How Rot in Lagos PHCs Fuel Maternal, Newborn Deaths

The sorry state of some Primary Health Centres in Lagos State has forced pregnant women to resort to self help or seek alternative healthcare in traditional and mission birth clinics, which are in no small measure leading to increasing deaths of women and newborns in the state, Martins Ifijeh reports

Alone and deserted is a fenced building with a swampy road leading to several communities in Epe Local Government Area of Lagos State, just about three kilometres from the tarred road. A casual look suggests it is an abandoned building overtaken by weeds, but the newly introduced mini sign posts by Lagos State government for direction to public institutions give a clue. It is the Oko-Oba Primary Health Centre.

The isolated facility is the clinic meant to provide the primary healthcare needs of several communities in Epe, including Ojaoko-Oba, Tagbati, Oluwogbe, Ajigbinwa, Aromi, Arakpagi, Oriba, Maire, Onikokan, Onijigba and Alaoufun. Residents living in these communities are estimated to be over 550,000, with their main occupation being farming.

But the bleakness of the building showed it has not lived up to its name in recent times. Goats and fowls were seen at strategic locations of the compound, while the level of growth of weeds suggests reptiles and other dangerous animals might be lurking around. A scenario that shows truly, the over half a million people have deserted the facility.

As at 1pm on Tuesday the 11th of October when THISDAY visited, the facility was under lock and key with no one in sight. There was no electrical power connected from the pole into the building, suggesting it was never designed to have power at all, or more directly, it was probably never designed to attend to patients, since light and running water are critical and important facilities for a clinic.

When Nigeria, along with other member countries of the World Health Organisation (WHO) adopted the 1978 Alma Ata Declaration, it agreed to provide accessible and affordable primary health centres for the grassroots such that healthcare will be much closer to the people. But the over 500,000 people in various communities under the Oko-Oba PHC have been disadvantaged already from their statutory right; right to healthcare.

Just as THISDAY was about leaving the compound, a resident of Ojaoko Oba community, Mr. Akeem Lacis, who was surprised seeing someone in the building said there were no workers manning the facility anymore, except for a woman who he said comes once in a while.

“She didn’t come to work today. Maybe you should come next week if you must see her,” Lacis said, adding that, if the reporter’s purpose of seeing the health worker was for treatment, that he should not bother coming back as the facility has no single drug for treatment.

Further discussions with Lacis showed that the people in the various communities have given up on the facility since the past two years, adding that people stopped patronising the centre months after it was inaugurated when they discovered there were no health workers, other than the woman who doubles as the nurse, doctor, cleaner and gateman.

“Many of my community people have brought their children and pregnant women here before, but they were never treated because drugs and other treatment facilities are not available,” Lacis said.

According to him, overtime, the once elated members of the various communities who felt their health needs would be met with the establishment of the health facility decided to take their destinies in their hands by patronising local traditional healers, and in some cases, some lose their lives to the lack of access to quality healthcare, which ordinarily the clinic was meant to provide.

“When they inaugurated this place, all our pregnant women were eager to register for ante natal here because it was somewhat like an upgrade for us. They were proud to tell their neigbhours and who ever cared to listen that they were going to the clinic for ante natal because everything was functioning well, including the presence of a doctor. But everything started going down with time. The doctor left because government refused to pay him, same with the nurses. Seems government no longer budget for this place at all,” he queried.

He said many people die in the area every now and then because of the lack of healthcare. “From here to the next health facility is about two hours journey on bike, because as you can see, cars cannot enter our communities due to the bad roads. All our transportation here during rainy season must be either with bike or bicycle,” he said.

Lacis imagined how members of the communities would carry their pregnant wives who were in labour on bikes for a two hours journey to the nearest health facility, adding that this has contributed to the maternal and child deaths in the various communities.

“When a pregnant woman has an emergency either during the day or night, there is no health facility around that can help save her and the child. There is even no private health centre here as well. So its either the woman in pain is taken to any of the unskilled birth attendants scattered all over the communities or taken on a two hour journey to the nearest health centre in Epe town.

“We are witnesses to the many deaths that have occurred among our pregnant women and newborns because they are unable to access health facilities on time or are being attended to by unskilled birth attendants,” he noted.

He said the matter has been reported on several occasions to the former Chairman of Epe Local Government Area, as well as the present Sole Administrator, Hon. Olu Ogunniyi, but that nothing has been done so far to address their health needs. “We have also complained to this new local government boss that our women and children were dying because of the sorry state of the health centre. He promised to do something about it, but till date, we have heard nothing from him or even the State government,” Lacis said.

Baruwa PHC, a no go area for women and children
Like the Oko-Oba healthcare centre, the Baruwa PHC in Ipaja area of the state is not any different. The facility is one of those government buildings community members wished was converted to museums or town hall facility. It is ideally meant to serve the healthcare needs of the over 400,000 people living in Baruwa and some parts of Ipaja, but it has not lived up to its billings.

