By Dan Atori, New Telegraph Online
For a nation to be productive and recognised among world powers, its citizens must be healthy and have access to quality and affordable healthcare services when the need arises. Citizen Journalist DAN ATORI writes on the state of health facilities, budgetary allocation, citizens’ participation and government’s effort in Niger State.
Apart from the issue of inadequate funding, untimely release of allocated funds, extreme weak supervision, monitoring and evaluation of programmes and activities have adversely affected the health sector in the country.
As a result of poor budget allocation, some key activities have been neglected with little or no funding such as immunisation, family planning and nutrition among others. Little is done to stop vaccine preventable deaths that occur daily.
When citizens, especially children who are the future leaders, are immunised through the administration of vaccines, they are made immune or resistant to infectious diseases.
Surprisingly, immunisation which is a proven tool for controlling and eliminating life threatening infectious diseases has not been given priority in the Niger State.
From the report of the 2015 immunisation checklist, it is clear that none of the 25 local government areas of the state received funds for its immunisation activities and only 28 percent of private health facilities offered routine immunisation.
Late Indian leader, Mahatma Gandhi, in one of his many quotes said that “It is health that is real wealth and not pieces of gold and silver” This quote, no doubt, speaks for itself as health is the greatest wealth any human being can boost of.
The quality of healthcare services in the country is generally considered as being poor due to shortage of manpower even when Nigerians are among the best doctors and nurses in the world.
The call for accountability has become pertinent, as a non-governmental organisation, the White Ribbon Alliance, Nigeria (WRAN), has remained undaunted in getting stakeholders especially citizens to advocate and hold the government accountable.
However, over the years, the health budget of the state has remained low irrespective of calls from many quarters to increase budget allocation to meet the 2011 Abuja Declaration of 15 percent of the total budget allocation to the health sector.
Looking at the 2016 state budget tagged “Budget of Restoration” out of the total budget of N85, 092,122,133.00 approved, N 7, 573,351,359.00 was allocated to health bringing the percentage to 8.90 percent.
Looking at the budget performance for 2016 as it concerned capital appropriation and capital release (Capital appropriation was N3, 067, 084,195.00 while capital release stood at N503, 430,975.00).
It is sad to note that out of the total sum of N10, 824,632,656.00 proposed by the state Ministry of Health and its parastatals for 2017, only N2.05 billion out of the N108 billion as proposed by the government as capital allocation in the proposed budget presented by the government to the state House of Assembly.
In Niger State, the people demand citizens-led accountability and involvement in the decision making process for proper accountability. At several advocacy and community dialogue meetings on citizens-led accountability for maternal, new-born and child health in Niger State, stakeholders have identified inadequate budgetary allocation and poor implementation of policies in the health sector.
Recently, WRAN organised a community dialogue on citizensled accountability in Meto village, Wushishsi and in Lapai Local Government Areas of Niger State where the healthcare facilities are in dilapidated state.
Citizens identified their healthcare challenges and suggested solutions in a way that if the government listens and more importantly act, it will yield positive results.
Commissioner for Health and Hospital Services, Dr. Mustapha Jibrin, at various events disclosed that increasing healthcare centres is very important to the populace because as the population grows, the healthcare facilities come under pressure and new facilities are needed.
According to him: “the governor has assured the people that his administration will ensure children and women are adequately taken care of in the state especially in the area of their health.”
“We understand the situation in the sector. Recently, 40 medical doctors, 10 specialists and 70 nurses were employed and additional medical personnel would be employed to fill the personnel gap in the sector.”
The Primary Healthcare Centre at Meto has been fully occupied by bats with offensive stench from the faeces of the mammals. The facility has been under lock and key as government according to the villagers did not send a single health worker ever since it was constructed.
A visit to the facility by Saturday Telegraph confirmed their claims as the facility is situated in an isolated area that the villagers complain is not serving the purpose for which it was constructed.
One of the women in Meto community, Hajia Hassana Mohammed, lamented the poor state of health facility in the community saying that: “If there are serious health cases, we usually rush patients to Wushishi, a distant location, and sometimes the patients die before we get to Wushishi.
“None of us has set eyes on any health worker or seen the facility here opened for a very long time. Bats have taken over the health centre and government seems not to even care about us.”
In his remarks, the Country Director, WRAN, Tonte Ibraye, while calling on the stakeholders to participate wholly on issues that affect them said: “Social and political changes can only be made with their involvement so that they can engage the government to bring about changes that will improve delivery of maternal and new born health at all levels of care.
