for treatment with the other option, sometimes, being going to Iworo-Ajido PHC, which is functional and better in terms of personnel compared with the PHC in Irewe, where the nurse comes just once in a week. He added that it cost N2,000 on the average to go to Iworo-Ajido.

Gbadamosi observed that the difficult terrain makes pregnant women patronise local nurses, some of whom are just drug hawkers and traditional birth attendants.

But the Taffin community used to have a health centre, which has become dilapidated and non-functional for about two decades now. He, therefore, appealed to state and local governments to please come to the aid of Taffin and its adjoining communities to help refurbished the health centre, which could easily be accessed by members of his community and others.

Residents of Agaja, another riverine village in Ojo, were very excited when the government promised, in 2018, to give them a health centre even though it was a mobile health facility. They were happy that it would remove or greatly reduce the pains and cost of going to Irewe and Ojo to access healthcare.

But five years after, that promise has not been fulfilled.

A community leader, Abiodun George, said when the containerised mobile health centre was imported, they were told it was for their community. He added that the local council later said the community could not have it because of the cost of shipping it on water to the village, which was too expensive. As a result, the mobile health centre was moved to one of the mainland communities. He said in fairness the government promised to construct a health centre for the community, which has not been fulfilled. The Guardian visited the site of the proposed health centre but only minimal work has started. The relic of construction works like granites, coaches of blocks already laid among others overtaken by bush were sighted.

George revealed that some government officials visited the community earlier in the year for an event, and the community leaders drew their attention to the abandoned construction works around the promised health centre and another promise of building a standard health centre for the village was given. He stated that nothing has been done in that regard too.

Providing an example of how a functional health centre would have saved a life if it was available, George said a boat capsized and the boy on board drowned, though he was rescued but died while being rushed to Ojo PHC.

George was very optimistic that if a functional PHC was close by, the boy would not have died. He added that if a child is sick, if the mother does not have money to take a boat or hire a boat, especially at night, it is a huge challenge, and the community has recorded deaths from such situations.

Mrs. Rashida Shittu, a resident, also said the experience is better during the day, but when labour sets in at night, they have no other option than to patronise traditional birth attendant, even if they had registered at the health centre.

“This is because at night, it cost as much as N10,000 to hire a boat to Ojo jetty because there would be no nurse at the PHC in Irewe, sometimes during the day. This sometimes forces residents to use private hospitals in town for those who could afford it and the pregnant woman is even admitted days before due date, because they do not want any implications around the logistics of getting to the hospitals when labour sets in.”

The CDA Chairman, Irewe, Liasu Kareem, enjoined the government to send medical staff to the PHC and make it truly functional for 24 hours daily, including providing staff quarters to make the staff stay back rather than going and returning every day or coming once a week.

He also said provision of a boat ambulance would be critical especially during emergencies. He added that the PHC has no potable water, as there is no functional borehole, no drugs, just as there is no electricity supply, while its generator is not functional.

On his part, Mr. Temitope Olusegun implored government to provide incentives for health personnel posted to PHCs in riverine communities, because it costs many of them extra to access and remain in these communities.

He observed that it is the reason many of these health personnel do not want to be posted to riverine communities and if they are, they usually work their way out of the communities or do not give their best, which is detrimental to the residents’ wellbeing.

Meanwhile, the National Primary Health Care Development Agency (NPHCDA), in a document on minimum standards for PHCs in Nigeria, said a PHC should be a detached building of at least 13 rooms, connected to the national grid and other regular alternative power source, have a clean water source, a sanitary waste collection point and waste disposal site, fenced with generator and gate houses as well as staff quarters within the premises. The document also stated that the accommodation should be a-two units of 1-bedroom flats.

NPHCDA further said the building should have sufficient rooms and space to accommodate: waiting/reception areas for Child Welfare, antennal care space, Health Education and ORT corner, staff station, two consulting rooms, adolescent health service room, pharmacy and dispensing unit, two delivery rooms, maternity/lying-in section, in-patient ward section, laboratory, medical records area, injection/dressing area, minor procedures room, food demonstration area, a kitchen, a store, and toilet facilities (Male and Female).

The NPHCDA added that personnel in each PHC should include one medical officer — if available, one Community Health Officer (CHO), four Nurses/midwifes, three Community Health Extension Officer (CHEW), one pharmacy technician, six Junior Health Extension Officer, one environmental officer, one medical records officer, one
laboratory technician, two health attendant/assistant, two security personnel
and one general maintenance staff.