THISDAY’s visit to the centre at about 2pm on Wednesday 12th October, showed that like the Oko-Oba PHC, the facility was also under lock and key, and grasses have taken over it, with no clear walk way from the front of the building to the main door leading to the lobby; a scenario suggesting the facility has not been in use for a long time.

But same cannot be said of other houses around the PHC, as they were seen to be tidy and habitable. Only the PHC in the area had the odd look, like an abandoned building.

Since no health worker was on ground for a chat with this reporter, he decided to move round the community and hear the people’s perception about the government facility and how useful it has been to them.

One of the residents, Mrs. Adekunle Oluwatoyin, a teacher, said the people of Baruwa and its environs have given up on the facility because anytime they go there, they no longer come out with desired results as against the previous practise many years ago, adding that now, people resort to other means of healthcare, rather than depend on the government’s facility.

“Many years ago, this health centre used to be very active because then they had drugs, doctors and nurses were on ground to attend to patients, but now, the only active thing happening in the PHC is the monthly immunisation. That is only why we take our children there, and it is just once a month,” she explained.

According to her, since the beginning of the present administration of Governor Akinwunmi Ambode, the PHC has lost its glory and name because there has not been a single doctor or nurse on ground to attend to the various health emergencies that occur in the community every now and then.

“I remember when my last child was ill about four years ago. I took her there and she was attended to promptly. But sometime last year when she had same issue, I didn’t bother taking her there again because you will not find anybody to attend to you. Even if you are lucky to see a nurse there, she will tell you there is no facility on ground to treat patients. Even plaster is not available in that healthcare centre,” she said.

How do pregnant women, especially the poor ones, access ante natal and/or delivery? Adekunle said that is why there were several Traditional Birth Attendants (TBAs) everywhere in the community, as they have decided to use the lack of proper healthcare by the government to their advantage.

“We have never had the number of TBAs we have now in this community, but the situation of things in the PHC has made our women choose what is available. Almost every pregnant woman here registers for ante natal in any of the numerous TBAs around. Also, that is where they give birth because they regard it as not just pocket friendly, but very accessible and most importantly an available alternative to the government facility,” she noted.

A chat with one of the women whose younger sister in the community uses TBAs during pregnancy and delivery, Mrs. Amina Nurudeen, showed that in recent years, women and their newborns have lost their lives due to the inaccessibility of skilled birth attendants and functioning PHCs around.

“When my younger sister had her pregnancy, she went to register in one of the TBAs where she started ante natal, but on the day of delivery, it was out of share luck and God’s mercy that she came out alive. There was complication as it was later discovered during delivery. She was carrying twins in her, but the birth attendant was only able to bring out the first child. The second child became difficult to deliver. They started giving my sister all manner of concoctions to force the baby out, but she was already dying because she had lost strength and blood.

“It was when someone rushed to call me that I knew the battle my sister was fighting. The TBA was helpless as it were. I immediately chartered a taxi that took her to a private hospital in Ayobo area of the state, where she was then saved. The second child could however not make it alive because the concoctions and delays may have affected his health,” Nurudeen stated.

She said the situation was not only exclusive to her sister, but that several newborns have been lost lately due to the practise of some TBAs in the community who were not skilled in the act of delivery and post-delivery care.

“I can’t say the job of TBAs in this community is bad because they are doing what the government is unable to provide for the people. But the issue is that not all of them are good in this job. Some always have one or two stories of either losing their patients or the children, though on a large scale, they are delivering women here better, when compared to what the PHC offers,” she said.

THISDAY investigations showed that when officials from the Ministry of Health are carrying out their supervision to healthcare centres, the ‘part time’ staff of Baruwa PHCs converge in the facility to receive them, and after which disappears into thin air until the next head count or immunisation day when their services will be needed.

A source, whose sister supposedly works with the PHC said she was surprised two weeks ago to see her sister dressed for work one morning. “I asked why she was going to work today, and her reply was that they were expecting people from Alausa, hence they had to converge in the centre to make it look like the place was functioning. After their supervisors left, my sister returned home. I am not sure she has attended work since then,” she said.

To be doubly sure of the observation experienced on Wednesday the 12th of October, THISDAY, again, visited the facility on Friday, 14th October at about the same time as two days before. The health facility was still under lock and key.

A passerby told this reporter that a snake was killed just a day before in the compound, and that he had not seen any staff in the facility that day. “May be you should come during the immunisation day, because this place will be full of women, children and some workers of the health centre,” he said.

Akinyele PHC, a facility operating at a suboptimal level
Unlike Oko-Oba and Baruwa health centre, Akinyele PHC in Abesan Estate was open for business when THISDAY visited Friday, 14th October, even though just few health workers were on ground to attend to people. But one thing was common to all health facilities visited; they all don’t have doctors manning the facilities.

