Despite BHCPF, Oyo PHCs face many challenges in delivering health care
Notwithstanding efforts by the Oyo State Government to reposition primary healthcare through the renovation of some primary health centres (PHCs), challenges such as the inadequate number of qualified health professionals, insufficient quantity of drugs as well as other supplies and consumables, are prevalent in many PHCs in the state.
ROTIMI AGBOLUAJE, who went to some health facilities across the state to assess the success or otherwise of the Basic Health Care Provision Fund (BHCPF) in boosting primary health care, reports the major problems undermining delivery at the grassroots.
Inaugurated in 2019, the Basic Health Care Provision Fund (BHCPF) is meant to strengthen public health facilities in remote areas across the country.
The BHCPF provides free minimum basic healthcare and emergency medical treatment to the poorest and most vulnerable Nigerians through accredited Primary Health Centres (PHCs) in each of the 36 states and Federal Capital Territory (FCT).
The Fund is meant to finance the Basic Minimum Package of Health Services (BMPHS), increase the fiscal space for health, strengthen the national health system, particularly at the PHC level, by making provisions for routine daily operational costs, and ensure access to health care for all, particularly the poor, thus contributing to overall national productivity.
The project is based on Section 11 of the National Health Act, 2014, which mandates the Federal Government to set aside one per cent of its Consolidated Revenue Fund (CRF) to increase public spending on health and reduce out-of-pocket expenditure by the ordinary Nigerian.
However, the consolidated funds from government sources, donors and partners for a result-based and decentralised facility financing approach were flagged off in 2021.
Oyo State keying into the project
THE Oyo State government through its agencies such as the State Primary Health Care Board flagged off the programme with the aim of reaching 45,000 persons.
However, data obtained from the Oyo State Health Insurance Agency (OSHIA) indicate that as at August 24, 2022, only 21,816 persons have been captured.
“The project covers vulnerable people including widows, the aged, children who are under five, pregnant women, the disabled, the poorest of the poor, orphans and pensioners with less than a monthly income of N5,000.
“The target is 45,000 persons but as at August 24, 2022, 21,816 persons have been captured. In Oluyole Local Government, 307 people have been captured, 256 in Egbeda, 515 in Oyo East, 744 in Itesiwaju and 283 in Lagelu,” an officer of the agency authorised by the Executive Secretary, Dr. Sola Akande, told The Guardian.
According to the 2006 census, Oyo State had a population of 5,580,894. Although the Oyo State Director of the National Population Commission (NPC), Mr. Abdulkareem Bello, could not give the total population of the state, it is estimated that, currently, the state is home to over eight million people.
About 721 PHC facilities are available across the 33 Local Government Areas (LGAs) in the state.
In June 2022, the Federal Government said about N56 billion has so far been disbursed from the Fund.
The Secretary of the Oversight Committee of the Federal Ministry of Health, Chris Isokpunwu, said, “With those releases, more than 7,000 PHCs get operational funds on a quarterly basis to provide for essential medicines, transportation for vaccines and other medical consumables in the health sector.
“It also provided for human resources for health and more than 1,500 midwives have been engaged with the fund.
“As at today, 1.040 million poor and indigent Nigerians have been enrolled to have access to basic minimum package of health services. This means that these people that have been enrolled in 35 out of the 36 states and the FCT now have access to free medical treatment for common ailments and even surgeries, taking care of a broad spectrum of health conditions that Nigerians may and will be exposed to.”
This, he said, would pull them out of poverty and contribute to the Federal Government’s objective of lifting 100 million Nigerians out of poverty in the next 10 years.
Effectiveness of the BHCPF in Oyo state
THE assess the effectiveness of the health care provision funds, this reporter went to five local government areas, which include Egbeda, Lagelu, Oluyole, Oyo East and Itesiwaju.
According to the Executive Secretary of Oyo State Primary Health Care Board, Dr. Muideen Olatunji, the selection of PHCs that benefitted from the fund was done by members of the various communities, in conjunction with health workers. PHCs with a higher patronage in each ward were selected.
“It was done in conjunction with health workers. That is the only condition. Once they select the facility, we will start developing it to make sure it serves the purpose it is meant for,” the Executive Secretary added.
At the Alakia Model Health Centre in Egbeda Local Government, a Matron, Mrs. Oluwaseun Adedeji, disclosed that the beneficiary facilities include Kajorepo – Ogungbade, Ikumapayi, Ajiwogbo, Erunmu, and Alakia Model Health Centres.
“We received a sum of N902, 250 in July this year covering the third quarter. We went on training on how to use the fund. It covers the third quarter of the year,” the matron said.
According to Adedeji, items procured with the money include drugs, mattresses, beds, couches, tables and benches. She said the fund was also used to pay salaries.
The matron said, “Items we bought with the money included drugs, mattresses, beds, couches, tables and benches and others. We are also paying workers’ salaries.”
The head of Alakia Model Health Centre, however, noted that inadequate number of health officers and decrepit infrastructure still stare the centre in the face.
