Sabo Primary Health Centre in Ibadan is one of the primary healthcare centres recently renovated by the Oyo State Government. However, Ajoke Bashiru lamented her experience when she gave birth at the centre Monday, June 17, 2024. “I shared a small ward with three other women, and the staff seemed overwhelmed,” she recalled.
Her complaint highlights the conditions of PHCs in Oyo State, where inadequate workforce and equipment continue to frustrate patients and health workers.
N12 Billion Investment in PHCs
Since Governor Seyi Makinde took office at the end of May 2019, the Oyo State Government has allocated over N12 billion to enhance service delivery at Primary Healthcare Centres (PHCs) across the state. On March 15, 2024, the state government highlighted its activities in the sector on its Feedback Oyo platform, stating that it had collaborated with the local governments to construct or renovate 299 PHCs in 351 wards across the state in alignment with Governor Makinde’s Roadmap for Accelerated Development (2019-2023) agenda.
For instance, the government, in its 2023 budget, allocated N2 billion to the Primary Health Care Development Agency (PHCDA) to renovate 209 PHCs, procure vehicles for monitoring activities, and meet UNICEF funding requirements. The 2024 budget allocated almost N4 billion for the same projects. See the table below:
The project contracts were awarded to Dominant Engineering Limited and Lanocks Construction Company Limited.
However, many PHCs in the state remain below the standards set by the National Primary Health Care Development Agency (NPHCDA) despite the allocations. While the renovations have largely improved the physical appearance of the facilities, crucial issues such as staffing shortages and a lack of essential equipment remain unaddressed.
According to NPHCDA guidelines, a PHC should offer 24-hour services daily. It should have a minimum of 13 rooms in a fenced standalone building on at least 4,200 square metres of land. The centre should also have staff quarters, essential drug supplies, equipped laboratories, and consistent electricity and clean water access.
Government neglects critical issues
For this report, the reporter on Tuesday, July 2, 2024 visited Ologuneru Primary Health Centre and three others – Sabo, Agbowo, and Oba Adeyemi PHCs on June 19, June 20 respectively. The tour revealed that the government-funded upgrades prioritised aesthetics over functionality. Besides the Ologuneru PHC building, which still appears old, many other centres lack essential facilities such as labour rooms, functional drug dispensing units, and injection rooms. These shortcomings force residents of the areas to seek medical care elsewhere.
Many residents said they travel far or pay high fees at private clinics for medical care because their public health centres are dysfunctional. This burden falls hardest on the elderly and vulnerable, who cannot travel far or afford the charges by private clinics.
Ologuneru PHC
“Imagine a mother taking a child with fever to the health centre only to meet a long queue and tired nurses juggling multiple roles,” Babajide Adeola said to the reporter at Ologuneru PHC. “There is no pediatric ward and no doctor on the ground. The nurses are overwhelmed and lack proper equipment, so they can only offer limited care.”
Another patient, Ajibola Bolatito, said she had her baby at a private hospital. “The shortage of staff and inadequate facilities forced me to deliver elsewhere, and I only came here for postnatal care,” she said.
The government also appears to forget people with disabilities (PWD), who are entitled to access public buildings on an equal basis with others. According to the accessibility law, public buildings must be constructed with the necessary accessibility aids, such as ramps and lifts, to ensure they are usable by PWD. During his visit to Ologuneru PHC on Tuesday, July 2, 2024, our reporter assisted some elderly individuals struggling to climb the steep stairs due to the lack of support features.
Adedeji Ajibola, a resident of Ologuneru, says he uses a private hospital because the PHC in the community does not have a doctor. “I came to the centre one morning when my child had a high fever. A large crowd was waiting, as it was parental education day for pregnant women and new mothers. I had to leave for a private hospital,” he said.
The matron at Ologuneru PHC, Ojo Awo, said the lack of restrooms for staff and patients was affecting the care of patients on admission. Though the Rotary Club renovated the toilets, they were quickly vandalised again because the centre does not have a perimeter fence.
“When patients need to use the restroom, we prioritise quick treatment so they can go home and use their facilities,” she said.
She said security was also a major concern, especially at night and during unrest because there is no perimeter fence.
Mrs Ojo said the clinic also had water access challenges until June 26, 2024, when Senator Alli Sarafadeen of the Oyo South Senatorial District donated a borehole to the centre. She said the local government also occasionally donated drugs when supplies ran low.
