“We received one million naira from October 2020 to February 2022”, said Halima Musa, the officer in charge of Beji Primary Health Centre (PHC) in Bosso Local Government Area (LGA) of Niger State. Proudly pointing out the facility’s solar-powered underground borehole and tank, Musa explained that a part of the funds was used to fix the borehole which according to her, was not functioning for over a year. “It was down for a long time, if not for the funds, it would still be down. We now have running water in all our toilets, and in our delivery room”.
Musa was referring to monies her PHC received from the Basic Health Care Provision Fund (BHCPF), Nigeria’s flagship funding program to improve basic healthcare delivery in primary healthcare facilities in communities across the country. Niger State has 274 political wards and one PHC per ward was selected to receive funds from the BHCPF. Beji PHC was picked in Beji Ward.
Doing so much with so little
Musa said the PHC received six hundred thousand naira in October 2020 and four hundred thousand naira in October 2021. Therefore, in addition to fixing the facility’s borehole, the BHCPF also made it possible for antenatal medications to be readily available and given for free to pregnant women on their antenatal days. This, Musa said has improved antenatal attendance in the health facility. “No woman would like to come for antenatal without getting her routine drugs, which was not frequent before. Now, we always have our routine drugs available thanks to the fund”, she revealed, adding that they have also been able to buy delivery kits, equipment, and consumables to aid the process.
Agreeing with Musa’s observations, Badukku Aminu, Beji community leader said the increase in antenatal attendance is largely from women who live in distant settlements. “They now know that medications are available, and tests are also carried out, all for free. So, they don’t see coming for antenatal as a waste of time or transport money.”
Delivery at the health facility, including the cost of consumables and drugs is free. In direct response to the increasing number of women giving birth at the facility, Musa and her team have purchased another delivery couch to add to the one they currently have. They bought a centrifuge for blood screening, and a sphygmomanometer for measuring blood pressure, especially for women during their antenatal visits. They are also able to cover transportation costs for health workers going into remote settlements to vaccinate children.
To improve service delivery, the funds were also used to pay two ad-hoc health workers who were engaged to address manpower shortages in the facility. According to Musa, even though the PHC had 10 permanent staff, including laboratory and dispensary technicians, they were not enough to provide 24-hour services in the health facility. The PHC had no form of security, and this left health workers on night duty as well as patients on admission vulnerable. A security man was also engaged to address this.
Accountability and robust governance structures lie at the core of every well-run public facility as it ensures that resources are used efficiently, and funds are managed judiciously. To ensure accountability in the utilisation of the BHCPF, each health facility has a committee consisting of community members and health workers to oversee expenditure. Additionally, each health facility has a dedicated bank account where the monies from the BHCPF gateways are credited and the officer in charge and community leader are the signatories to the account. In Beji PHC, Musa and Aminu are the signatories. However, before any expenditure is made, a detailed proposal is prepared and sent to the Bosso LGA primary healthcare department for review and approval. Once an item of expenditure is approved and executed, the officials of the department visit the PHC for a confirmation visit.
A rare PHC
Beji PHC can best be described as a model PHC as it appears to be fairly well maintained. Besides its relatively standard building structure, the facility has a laboratory, a dispensary, male and female toilets, a delivery room, and a six-bedroom staff quarters. However, the PHC has its own challenges which inhibited delivery of quality services to the 32 settlements it serves. Musa is grateful for the BHCPF as these challenges are gradually being addressed from the funds the facility has received.
Plans for 2022 BHCPF Allocation
As the PHC awaits receipt of their BHCPF allocation for 2022, Musa and her colleagues already have plans for utilising the funds. According to Musa, they have seen the huge benefits in having a constant supply of essential drugs for both antenatal and delivery, as well as increases in human resources. The plan is to ensure that the benefits are sustained and that medications for treating common diseases such as malaria are added to the list. They also plan to engage more ad-hoc workers to be able to attend to more patients on time and carry out immunisation outreaches in all the 32 settlements the PHC serves. Their third plan, she said, is to ensure that all windows in the health facility are kitted with netting to minimise the risk of mosquito bites for patients on admission and health workers on night duty. “It is not okay to come to the health facility and get infected with malaria”, Musa said, with a big smile.
While their plans for the 2022 BHCPF allocation are excellent, Musa and her colleagues should reconsider engaging more staff as 10 health workers for a PHC could be said to be adequate. It might serve the PHC better if the funds budgeted for engaging ad-hoc health workers are channeled in other areas such as providing an alternative source of power supply, engaging a sanitation worker to ensure adherence to infection prevention and control protocols, and additional security personnel.
The purpose of the BHCPF is to ensure the provision of quality basic healthcare services for people in communities across Nigeria, especially to pregnant and breastfeeding women, children under five, and the elderly, through continuous availability of essential drugs, basic equipment, and infrastructure in health facilities as well as adequate human resource for health. It is safe to say that Beji PHC which appeared to be doing okay in that regard is now doing even better, thanks to the boost in funding from the BHCPF.