A nurse who spoke on the condition of anonymity, said apart from not having doctors, they were short of health workers, hence they do not do 24 hours, adding that once its 3pm or latest 4pm they lock up the facility till the next day.

On whether pregnant women access the facility for delivery and ante natal, she said they were lacking a lot of facilities, like drugs and other treatment tools needed for safe delivery and other types of treatment. “Only few women come here for delivery, but during immunisation days, you will find a lot of women here with their children,” she adds.

Ironically, the other two facilities visited by THISDAY had a well built structure, supposedly dedicated to PHC, but Akinyele PHC that was open to the public operates from a dilapidate building with just three rooms built like stores.

Lack of functional PHCs, a motivation to own a TBA clinic
An assertion by the ‘Medical Director’ Mama Metta Traditional Birth Clinic in Iyana Ipaja area of the state, Mrs. Temilade Fayemi, sums up why there exist several hundreds of Traditional Birth Attendants in the state, often regarded by healthcare professionals as unskilled birth attendants.

She never saw reasons to start the practise of TBA full time until she relocated to Iyana Ipaja in 1981 and discovered there was no where for pregnant women to access ante natal care and subsequently delivery. “Though back in Ilupeju, I used to help my father to deliver some of his patients. When I got to Iyana Ipaja, I saw where women were suffering because there was no health facility for them to deliver. I then took it upon myself to help them. Over time, everyone knew me and it became a reason to establish this clinic just to help people,” she said.

Mama Metta said she wonders why journalists and most healthcare professionals do not consider the role of TBAs as very vital, especially in areas where primary health facilities were not available. “Some of us are very well trained in this job because Lagos State government has given us different forms of trainings which has made us better. “TBAs are ready to die with their work because they are always available in the communities, but how many PHCs are available even at night to care for pregnant women?” She queried.

Before THISDAY left her ‘clinic’ at about 3pm, 38 pregnant women had come for ante natal that day alone. She said they were still expecting more before the end of that day. Asked about successes and fatalities, Mama Metta was careful enough not to delve into that. “It is God that knows which will survive or not. Ours is to do our work,” she retorted.

The abysmally poor level of healthcare in Oko-Oba PHC, Baruwa PHC and Akinyele PHC has again may have brought to rest, the imagination by most people in the state, who often wondered why Lagos State did not meet the Millennium Development Goal (MDG) five, which is on maternal and newborn health, despite the enormous economic resources at its disposal, as well as the number of healthcare professionals when compared to other states of the federation.

Of the 36 states in the country, including the Federal Capital Territory, Abuja, only Ondo State met MDG five, while the remaining states are still grappling with reducing maternal and child deaths.

The grim picture
According to the World Health Organisation, out of 100 per cent Maternal Deaths in the world, Nigeria constitutes about 10 per cent and out of every 100,000 live births, 575 are lost, while 145 women are lost daily due to pregnancy related issues or during childbirth.

Society of Gynaecology and Obstetrics of Nigeria says 11,600 maternal deaths were recorded in Nigeria between December 2015 and January 2016.

Last available data from Campaign Against Unwanted Pregnancy, CAUP, shows that while maternal mortality rate may have reduced in some parts of Lagos like Victoria Island and Surulere slightly, far more than 570 deaths per 100,000 live births were still experienced in places like Alimosho and Epe area of the state with no significant improve in the healthcare systems in these area.

Baruwa and Akinyele PHCs are in Alimosho LGA. Oko-Oba PHC is in Epe LGA.

Expert’s perception
A consultant Paediatrist and Gynaecologist, Dr. Ben Onaiwu, says what is being experienced in PHCs across the state was a result of systemic errors, noting that across the nation, priority has generally not been given to primary healthcare.

“If you check our budget, majority goes to the tertiary level of care, while just little is trickled down to primary healthcare. I don’t think the situation is any different in Lagos State. But if we all fix our healthcare system from the grassroots, there is the likelihood that maternal and newborn deaths will be greatly reduced.”

Onaiwu described primary healthcare as a pyramid where those at the base need more basic healthcare. “Those who will require secondary care will not be as much as those who would require primary healthcare. Same for tertiary and compared to secondary. But why do governments put more focus on tertiary healthcare while neglecting the base of healthcare which is the primary,” he said.

The Special Adviser, PHC to Lagos State Governor, Dr. Olufemi Onanuga says there is a new vigour to tackle issues relating to primary healthcare needs of Lagosians, adding that prioritising healthcare at the grassroots will make life easier for the rural poor.

He said a monitoring team was now in place to pay unscheduled visits to PHCs across the state.

THISDAY couldn’t confirm if the team has paid such unscheduled visits to Oko-Oba, Baruwa and Akinyele PHCs.

According to him, “PHCs that have not been functioning are now being equipped, like Orile Iganmu Primary Health Clinic have been equipped,” adding that the state was also recruiting health workers into flagship PHCs.