“When this correspondent visited Lapai LGA, one of the midwives, Hajia Amina Monkwo, the Director of Primary Health Care, Lapai LGA, said that, their major challenge was the rate at which health workers were retiring without effort by government to replace them. She said: “There are no workers. Government needs to employ more people. I will soon retire.
My worry is that most of the pregnant women for fear that they may not get medical attention resort to Traditional Birth Attendants (TBAs). Many of them cannot even afford transport fare to the facility because of the distance.”
She also complained that since 2013 they have not received any form of capitation, adding that “since 2011 when we discovered that we are understaffed, we decided to engage the services of ad hoc staff. And we pay them through the capitation.
All our facilities in Lapai are in dilapidated state. We have notified the local government authorities in charge but nothing has been done since then.
“We want the state government to help the LGAs because the majority of the people with health problems and those who don’t have access to good health facilities are in the rural areas and not the urban areas.
We need referral vehicles that can convey our elderly people to health centres,” she added. Also, the Chairman, Ward Health Development Committee and Village Head of Yamma, in Lapai, Alhaji Ibrahim Tafida, said in order to achieve success, there is need for political commitment by the state government to increase health budget allocation and ensure timely release of allocated funds. “I am a retired nurse, the health facilities in Lapai are in bad shape, we are the ones equipping and maintaining the PHC in Yamma.
These politicians have abandoned us. There are no drugs, our communities usually contribute money to buy drugs. Only one health worker in a facility. How possible is that? You have one nurse attending to 50 to 80 patients in a day; we have retired yet government has not been able to employ and replace us.” In Nigeria, it is estimated that for every 10,000 people, there are only four doctors to attend to them as most of the highly trained ones have left or are leaving the country to places where there are better infrastructure and better pay package.
Since the creation of Niger State in 1976, it has passed through many administrations both military and civilian with the various governments coming up with different policies aimed at improving the health sector.
But one thing for sure is that without adequate budget, timely release of allocated funds, citizens’ engagement, accountability and transparency in the health sector which represents the second component of human capital development, the state economy will suffer. However, the state Governor, Alhaji Abubakar Sani Bello, after assuming office in May 2015, promised to reposition the state especially the health sector which is a key priority of his administration.
He acknowledged in his manifesto that the wealth of a nation depends on the health of the people and that he had a roadmap for the sector which includes undertaking comprehensive renovation and rehabilitation of existing general hospitals and other health facilities to meet basic standard and also ensure that the state benefits and key into the free quality comprehensive healthcare based on a national health insurance scheme among others.
To demonstrate his interest in providing quality, comprehensive and affordable healthcare services to citizens, health was adopted as one of his four-point agenda for the state.
Seeing that the decay in the sector was enormous, in 2016, he revealed plans of his administration to build 274 Primary Healthcare Centres under its Primary Healthcare Under One Roof (PHCUOR) programme to offer 24 hours comprehensive medical services in each of the ward aimed at improving it.
So far, only two of such facilities have been upgraded in Beji in Bosso LGA and Minna, the state capital. Governor Bello declared a state of emergency in the health sector and approved the immediate payment of 100 percent salary structure for all categories of health workers in the state with a view to repositioning it for better service delivery.
Recently, he lifted the ban on employment in the health sector in line with his agenda to double the number of practising physicians and healthcare professionals and bridge the human resource gap in the state which would bring quality healthcare closer to the people especially those at the rural areas.
Not satisfied with the state of the sector, citizens of Niger State, are calling on the State House of Assembly to, during their budget scrutiny, look into this development as promised in a communique issued at the end of a two-day legislative retreat held in November 2016, where they expressed their commitment to support and approve increased allocation to the health sector in order to meet the 2001 Abuja Declaration of 15 percent budget.
“Governments don’t have to wait until there is problem before they take action according to a worker at the State Ministry of Health who pleaded anonymity. Governor Bello recently said that the state government would complete 74 Primary Health Care Centres across the state before the end of 2017.
He made this pledge at the commissioning of the Children and Women Health Centre which was completed by the Member representing Suleja/ Gurara/Tafa federal constituency in the House of Representatives in Tafa Local Government Area of Niger State.
He said that he would ensure there is adequate access to healthcare facilities to people in the rural areas. Speaking to Saturday Telegraph, a Director in the state Ministry of Health, Dr. Audu Bala, stated that the ministry and indeed the state government had begun plans to equip PHCs and ensure that more health workers were engaged.