NPHCDA also said operating hours should be 24 hours, with each PHC having one ambulance vehicle, a bicycle, mobile phone, computer, internet services, one motorcycle, and one small motor boat for riverine area.

In Agboyi, Kosofe Local Council, another riverine community with suburbs that include Agboyi I, Agboyi II, Agboyi III, Okunagbon, Papa, and Ilaje, the situation is only minimally better compared to other locations visited.

There is a PHC that has a nurse that comes almost every day and two health technicians attending to patients though residents claimed they close early, most times by 2.00pm.

It was gathered that Agboyi has two old federal wards, which implies that by the standard of a PHC per ward, the community ought to have two PHCs. The good news is that another 40-bed PHC being built by the Federal Government is nearing completion.

The World Health Organisation’s (WHO) recommendation on doctor to patients’ ratio is a doctor to 600 people, but the over 40,000 residents of Agboyi do not have a doctor to attend to them at the only functional PHC in the community.

At present, even with the availability of a functioning PHC, accessing public healthcare does not come easy for residents of the community, especially during the night, when they have to go to the mainland because community’s PHC would have closed for the day.

One of the traditional titleholders in the community Prince Abubakar Seriki, revealed that the state government also agreed that the PHC that was built over 70 years ago has lost touch with reality of healthcare provision. He said the government has told members of the community that it would demolish the PHC to build a befitting one, but nothing concrete has come out of that effort.

He added that the facilities at the PHC are nothing to write home about, which is why pregnant women prefer to go to traditional birth attendants while some other residents prefer to visit people that could be best described as quacks, even if it is for stabilising factors before the case is moved out of the community to Gbagada General Hospital or the PHC in Ketu depending on the severity of the issue.

According to him, there was a complaint from the health officer manning the PHC some years back that the residents do not visit the PHC. He said that the managers of the facility should be blame for the lost of trust in their services because when residents go there, there is no proper care, drugs and then the PHC runs for few hours.

“All these naturally put off the people from seeing the facility as a place to access care.”

It is, therefore, not surprising that the total health facility attendance figure for primary healthcare facilities has been dropping. Statistics provided by the Lagos State Primary Health Care Board (LSPHCB) in one of its 2023 bulletins on facility attendance between 2020 and 2022 revealed that the total health facility attendance for 2020 was 2,133,457, which dropped to 1,966,926 in 2021 and further dropped to 1,902,376 in 2022. The said bulletin also revealed that the total antenatal care attendance for 2020 was 139,239, which dropped in 2021 to 107,783, but increased in 2022 to 125,960.

Also, in the September 2023 bulletin, the LSPHCB stated that through the National Primary Health Care Development Agency (NPHCDA), 228 PHCs in Lagos benefitted N300,750.00 every quarter for daily operational costs through the NPHCDA gateway.

Attempts to get the Lagos State Primary Health Care Board to provide if the PHCs in Gberefu and Irewe were among the 228 collecting N300,750 through NPHCDA was not successful. A message was sent to the LSPHCB to provide the list of the 228 PHCs collecting N300,750 quarterly, but the list was not provided. The LSPHCB, in response, to a number of other questions revealed that there are 329 PHCs functioning of which 27 are health posts.

Although the three health facilities visited were designated as PHC but they did not meet majority of the standard set for an health post by the NPHCDA, let alone a PHC. According to NPHCDA, an health post should have a minimum land area of 1,200 square metres, two rooms with cross ventilation; walls and roof must be in good condition with functional doors and netted windows, functional separate male and female toilet facilities with water supply within the premises, a clean water source, be connected to the national grid and other regular alternative power source, have a sanitary waste collection point and waste disposal site, fenced with gate and generator houses, staff accommodation provided within the facility, which should be two units of 1-bedroom self-contained apartments.

The NPHCDA said the Health Post should be headed by at least a JCHEW, who supervises Community Resource Persons (CORPs) working within the community. The agency said that the minimum working hour should be 9am to 4pm and 40 per cent of JCHEWS time should be spent in the health post while 60 per cent in the community.

It listed other requirements that a health post should have to include a bicycle, a motorcycle, community assigned canoe for riverine areas and a mobile phone.

This report was facilitated by the Africa Centre for Development Journalism (ACDJ) as part of its 2023 Inequalities Reporting Fellowship and supported by the MacArthur Foundation through the Wole Soyinka Centre for Investigative Journalism.