She said: “Notwithstanding the efforts of the state government and support by the BHCPF some challenges are still here. We need more health officers – two midwives, three community health extension officers, two nurses and one doctor. We also need mosquito nets and a new generating set. The toilet needs wiring and the leaking laboratory needs attention.”
Adedeji said the fund is not enough to take care of the centre’s needs. “The money is too small to meet our needs. It should be increased,” she added.
Adedeji, however, commended the initiative. “So far, it has been a success story. It has been of tremendous help for widows, children and aged people.”
Mrs. Morenikeji Durodoye, who took her five-year-old boy, Suroh, to the PHC in July, said: “We collected drugs such as Vitamin C, Paracetamol, antibiotics and others for my boy when he fell sick. The drugs were very effective. Anytime he falls sick, I will take him to the Alaska PHC,” she said.
Also, Mrs. Omotoke Hussein, who took her four-year-old son, Jamiu, to the centre, expressed satisfaction with the services she received.
Ikumapayi PHC, Olodo, in Ibadan, is a newly refurbished facility but it still lacks many basic facilities such as essential drugs, medical equipment and clean water.
Also, there is inadequate number of qualified health care practitioners. By the time of compiling this report, there were only six workers in the facility.
Health officers at the centre revealed that they work as general-purpose personnel.
The matron of the centre, Mrs. Adenike Olabode, a midwife, said the centre has bought some essential supplies, which include delivery couches.
Olabode noted that the facility provides services to many communities in the ward because of its huge population. Mrs. Suzan Temitope Adisa, a community health officer, attributed this to the renovation recently carried out on the facility.
At Agboye Primary Health Centre, Oyo Town, Mrs. Ikeoluwa Adewole, the Officer-In-Charge of the facility, said it got the sum of N601,500.
She added, “We applied for one nurse and one CHEW but we were given only nurse.’’
At this centre, 11 patients have benefited from the scheme. Two of them – Mrs. Muyidat Bello and Mr. Tajudeen Busari, who spoke with this reporter, lauded the scheme.
“I went to the facility in August to treat malaria and headache. I was attended to without paying money. I am okay now,” Bello said.
On her part, Busari said, “I was there in July this year to treat malaria. I was given some drugs and I am better now.”
Notwithstanding the funds received by the PHC, Adewole said manpower and equipment available in the facility are not enough.
She said, “We need a generating set, bed space and about 10 staff but we have just three. At present, we have three volunteers before but they are being paid N10,000 monthly including a night guard.”
It was the same scenario at Itesiwaju Local Government Area, in the Oke-Ogun area of the state.
Only two centres – Otu Ilesan and Otu Ibise – have so far accessed the funds in the council. They collected the funds in July 2022.
A senior official at the Otu Ibise PHC said the facility lacks enough qualified manpower.
The source said: “The sum of N600,000 was approved for each centre for the third quarter. We are going to get another N300,000 of which its budget has been approved. The ten centres are expecting for this year, which they will start spending by the fourth quarter of the year. We are also going to get another sum of N300,000 each for ten centres in the council of which the budget has not been approved.”
The source, who is a senior medical official, listed the challenges faced in the centre to include: understaffing and inadequate quantity of drugs and equipment.
“We don’t have enough staff. The state government said they wanted to recruit staff. People have applied online but the processes are ongoing. The ambulance here is not working. They are supposed to repair it. This is the only one in this council. We need a bigger one. We get money from the state and BHCPF. But they cannot be enough. The money is not enough for a year. We need the sum of N2 million for each centre,” he said.
He however noted the Board is renovating all PHCs, adding that it has promised to equip the facility, after renovating the structure.
Assessing the BHCPF, the senior officer said it is the best thing to happen to PHCs in the country.
“The funding is a masterstroke and that is what we need in Oyo State. Before the money came, the funding of primary health care had been at its lowest ebb. But with the coming of the BHCPF, we have been able to do some essential work and buy some equipment as well as materials needed for the effective delivery of healthcare at the grassroots. We are able to buy drugs, do outreaches, advocacy and mobilisation,” he said.
Some of the beneficiaries of the scheme at the council expressed satisfaction with the treatment given to them when they visited the PHCs.
State government reacts
REACTING to the findings made by the reporter, the Executive Secretary of Oyo State Primary Health Care Board, Dr. Muideen Olatunji, said the government is working to address the challenges of infrastructure and personnel.
“We are working round the clock to ensure that we get the required complementary staff. The state government is trying to think outside the box on the other methodologies we can adopt to get people working there without foreclosing on recruiting other staff, which the process has commenced. More personnel will come.
“We have a plan for them to get drugs. Not only that, the state government is procuring drugs every month for the all facilities whether basic care or not basic care, all of them are receiving drugs from the state government. In the last three months, that has been what we have been doing. All facilities get a regular supply of drugs,’’ he said.
Speaking on the poor state of infrastructure, Olatunji said, “The state government is addressing that. It targets 351 PHCs and we have done 200. It only points to the fact that it is a gradual process. It will soon get to others when the time comes.”
•This report is supported by the International Budget Partnership and the International Centre for Investigative Reporting (ICIR).