Primary healthcare is established essentially to bring health closer to the people, in the community.
Primary healthcare is to provide services to the majority of people in rural areas based on needs, without geographical, social or financial barriers.
Shortage of manpower, lack of infrastructures is the situation of Primary healthcare centres in Osun state as the quest to access quality and affordable healthcare by residents at various communities have become a mirage.
An E-document from the Osun State Ministry of Health dated in 2021 indicated that at the primary health centres, there are 19 medical doctors, 17 pharmacists, 19 medical laboratory scientists and 230 nurses; while health assistants are 830 in number and Junior Community Health Extension Workers (JCHEW) are 790, among other categories of workers providing health care services in the 876 functional PHCs across the state with a population of over five million.
The report also stated that there are over 1,000 Primary Health Centres in Osun state while only 876 of the facilities are functional, out of which 332 were revitalized under the Save One Million Lives (SOML) $20 million Federal Government/World Bank grant obtained by the state government in 2019.
What this translates into is that on the average, a medical doctor in Osun State serves no less than 263,000 patients, as opposed to the World Health Organization’s standard of 600 patients to one doctor if patients must enjoy adequate medical attention”, the report revealed.
In contrast, the British Medical Association recommends that General Practitioners see a maximum of 15 patients with complex needs per day. Examples of these include patients with multiple medical problems such as heart failure, diabetes and related kidney disease, frail seniors, and patients with chronic mental health conditions.
In an interview, community health expert with the Osun State government who identified himself simply as Dr. Femi, said that most of the PHCs have just between two and three clinical and non-clinical staff, who are majorly Community Health Extension Workers [CHEW] or health assistants.
From herbal home in search of cure
Mrs. Omotoso Khadijat, a petty trader and single mother travelled from Ijana village in Obokun Local Government area of Osun State to Orinkiran Primary Health Center in Ilesa West LG, covering a distance of about 50 kilometers to save her son who had been down for nine days from suspected typhoid fever, having been placed on herbal remedies that had not made the situation better.
She told Radio Nigeria that she was one of the few lucky ones who could afford such ‘luxury’ of seeking medical care away from the village.
“I am just lucky that I have little education and I can raise money to come here. Many children are lost to cases like this and our people call it spiritual attack. There are no medical personnel in Ijana Primary Health Centre to attend to anyone,” she said.
Unwittingly corroborating the unwieldy statistics of Nigeria’s child mortality rate, which currently stands at 117 per 1,000 under-five children, according to a data from UNICEF.
Mrs. Omotoso noted that residents of Ijana, Ibala and other communities in Obokun LG often come to Ilesa for medical care and those who could not afford transport resort to alternative traditional medicine care.
The traditional ruler of the community, the Atarua-elect of Ijana, Oba Olusegun Ogunleye, confirmed the development with a plea to the government to make the only health center in the community functional.
“There is only one nurse, a female that covers both Ijana and Ibala communities (a distance of about 20 kilometers with a population of over 40,000 people). I will give you her contact to verify my claims. The Ijana health center that was inaugurated with fanfare has been completely abandoned due to the absence of requisite workforce. As a community, there is little we can do to employ healthcare providers,” the ruler stated.
The situation is the same at Odeyinka village in Ayedaade local government. The community, which is about 35 kilometers to Ikire, the local government headquarters, is only accessible by motorcycle.
When Mr. Hafeez Kolapo, the motorcyclist that drove the reporter learnt the destination was the health center, he betrayed his emotions claiming that he lost his pregnant wife early this year when he brought her on an emergency to the newly revitalized health center where he met only two personnel who he said could not handle the case.
He said there was no means of referral until his pregnant wife died.
“When we got here that night, the whole place was dark. We met a security man and two women who looked like assistants in the place. It was in rage I asked for the doctor on duty, but they said they were the ones on duty. They could not do anything tangible until the women and the security man we met promised to call the nurse on duty,” Kolapo said.
The situation was not different in other Primary Health Care facilities visited across some Local Governments in the state.
Inadequate, incompetent manpower
Most of the primary health centers visited were being managed by personnel referred to as Community Health Extension Workers, CHEW, pharmacy technicians and laboratory attendants assisted by N-Power health assistants in some cases.
The CHEW, according to Annals of Family Medicine published by the National Library of Medicine, “are trained individuals with limited to no formal medical education who provide patient-facing support and services in primary care. They carry out functions that are person-centred, support team-based care.”
In the same vein, the N-Power health assistants were workers engaged under the Federal Government N-Power programme to give support to health workers in medical facilities.
At the Alujue PHC in Ede North Local Government, Radio Nigeria met one female CHEW official attending to patients and assisted by N-Power health assistants.
The lady, who did not want to be mentioned, but simply identified as ‘Aunty Ade’ by the patients, directed our reporter to a notice containing a list of staff.
On the list were eight names comprising those of four CHEW personnel, two pharmacy technicians, one laboratory assistant and one N-Power health assistant.
Visiting health center; a waste of time
A community leader in Oteu village, Elder Michael Alabi, said going to the health center was a waste of time, as one could wait for more than six hours before he could be attended to.
Indeed, most of the health centers visited were headed and managed by the CHEW crew.
A Public Health Consultant with the Ekiti State University Teaching Hospital, Professor Olusola Odu, explained that “ordinarily, CHEW personnel should not lead a Primary Health Centre, but in the absence of a doctor or public health nurse, they could be in charge”
Government making efforts to address situation
The Osun State government did not deny the challenge of inadequate manpower in its primary health centers, but it described it as a national problem, with assurance that it is making efforts to address it.
The State Commissioner for Health, Dr. Rafiu Issamotu, who told Radio Nigeria that government had taken steps to mitigate the consequences of shortage of manpower at the PHCs.
He noted that the $20 million SOML grant did not only cover personnel hired, but was used for basic facility turnaround.
“We can have a situation where the most senior person in a facility is a CHEW. They have been trained to function so that the place will not suffer.
“We have a policy of Task Shifting/Task Sharing; a situation where a CHEW in our facility can perform the function of a nurse, such as taking delivery of a pregnant woman, even though they are not midwives. They have been so trained.
“A pharmacist technician should be able to perform the function of a pharmacist, though he knows he is not a pharmacist. In a rural area, they should be able to perform without hitch. This practice is recognised by WHO,” the commissioner stated.
But this practice is at variance with the National Primary Health Care Development Agency’s minimum standard for Primary Health Care in Nigeria, which states that, “for a PHC per political ward with a population of 10,000, each PHC must have a medical officer if available, a community health officer, who must work under a standing order, four nurses/midwives, three Community Health Extension Workers who must work under a standing order, one pharmacy technician, six Junior CHEWs who must work under a standing order, one environmental officer, one medical record officer, and one laboratory technician’.
It said the workforce is to be supported by two health assistants, two security and one general maintenance staff.
Writing by Adenitan Akinola with support from Wole Soyinka Centre for Investigative Journalism and MacArthur Foundation; Editing by Daniel Adejo & Annabel Nwachukwu.