Strengthening Nigerian healthcare infrastructure during COVID-19: The Apete community in Nigeria

By Nigerian journalist Emiola Ibukun, first published in News Agency of Nigeria.

The COVID-19 pandemic has shown the Nigerian healthcare system to be in need of strengthening.

A report conducted on Apete Primary Healthcare Centre has highlighted some of the things the government at all levels need to address to strengthen the health sector.

Apete Primary Healthcare Centre (PHC) situated in Apete community, a suburb in Ibadan city, Oyo State, Nigeria, hosts a population of about 103,261 people, having evolved from an agrarian community into a commercial hub, according to the 2006 census.

The Apete PHC caters for about a thousand (1,000) people’s healthcare needs on a monthly basis.

Adeola Olutu, a civil servant, who was delivered of her five children in the centre, said: “We don’t have toilet facilities at the Apete Primary Healthcare Centre and the centre is even small in capacity to accommodate the number of patients that visit the centre daily.

Pregnant women alone number more than 60 patients at one-time visits.”

The advent of the COVID-19 pandemic has heightened the clamour for repositioning of the health sector in Nigeria as the virus brought to the fore decadence in the healthcare system.

According to the Community Report: Impact of state of Primary Health Care survey conducted in September 2020 with more than 50 community members at Apete, a greater percentage of respondents wants to see more interventions from the government to build infrastructure and provide healthcare facilities.

The Community Report survey collated views from 73.68% female respondents and 26.32% males in Apete community on the state of their primary healthcare centre, government’s intervention to strengthen the sector in the face of COVID-19 and the impact of COVID-19 on them.

Although the Federal Government of Nigeria as at September 2020 said it has spent N30.5 billion (US$ 0.0793) in four months to fight COVID-19 pandemic out of the N36.3 billion (US$ 0.09438) public funds and donations in its response to the inquiry made by Socio-Economic Rights and Accountability Projects (SERAP).

Out of this sum, N7 billion (US$ 0.0182) was given to the states in the country to support their COVID-19 initiatives.

Dr Babatunde Olatunji, the Executive Secretary, Oyo State Primary Healthcare Board, said that on COVID-19, the Federal Government supported COVID-19 response at the Local Government Areas level with more than N40 million (US$ 0.104).

Olatunji, further said the fund was used for training of front line health care providers on Infection prevention control.

On the intervention at the state level, the Oyo State Government said it has spent N2.779 billion (US$ 0.0072254) in the ongoing fight against COVID-19 according to the Commissioner for Finance, Akinola Ojo.

The state government stated that it raised N378 million (US$ 0.9828) cash from willing donors, including individuals and corporate organisations to the tune of N1.177 billion (US$ 0.0030602), adding that the Coalition Against COVID-19 (CaCovid) alone donated items to the tune of N250 million (US$ 0.65).

Out of which N900 million (US$ 2.34) was spent on palliatives and seedlings for affected farmers and N370 million (US$ 0.962) was spent on the Infectious Disease Centre, located in Olodo area of Ibadan, the state capital.

Ojo said N453 million (US$ 1.1778) has been spent on security and securing the state borders on the right against COVID-19 pandemic, N156 million (US$ 0.4056) to be paid to health workers, including volunteers and medical and health workers as allowances.

The survey indicates that 77.19% of respondents say the state of the health centre in Apete community is bad, while 54.39% stated that governments’ intervention on COVID-19 pandemic is inadequate.

However, 19.3% respondents claim they are not aware of any government’s intervention in the health sector.

Prof. Innocent Ujah, the President, Nigerian Medical Association and the Oyo State Chairman of the association, Dr Ayotunde Fasunla as well as some patients interviewed at Apete Primary Healthcare Centre also said that there were challenges in the Nigerian healthcare system.

Ayomide Alawuye, a housewife, who brought her child for care at the primary healthcare, said that if the government provides the necessary infrastructure the healthcare would deliver more than it is currently doing.

