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SPECIAL REPORT: In Akwa Ibom, Buhari govt’s initiative is revitalizing rural healthcare services



When Okon Emannuel, 56, fell in poor health in June 2021, he visited an area chemist (drug retailer) 4 blocks from his residence in Midim, Abak Native Authorities Space of Akwa Ibom State.

“I believe it was malaria. However after taking the tablets the chemist blended for me, I nonetheless felt fever(ish) once more,” he stated.

As his state of affairs acquired worse, he sought care at “Polyclinic” – the Major Healthcare Centre (PHC) Operational Base – located some three kilometres away, regardless of the existence of the Midim PHC in his group.

Mr Emmanuel stated his desire for Polyclinic is shared by many different residents of the world. “The one you speak about (Midim PHC); how many individuals go there that point?” he requested.

“Perhaps pregnant ladies for antenatal,” a lady, who had been listening to the dialog rapidly added. “Many individuals right here go to Polyclinic, as a result of it’s higher,” Mr Emmanuel stated.

The low patronage at PHC Midim was not unconnected with its dilapidated state on the time. In keeping with a 2021 evaluation report by UDEME, a social accountability initiative of the Centre for Journalism Innovation and Growth, the PHC had damaged ceilings, crumbling roofs and doorways and home windows affected by termite infestation.

Nonetheless, this isn’t the state of affairs at PHC Midim as we speak courtesy of the Nigerian authorities’s intervention by way of the Primary Healthcare Provision Fund (BHCPF). A go to to the PHC in August confirmed that it had been renovated and repainted.

“The fund has helped to remodel this place. Now we have changed the doorways and the wooden within the ceiling that have been destroyed by termites and fumigated the place from the ceiling up and down,” Itohowo Duncan, the officer accountable for the PHC, informed PREMIUM TIMES. “Now we have extra sufferers coming in right here now than earlier than.”

A generator was additionally procured to supply energy provide on the PHC, placing an finish to the lengthy years of borrowing the village head’s generator.

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Sylvester Ibanga, the village head, was stuffed with reward for the federal authorities’s intervention.

“It has helped to enhance the well being centre rather a lot. They have been in a position to restore loads of issues within the place. They even procured a generator to repair the electrical energy and water points there. We’re blissful and we thank the federal government for this venture,” he stated.


The Nigerian authorities launched BHCPF below the Nationwide Well being Act (NHAct) 2014 to supply free minimal primary healthcare to probably the most susceptible populations by way of PHCs throughout Nigeria and scale back private out-of-pocket funds and related monetary dangers, by way of medical insurance.

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The initiative is funded with a minimal of 1 per cent of the Consolidated Income Fund (CRF), grants from worldwide companions and different donors. The fund is disbursed through three gateways: 50 per cent for the supply of Primary Minimal Bundle of Well being Companies (BMPHS) to residents through the Nationwide Well being Insurance Scheme (NHIS), 5 per cent for remedy of medical emergencies and 45 per cent to enhance PHCs’ service supply by way of the Nationwide Major Well being Care Growth Company (NPHCDA).

Of the 45 per cent, 20 per cent is for the supply of important medicine, vaccines and consumables for eligible PHCs, 15 per cent is for the upkeep of PHC services and tools and 10 per cent is for the event of PHC employees.

Some payment receipts on BHCPF spending
Some fee receipts on BHCPF spending

READ ALSO: Nigeria lacks enough PHCs for remedy of residents – Ehanire

For the NHIS Gateway, residents and healthcare suppliers are anticipated to be enrolled as beneficiaries of the BHCPF, to allow them to entry preventive, protecting, promotive, healing, and rehabilitative well being providers at designated PHCs. Nonetheless, these well being providers shall be funded by way of the State Well being Insurance Businesses and State Well being Insurance Schemes (SHIA, SHIS), at an agreed premium.

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In 2018, President Muhammadu Buhari flagged off the Primary Well being Care Provision Fund (BHCPF) with an appropriation of N55.1 billion from the Consolidated Income Fund (CRF), along with $2 million from the Invoice and Melinda Gates Basis, $20 million from International Financing Facility (GFF) and £50 million donated by the Division for International Growth (DFID) to cowl 2018 – 2023.

A number of stories had beforehand documented the decrepit circumstances of PHCs throughout the state, citing inadequate drug provides, understaffed, ill-equipped and dilapidated services, occasioned by neglect, lack of political will and poor well being financing.

Nonetheless, following the launch of the BHCPF in Akwa Ibom within the second quarter of 2021, and subsequent disbursement of funds in 2022, PREMIUM TIMES’ go to to Essien Udim, Uruan, Abak, Eket and Esit Eket council areas, revealed that PHCs have been revitalized, notably almost about the rehabilitation of beforehand dilapidated buildings and services.

