It is a dusty Tuesday morning in Maito village, typical of the early harmattan season. Men and women carrying farm equipment walk on either side of the small road that divides the village into two. The rainy season has ended, and the villagers are busy harvesting. Not so for Malam Aliyu Bala, who has to rush his four-year-old son Nura to the village health facility. Nura has been down with a fever for two days according to his dad, but the situation got worse this morning, he said. ‘’Get me the RDT kit,’’ Jummai Saba, the facility in charge, orders as she performs a physical examination on the young boy. She carries out rapid malaria test, confirming that Nura has malaria. On a table beside Saba are health worker Mairo Musa and volunteer Garba Babandije going through the facility’s immunisation register. Tuesday is also the facility’s weekly fixed immunisation day and the two staff are preparing to receive children.
Maito is a village in Wushishi local government area of Niger state, between the towns of Bida and Zungeru, Nigeria’s first colonial capital. The mainly agrarian village did not have a functional health facility for almost four years because its primary health centre (PHC) which was serving 12 other settlements around the village was completely dilapidated. Built in the early 2000s, the PHC had never been renovated, so its roofs were leaking, its walls dirty and its bed broken. The situation got worse when bats and other birds made the PHC their home. Saba and her colleagues had to seek refuge in a community member’s house who donated two rooms to the health workers to serve as a makeshift clinic. They operated from the makeshift clinic since June 2019 usually conducting antenatal and immunisation services under the scorching sun and abruptly stopping service provision whenever it rained.
Nigeria Health Watch reported on the condition of Maito PHC in July 2019, comparing it to the Beji PHC in neighbouring Bosso LGA, and calling on the state government to expedite action in rehabilitating Maito. The two villages are about 40km apart. While Beji villagers enjoyed quality healthcare services from their PHC, the people of Maito village had to endure the exact opposite. When contacted in July 2019 about the condition of Maito PHC, the director of Primary Healthcare of Wushsishi LGA Malam Muhammad Gimba assured that contract had already been awarded for its rehabilitation by the state government and work would soon start. The rehabilitation started in early September and was completed early November, and the health workers have started providing healthcare services in the facility.
Wearing a new look
Maito PHC used to be a block of two rooms with a store and toilet. In the past, when they had a large number of patients, especially on antenatal and immunisation days, people had to sit outside to wait their turn. The state added three blocks, each with a hall, a consulting room, and a toilet. Each block also has a veranda that can serve as a waiting area for women and children on antenatal and immunisation days. The halls in the three blocks have already been converted to male, female and children wards respectively. Twenty new beds and mattresses have also been supplied by the state. Health workers used to rely on water from nearby wells for their needs, and even though Maito has electricity, constant disruption in supply meant the facility could go days without power. The health workers also had to close work once darkness starts setting in. The state while renovating constructed a brand-new borehole with pipes connected to all the toilets in the PHC, and a standalone water tap outside. They also installed a solar power system, which is connected to every block in the PHC.
A brand new feel, new room for impact
‘’A few months ago, I would not have brought him to this facility. I would have taken him to Zungeru or Bida’’ says Mr. Bala, sitting on a bed beside Nura in the new children’s ward. He says the previous condition of the PHC discouraged many people including himself from accessing care at the facility. Saba agrees. ‘’Patient flow was really low before. Some days I would spend the whole day without anyone coming,’’ she says, adding that the situation improved slightly after moving to the makeshift clinic. Within the last month however, she said some days are so busy they attend to patients till late evenings. ‘’Yesterday we were attending to people till 8pm’’, she said.
Maryam Mohammed can remember vividly how she missed some of her antenatal days while pregnant with her now two-month-old daughter Hauwa, when the health workers were operating from the makeshift clinic. Having to wait under the sun for many hours discouraged her and many women in the village from going for antenatal services, she said. Community leader Ibrahim Adamu agrees. “Most women were not attending antenatal in the facility before. The smell alone from bats was a deterrent,’’ he said.
This morning, Maryam is one of the early birds to arrive for the fixed immunisation session for her child. Adamu said the new condition of the PHC will encourage patronage especially from pregnant women.
Still room for improvement
Despite its new look, Maito PHC is still lacking in some things a standard PHC should have. With only three full time staff and one volunteer, the PHC can clearly do with more manpower. As it stands, these four staff provide services such as antenatal, family planning, delivery, and immunisation. But they are only able to work during the day and are only called upon at night when there is an emergency such as labour. They could accommodate night shifts but increasing the workforce will make room for more flexibility. According to Saba, having a medical doctor in the facility will also enhance their ability to provide more services.
The security of the health workers could be improved if the PHC is fenced. It would make it safer for them to work at night. Fencing the PHC will also protect it from possible land encroachment and animals. Storing vaccines is also a challenge for the health workers as they are yet to be provided with a refrigerator. They get vaccines from Wushishi LGA office using small coolers, limiting the stock they can have. Also, the design of the PHC does not make provision for a laboratory. There is also no laboratory technician to carry out tests, limiting the scope of services they can provide. The Niger state government can enhance service delivery at Maito PHC by revisiting and upgrading it further with the infrastructure, equipment and manpower it is presently lacking.
Primary health care is arguably the most critical level of health care delivery. At this level, minor health conditions that can become life threatening are identified early and treated or referred. As acknowledged by the World Health Organisation (WHO), standard, well equipped and staffed PHCs are able to not only manage illnesses, but also prevent them through health promotions, community and house to house outreaches. They also take substantial burden off the secondary and tertiary health facilities.
Because they are mostly located in rural communities, PHCs are usually the first port of call for rural dwellers when seeking health care. If they can access the services they need at that level, this will prevent them from spending monies they probably don’t have for travel to urban areas for treatment. This makes primary health care an integral aspect of Universal Health Coverage. Standard PHCs will ensure optimal provision of maternal and child health services such as antenatal, delivery and postnatal care and immunisation. This will contribute to the reduction of our high maternal and child mortality rates. Niger state government must seize the opportunity to replicate and scale up what has been done in Maito village in other PHCs that are in bad condition across the state. Children like Nura in other villages of the state deserve to have health facilities where they can be taken to for treatment when the need arises.
Is the primary health centre in your community equipped to provide quality care? Share the name of your PHC and let us know in the comment section or on social media if they are providing quality service!
Maintenance should be the key word here. People should own and take over the maintenance of the PHC once it is built or rehabilitated. Days of depending heavily on donor agencies and govt is over.
Kudos to the Nigeria Health Watch team. Your reporting has changed the health dynamics in Maito community. I wish this will be emulated in other rural areas which are also in the same condition as Maito before the renovation. Well done.
Thanks alot for sharing about Maito village. As I reflect on this I realise that it is possible to have a PHC that is well furnished, equipped and with the proper staff strength. It just takes political will.