On a sunny afternoon in the month of March, my bike man and I were travelling to Chorin Boso, a high-burden rural community in Abuja, to visit a Primary Healthcare Centre (PHC) that is serving the villages in Chorin Boso. The road to the PHC is terrible and rough, and the problem is further compounded because the road was under construction, which made it difficult to pass through. While traversing this rough road, this reporter suffered from back and body pain before reaching the primary healthcare centre.
On getting to the Chorin Biso PHC, no community extension worker was seen inside the PHC, and the facility was left open. In the PHC, there is infrastructure decay, the roof is leaking, and the facility lacks medical equipment. The question this reporter asked himself is: what if they rushed a pregnant woman or elderly person with complications on that terrible road at that time? Is that how they would reach the facility without any health worker to attend to them?
The facility has only two wards and one consulting room. There are just three beds, but only two are working. There is no pharmacy, and the PHC has not been renovated since its construction. When it rains, the roof leaks, and again, there is no pharmacy.
The facility has a borehole, but it is no longer functioning. The facility now resorts to buying water from water sellers. There is no electricity, no solar power, and if health workers want to perform their duties at night, they use torchlights and rechargeable fans. Whenever they receive complications, they usually refer patients to Waru or Karshi General Hospital, which takes up to one to two hours on a terrible road. The facility lacks medical equipment such as bandages, gloves, oxygen, and the protective equipment they are using is what was supplied during COVID-19.
The facility needs total renovation, electricity supply, solar or generator power to aid their work, and the borehole needs to be repaired. The Abuja Municipal Area Council employed only one primary health worker at the PHC, and two other health workers were volunteers.
A newborn baby was coughing uncontrollably in the hands of Joy Danjuma, a resident of Chorin Boso who was trying to breastfeed her baby. When this reporter approached her, she complained bitterly that there were no drugs for the baby in the facility. In case of emergency, there is no ambulance to transport patients to the general hospital in Waru or Karshi, which takes one to two hours to reach on a terrible road using a motorcycle.
The problem of lack of ambulances in PHCs is a serious issue that needs to be addressed by the government. Out of 10 PHCs this reporter visited, only the 7 Guards Battalion PHC located inside a barracks has a functional ambulance and enough bed space and medical facilities to accommodate patients.
In Gishiri Primary Healthcare Centre, though the facility is about 10 minutes from the main road, the road to the facility is terrible and even worse during the rainy season. The healthcare centre is too small due to lack of space. During immunization, women usually fill the facility, which results in no privacy, and some patients usually leave stranded and frustrated due to lack of space.
Despite the small size of PHCs, they conduct HIV and Hepatitis tests. The hospital has no ward, no consulting room, the delivery bed is damaged, and the waiting area is used as an office for the health workers in charge. There is no pharmacy in the facility, and no renovation has been done since it was constructed. The only renovation carried out was by Christ Embassy, the church the community health worker attends. The equipment used in the hospital was donated when the health worker in charge went for family planning training.
In Gbagalape PHC, Ladi Okewu, a resident of Gbagalape, lamented bitterly over the absence of health workers in the facility during critical times. He stated that there is a need for health workers to be present throughout the day and night in case of emergencies.
“We need active health workers in the facility. Even in the afternoon, if there is an emergency involving a pregnant woman about to give birth, they have to call the health workers before they come, even if it’s urgent. If the person is in critical condition, that is how the patient would die. If there are any complications, they usually refer patients to Nyanya General Hospital,” he said.
Expert Weigh in
Lawal Jamiu, a Public Health Analyst, stated that the lack of ambulances and inadequate facilities in healthcare centres has serious health implications. These issues critically delay emergency referrals and cause pregnant women to experience complications and excruciating labour.
He noted that these delays can be fatal and may lead to long-term disabilities. In the absence of an ambulance, which serves as an emergency transport system, it contributes significantly to the high burden of maternal mortality.
“Lack of ambulances and enough medical equipment affects patients with chronic conditions, especially elderly patients, and those with stroke, diabetes, and hypertension. They are seriously affected because a functional referral system requires timely evacuation, which is nearly impossible without ambulances, especially in hard-to-reach areas.
“Shortage of bed capacity is a recurring issue that patients have been experiencing for a while in some of these PHCs. This primarily affects patient dignity and comfort, and the clinical outcomes may be compromised. Imagine a sick patient being treated on the floor. A woman in labour may be forced to deliver on a bench, which increases the risk of infection and violates basic standards of care,” he said.
He, however, noted that the combined effect of these deficiencies is that it increases out-of-pocket costs, violates one of the core principles of PHC which is affordability and usually forces patients’ families to rent private transport when referred to secondary or tertiary hospitals.
He added that it overburdens secondary and tertiary hospitals because when patients know there are no beds or equipment in PHCs, they go directly to these higher-level facilities, which then become overwhelmed.
“It delays care and causes avoidable deaths. Patients are not given the dignity they deserve at PHCs,” he stated.
This story was produced for the Frontline Investigative Program and was supported by the Africa Data Hub and Orodata Science.