PREMIUM TIMES gathered {that a} complete of 231 PHCs had benefited from the fund, every receiving across the sum of ₦611,000. PREMIUM TIMES noticed that every one beneficiary PHCs had been renovated and repainted; every recognizing uniform yellow and inexperienced colors.

PHC Nwaniba, renovated
PHC Nwaniba, renovated

At PHC Nwaniba in Uruan LGA, the unhealthy doorways and home windows have been changed whereas the constructing has been repainted and the borehole repaired. A member of employees, Mfon Charles, counseled the federal government for introducing the scheme.

“The doorways and home windows which have been unhealthy earlier than have been modified and the borehole that was not working earlier than,” she stated. “As you possibly can see, the constructing was additionally repainted to make it look higher.”

The Fund served the same objective at PHCs in Ekpene Ibia and Ndon Ebom, masking the price of portray, restore of ceilings that have been beforehand falling off and alternative of picket doorways and home windows with metallic ones to enhance safety on the services. It additionally facilitated the acquisition of a Sumo pump and a brand new signpost at PHC Ekpene Ibia.

PHC Ekpene Ibia, renovated thanks to BHCPF
PHC Ekpene Ibia, renovated due to BHCPF

“The fund we acquired has actually helped to repair lots of our wants right here. Like the previous door that fell off one morning after I had evening supply, we have now modified it and others to iron doorways that are extra sturdy to guard the vaccine cooler, photo voltaic batteries and freezer from theft,” Anthonia Attah, who heads the ability, stated.

Earlier than the arrival of the BHCPF, solely the PHC Adiasim was in fine condition in Essien Udim LGA, having been demolished and rebuilt to plain by a philanthropist in the neighborhood, Oliver Ebong, in 2018. Mfonobong Sam, the OIC of the PHC, stated she didn’t have full data of how funds from the BHCPF have been utilised as she was “simply posted there in March 2022.”

The BHCPF can also be accountable for the latest renovation of the beforehand dilapidating buildings at PHC Odoro Ikot I and II – the opposite beneficiary PHCs within the Essien Udim LGA. Catherine Icho, the OIC, thanked the federal government for the initiative, including that it had improved circumstances on the facility.

PHC Adiasim

“If you happen to see this well being centre earlier than, the roof was leaking and falling off. I used the cash to purchase zinc, ceiling and the brand new doorways,” she stated.

She lamented the scarcity of employees, and lack of water and energy provide on the facility and appealed to the Rural Electrification Company (REA) to restore the solar-powered generator it donated to the ability.

In Abak LGA, BHCPF has equally introduced succour to beneficiary-PHCs. On the operational base, Ime Udo, the monitoring and analysis officer, counseled the federal government for the Fund, saying it has improved the situation of most of the PHCs. He nevertheless added that “extra must be performed.”

Blessing Ime, who used to attend antenatal care at PHC Ibanang Ediene, was delighted by the renovation of the PHC.

“Prior to now, we couldn’t use the bathroom however now they’ve repaired it,” she stated. The damaged roofs and ceilings have additionally been changed, courtesy of the BHCPF.

Crumbling ceiling at Abak LG PHC Base supported with sticks
Crumbling ceiling at Abak LG PHC Base supported with sticks

The top of the ability at PHC Midim, Itohowo Duncan, was additionally stuffed with reward for the BHCPF. Via the Fund, the ability, which had been ravaged by termites, had been rescued.

“The fund has helped to remodel this place. Now we have changed the doorways and the wooden within the ceiling that have been destroyed by termites and fumigated the place from the ceiling up and down,” she stated. A generator was additionally bought to supply energy provide on the PHC, placing an finish to the lengthy years of borrowing the village head’s generator.

PHC Okudomo, Eket
PHC Okudomo, Eket

There have been indicators of latest renovations at PHC Afaha Obong, together with the newly put in gate, home windows, iron doorways, ceilings and electrical tools. The OIC, Mfon Nseyo, stated “the fund has assisted in rehabilitating the PHC.”

From Ikot Okudomo to Ikot Ukpong, Mkpok and Afaha Atai, there are tales of rehabilitation of PHCs in Eket LGA, courtesy of the BHCPF.

Nwaiwu Florence, a affected person at PHC Idua in Eket LGA, acknowledged latest adjustments on the facility courtesy of the BHCPF intervention.