Khadijat Oriolowo, a fashion designer who also accesses care at the health centre with members of her family said “this primary health centre is okay and it is one of the centres residents love the most in this area.

We want the government to recruit more healthcare workers. We are being delayed unnecessarily each time we come here because of a shortage of healthcare workers.’’

The Community Report: Impact of state of the Primary Health Care survey further shows that 92.98% of respondents note that there is a need for more healthcare workers as they are presently inadequate to cater for the teeming patients.

While 77.19% rated the service delivery of the healthcare workers as good, only 1.75% see it as excellent and 7.02% of respondents say the care service is poor.

According to the survey, at Apete a good number of grassroots people (84.21% of respondents) use the primary healthcare centre from time to time while 15.79% do not use the centre. Others (3.51%) said they don’t use the centre for lack of facility and 12.28% have other reasons for not using the primary healthcare centre.

A visit to the Primary Healthcare Centre in Apete revealed its true state and attested to the respondents’ views.

Ayokunle Anthony, a healthcare provider at the centre, said the state government sprang into action when Nigeria reported its first COVID-19 case to put the healthcare sector in a good state to combat the virus.

He said that the state government organised training for health workers which they all participated in.

Anthony said that a good number of the people seen at the peak of COVID-19 pandemic came in with illnesses such as malaria.

He noted that during the lockdown occasioned by the pandemic, more people came for family planning than usual and people are still registering for antenatal services.

Anthony, however, urged people to continue to practice good hygiene like hand washing to reduce contracting other diseases preventable by good hygiene.

He further enjoined the government to provide facilities and personnel for effective service delivery, adding that it would aid the free health services being provided for the people at the grassroots.

Dr Babatunde Olatunji, the Executive Secretary, Oyo State Primary Healthcare Board on COVID-19, said the present administration had begun the renovation of 351 primary healthcare centres.

He said this is in line with the envisioned Ward Health System to address the decades of rot and neglect in the sector.

“If you have been following the narrative in the state with the coming of this administration, we’ve been talking about healthcare service strengthening.

“Primary healthcare on the platform of one roof concept, the establishment of a primary healthcare board and the strengthening of the process.

“In line with the ward health system on which foundation PHC rests, we have decided that in an attempt to bring up the envisioned principles of the Ward Health system, that is one functional healthcare facility per ward, the government has decided to renovate at least 351 healthcare facilities in the first line among the lists of facilities that we have.”

Olatunji noted that the state was funding the renovation of PHCs and it will be completed before the end of the first term of Governor Seyi Makinde of Oyo State.

Speaking on Federal Government intervention on the COVID-19 pandemic, he said primary healthcare has been able to come out very strongly and strengthened for contact tracing and mobilisation activities.

“Between 400 health workers and 500 healthcare providers were trained on the first line. Then again, we were able to procure appropriate Personal Protective Equipment (PPE) for the healthcare providers.

“We are partnering with the Ministry of Energy and Power to support the primary healthcare system. I have discussed with the Commissioner for Energy and Power to support most of our facilities with the solar power system,’’ he said.

On the ratio of doctors to patients, he said “it is not only doctors that are needed but all other healthcare workers are not enough to cater for the number of patients visiting hospitals or health centres all over Nigeria.

“That is global in Nigerian context and it is everywhere, it is abysmal but like I said we have been able to do a kind of document that I refer to as a minimum service package with that document we have been able to identify what supposed to be the ideal.

“But there is a discussion now at the Oyo State level to see how we can gradually close that gap and recruit more hands to fill the space.

“Like I said, it is work in progress, the cup is half filled not half empty, we will continue adding up to it till it gets to the point of envisioned glory’’.

The Community Report: Impact of tate of the Primary Healthcare survey further buttresses the fact that health workers are not sufficient for teeming patients.

The respondents which represented 92.98% also agree that health workers are not adequate.