Isiaka Wakili
21 September 2008
Primary healthcare, which is a major component of the Millennium Development Goals (MDGs), especially in the areas of child mortality and maternal health, is yet to achieve the desired result in spite of billions of naira expended so far on the project.
Records show that, more often than not, the health sector has emerged top priority of the federal government in the budget.
Since 2006, according to findings, the sector has always received substantial allocation from the debt relief funds in the budgets. The rationale behind this is to engender "refurbishment and equipping of selected referral centres, building and rehabilitation of primary centres and procurement of vaccines for routine immunisation and equipment for cold storage".
The Overview of Public Expenditure in NEEDS (OPEN) reveals that in 2006 budget alone, N21,288,000,000 was allocated to the health sector to achieve the set objectives.
On how this allocation was used to impact on the primary healthcare system in the country, the government was said to have claimed to have built 166 new primary healthcare centres and rehabilitated 207 across the federation.
In 2007, it was learnt that the budgetary allocation of the sector rose to N15,348,000,000.
According to a report of the National Health Care Development Agency (NHCDA), N30 million was earmarked for the construction of each primary centre in 110 locations in the country, implying that a total sum of N3,663,000,000 went down the drain.
The level of the construction project as of June 2007 was reportedly unsatisfactory, with only about 26 primary healthcare centres completed and only 24 centres renovated. According to the report, 12.6 percent of the construction projects has been completed, 80.9 percent is ongoing, while 6.5 percent is yet to be started.
"Many of these primary healthcare were completed but could not be commissioned either because electricity and water supply had not been provided or healthcare staff had not been provided...This situation would greatly limit the usefulness of the completed centres and seriously dampen confidence on the programme...", the report revealed.
It was said that sequel to the non-completion of the construction of the PHCs, there had been a recurring problem of PHC equipment and drugs being supplied with no place to keep them. "Equipment and drugs have therefore been kept with the local chiefs, at the local government offices, in other health centres or in the uncompleted facilities where the security and safety of the supplied equipment were invariably jeopardised".
Sunday Trust gathered that though the specified equipment, quantities and specifications were enough for both construction and renovation sites, there was inadequate quality enforcement as measurement and evaluation consultants in various states were said to have reported unsatisfactory quality of the supplied equipment.
Also, the award of contracts for the supply of drugs to many of the PHCs was also said to contravene due process. "The contracts for the supply were awarded (and the suppliers mobilised) at almost the same time as that for construction/renovation. As a result, drugs have been supplied to PHCs that have not been constructed/renovated".
Also said to be problematic were the PHCs' renovation contracts. "Contracts were awarded and contractors mobilised, but there were no designs, drawings or bills of quantities. In many instances, even sites had not been decided. A detailed costing of the individual projects was supposed to have preceded the determination of the contract sum for each site. Obviously, this had not been done... Many locations had not been chosen at the time of the award of renovation contracts. Some of the chosen locations were not in need of renovation as they had only recently been renovated..."
In the same vein, according to the federal government's proposed allocation of N144,659,657,132 for the Federal Ministry of Health in the 2008 budget, the primary healthcare was billed to gulp N12,496,971,041 out of which over three billion naira has been earmarked for the building of primary healthcare centres in 110 different locations across the country, with each to gulp N30,000,000.
Renowned obstetrics gynecologist and Medical Director, Garki Hospital, Abuja, Dr Ibrahim Wada, identified the lack of maintenance as the major problem of the primary healthcare system in the country.
According to him, although the primary healthcare system in the country had not gained the kind of momentum it did in the late eighties and early nineties, the introduction of the National Health Insurance Scheme (NHIS) would widen the coverage of the primary healthcare delivery service.
Wada posited that the nation needed a primary healthcare scheme that would be accessible to the people in accordance with their contributions. "The primary healthcare means universal coverage; that is, it is next door to you or within your locality, and you can access it easily when you dip your hand in your pocket and contribute", he explained.
He, therefore, contended that the government alone should not be expected to build and equip primary healthcare centres and provide free services to the people".
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