New seats at PHC Idua, Eket courtesy of BHCPF
New seats at PHC Idua, Eket courtesy of BHCPF

“The final time I used to be right here for my vaccine final 12 months, this place was not like this. I observed that the damaged flooring, unhealthy roof, doorways and home windows have been labored on. They’ve additionally bought extra seats,” she stated.

On the PHC Idung Iniang, the OIC, Mfon Batta, urged the federal government to maintain the venture in order that a few of the challenges going through the services could be a factor of the previous.

PHC Idug Iniang, Eket wears new look, courtesy BHCPF
PHC Idug Iniang, Eket wears new look, courtesy BHCPF

“That is the primary renovation of this PHC because it was constructed. If they will proceed like this earlier than you recognize, most of the points we have now been having shall be solved,” she stated.

The story is not any totally different for PHCs in Esit Eket LGA. PREMIUM TIMES discovered that every one the beneficiary-PHCs had acquired varied ranges of renovation, and might be simply recognized by their not too long ago painted yellow and inexperienced partitions.

The PHC in Etebi was doubly fortunate. A brand new constructing was not too long ago constructed by a former Minister of the Niger Delta, Godswill Akpabio, however the outdated constructing within the facility additionally acquired renovated by way of the BHCPF.

Charlie Hannah, the pinnacle of the ability, stated the PHC had been chosen as a beneficiary of the BHCPF “earlier than the brand new constructing was constructed by the minister.”

Not like lots of its type, the PHC has water and energy provide, identical to the PHC in Iko-Effak Akpautong, one other beneficiary of the BHCPF.

Aside from the renovation of the constructing and buy of furnishings, a brand new producing set was not too long ago bought for the PHC Ikpa City. In keeping with the OIC, Ekaette Bassey, the choice to make the acquisition was made to sort out the ability’s long-drawn problem with irregular energy provide.

Findings by PREMIUM TIMES revealed that the event strides on the PHCs are a product of the synergy with their respective Ward Growth Committees (WDCs) – a gaggle of group members chosen to assist the heads of the PHCs within the administration of the Fund.

There’s additionally a tradition of record-keeping for accountability by the heads of the PHCs. Every maintains a folder the place all paperwork – together with fee receipts, photos of the PHC’s earlier situation and financial institution statements – are saved.

Controversies over beneficiary PHCs choice

In the meantime, the choice of the PHCs to obtain the funds within the state sparked controversies, stemming from the inequitable distribution of beneficiary PHCs throughout the LGAs. PREMIUM TIMES gathered that some LGAs acquired extra beneficiaries than others.

In Uruan LGA, as an example, solely three out of 9 PHCs have been chosen to obtain funding. Of the 19 PHCs in Essien Udim LGA, solely three have been chosen, and 10 out of 14 PHCs have been chosen in Abak LGA. In Eket LGA, 11 of the 15 PHCs benefited from the Fund, simply as 9 out of the 13 PHCs in Esit Eket LGA have been chosen.

The standards employed within the choice of beneficiaries stay a thriller to the general public.

PHC Ekpenyong Attai, Essien Udim LGA
PHC Ekpenyong Attai, Essien Udim LGA

“It’s unlucky. Right here in Essien Udim, solely three out of virtually 20-something services have been chosen. So, I’m wondering what standards they utilized in deciding on the services. How come different native governments have extra beneficiaries and we have now simply three?” a nurse working in one of many PHCs queried.

There are additionally issues that some dilapidated PHCs critically in want of intervention, have been unnoticed.

A go to to the non-beneficiary PHCs throughout the 5 LGAs revealed that a lot of the services are grossly understaffed, ill-equipped and dilapidated.

Amenities like PHC Mkpatak and the PHC Operational Base, Ikot Ebak in Essien Udim LGA, reek of dilapidation and lengthy years of neglect, particularly PHC Ekpenyong II which is completely in shambles. The ceilings on the PHC had crumbled, forcing employees and even sufferers who have been receiving remedy, to at all times run for canopy.

Head, PHC Ekpenyong Attai calls for urgent intervention
Head, PHC Ekpenyong Attai requires pressing intervention

In Abak LGA, the ceilings of most of the wards and places of work on the PHC Operational Base are prevented from crumbling with the assist of sticks, simply because the well being publish at Abak Itenge requires pressing intervention.

There’s a want to supply intervention for PHCs in Esit Urua and Ikot Abia in Eket LGA, which function from single school rooms in colleges – Apostolic Excessive College Esit Urua and Authorities Major College Ikot Abia, respectively.

Others requiring consideration additionally embody the PHCs Odoro Nkit, Ntak Inyang and Akpasong in Esit Eket LGA.