Sabo PHC
At Sabo PHC, the Officer in Charge, Akinlabi Akande, reported that no doctor had been assigned to the centre.
The facility also lacks a laboratory, equipment and a standard pharmacy. “If we had the necessary resources, we wouldn’t need to refer patients elsewhere,” Mrs Akande said. “We often refer patients to Jericho or Adeoyo because we can’t manage their cases.”
Bilau Kehinde, the tuberculosis supervisor for Ibadan North, and Ogundele Kafayat Motunrayo, a community health extension worker, echoed the same concerns. The two officials stationed at Sabo PHC said the centre needed additional staff and basic medical equipment. It had only three permanent staff members, with a few others working ad hoc.
Mrs Akande said that PHCS can provide robust healthcare services at the community level if it is properly funded and managed. “If we had everything we needed here, we wouldn’t need to refer patients elsewhere,” she reiterated.
However, Nafisa, a Sabo resident who frequented the local PHC, said the public facility’s shortage of doctors and nurses was forcing many residents to seek care elsewhere.
Agbowo PHC
Despite it being part of the newly renovated PHC, it was discovered that some of the roofing at Agbowo PHC is in bad condition, while some have ripped off completely from the ceiling and some are seen still hanging.
The Officer in Charge of the centre, Mrs Olanrewaju Omolade raised the issue of the ripped off ceiling, inadequate chairs for patients, especially during immunization and antenatal days, inadequate staff to oversee day to day activities of the centre.
“On Wednesday, June 19, 2024, we had almost 200 babies who were brought for immunization because there was a public holiday the previous week. We could not provide chairs for them because we have just a few and there was not enough staff on ground to attend to them,” Olanrewaju said.
One of the residents, Mrs Ajibade Odunola, who gave birth to her child at the centre said they once asked the pregnant woman to bring petrol when coming for delivery, because they could not afford it due to the increase in PMS price at that time.
She also complains about the shortage of staff at the centre. “Most times it might just be one or two people that will be on night duty. Even when I was in labour, it was only two of them that were on duty that day, despite the fact they have three pregnant women to attend to that night. During that period, they brought in some patients who had sustained injuries from an accident that night. How can just two-person cope or handle all of these at a time,” Ajibade complained bitterly.
To corroborate with what Olanreaju and Ajibade said, Aleju Kafayat, a registered nurse at the centre complained that the centre lacks some basic equipment like resuscitation for asthmatic patients. She also noted that they have a visiting doctor who comes twice a week.
However, Mrs Adewale Bolanle who came to check on one of the patients commend the centre. She said despite their shortage of staff, they tried to give their best to the community. “There was a time, they asked them to stop working due to strike. In between that period, a parent brought in a child who was faint and they tried all that they could to resuscitate that child,” Adewale stated.
Though she complains that the centre has stopped giving free drugs, they now ask them to buy at the pharmacist because the government is not dispensing drugs to the centre again.
Communities, NGOs bridge gap
Mrs Akande said some community leaders were offering support to her facility. “What once was a six-hour clinic is now running 24-hour, thanks to community support. Because of the community’s involvement, we operate three shifts – morning, afternoon, and night. The community has helped employ four staff, with me being the only permanent staff. The rest are ad-hoc, and Basic Health employs two.
“Without the community’s assistance, we wouldn’t be able to sustain the three shifts. This centre was among those renovated by the government.”
Mrs. Busari, a health technician at Oba Adeyemi PHC, Oyo town, highlighted the roles of local leaders in public health initiatives in Oyo town: “For our immunisation programmes, we rely on imams, pastors, elders, and traditional rulers to encourage community participation. Some residents are resistant to immunisations unless they receive food, so the support from these leaders is invaluable in overcoming these challenges.”
She said some community-based NGOs also donated drugs for pregnant women.
Ogundele noted that the community absorbs some voluntary workers. “The community development committee is doing a commendable job, regularly engaging with political leaders. However, the feedback remains that the Oyo State government has yet to recruit additional healthcare workers.”
The reporter tried to contact Seri Ajetunmobi, Oyo, the state Commissioner for Health, for his comments on this report, but his efforts were unsuccessful.
The story was supported with funding from the Centre for Journalism Innovation and Development (CJID).