Aside from the difficulty of structural deficiency noticed, many of those PHCs are additionally plagued with a scarcity of drug provides. Once they can, PHC employees replenish the pharmacies with medicine and necessities from their private pockets, in a bid to make the medicine available for sufferers at a value. Aside from availability, sufferers who spoke with PREMIUM TIMES stated it saves them the danger of shopping for counterfeit medicine.

“Most instances it’s higher to purchase the medicine on the well being centre since you are positive that it’s unique as an alternative of going by your self to the chemist or pharmacy and shopping for faux,” Esther Monday, a affected person, stated.

The state of affairs is identical throughout the state. Aside from antimalarial medicine and antiretrovirals (ARVs), sufferers bear the prices of medication and different medical therapies, regardless of the implementation of the Primary Healthcare Provision Fund (BHCPF) within the state.

Dilapidated Health Post, Abak Itenge
Dilapidated Well being Publish, Abak Itenge

PHCs’ process of income era

Regardless of efforts to enhance rural healthcare with initiatives just like the BHCPF, findings by PREMIUM TIMES revealed that PHCs throughout the state are tasked to generate and remit revenues by LGA councils.

Councils preserve income registers at each facility, with which PHC employees are mandated to report the main points of each affected person and the charges collected. Expenses differ throughout LGAs. At PHCs in Uruan LGA, adults pay ₦100, youngsters ₦50, whereas pregnant ladies pay ₦100 and ₦200 after supply. It’s barely totally different for PHCs in Essien Udim LGA, the place pregnant ladies pay ₦500 earlier than and after supply, and Eket LGA, the place adults are charged ₦50.

Patients charged to generate revenue for LGAs
Sufferers charged to generate income for LGAs

Income collector’s registers seen by PREMIUM TIMES confirmed proof of income fee by PHCs throughout the state. For example, between April and June 2022, PHC Nwaniba remitted ₦5,070 to the Uruan LGA and ₦1,910 in July. In August 2022, Essien Udim LGA acquired ₦4,050 as income from PHC Odoro Ikot.

The story is essentially the identical in all of the PHCs throughout the 5 LGAs visited.

PREMIUM TIMES additionally discovered that regardless of these tax funds, PHCs obtain no assist from LGA councils in type of imprest or subventions to help the services for higher service supply. Instead, employees usually depend on private contributions and typically donations from kind-hearted members of communities to run the services.

PHC revenue sheet
PHC income sheet

We’re doing our greatest — Govt

The Chairman of the Akwa Ibom State Major Healthcare Growth Company (AKSPHCDA), Martins Akpan, stated the poor state of the PHCs stems from years of neglect below the management of the LGAs. He stated the state governor, Mr Emmanuel, was doing his greatest to revive the first healthcare system within the state to ship high quality healthcare to residents.

“We should recognise the truth that these issues didn’t simply begin in a single day. It’s a product of neglect over time. We simply must be grateful to the present governor, Deacon Udom Emmanuel, who has given visibility to the first healthcare sector. Prior to now the PHCs have been below the native authorities system. All the things was in shambles.

“It was simply a few years in the past that the FG determined to enact the Nationwide Well being Act, which shifted the duty of the PHCs from LGAs to the state authorities below the supply of the Major Well being Care Underneath One Roof (PHCUOR). We’re nonetheless within the means of the migration from the Native Authorities Service Fee to the state company which can maintain these issues,” he stated.

Mr Akpan stated that plans have been underway by the state authorities to interact high quality well being personnel to handle the difficulty of employees scarcity.

Addressing the difficulty of inequitable choice of PHCs, he revealed that the AKSPHCDA was not concerned within the choice of the beneficiary PHCs, however famous that the PHCs that weren’t beforehand captured, particularly probably the most affected ones, shall be thought-about within the second section.

Whereas Akwa Ibom at the moment enjoys its share of 45 per cent of the BHCPF, the state is but to entry funds from the 50 per cent NHIS gateway meant for the supply of Primary Minimal Bundle of Well being Companies (BMPHS) to residents, following the failure of the federal government to supply counterpart funding and the institution of a medical insurance company. Nonetheless, Mr Akpan assures that that will quickly be a factor of the previous.

“Medical health insurance is part of the BHCPF. Now we have now 45 per cent (NPHCDA gateway), we nonetheless want the 50 per cent which is much more than what we have now already and you recognize his excellency (the state governor) understands and is engaged on it. I believe what’s left now’s the nitty-gritty of establishing the company in order that they will have their very own board and administration,” he stated.

*This report is supported by the International Price range Partnership and the International Centre for Investigative Reporting (The ICIR)

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