Healthcare in FCT: A Case of Dysfunctional Service Delivery, Overcrowded General Hospitals

The health sector in the Federal Capital Territory is confronted with many challenges that hamper delivery of public and primary health care delivery in the territory, Olawale Ajimotokan examines some of those issues

Poor Infrastructure and Overcrowded Wards

A visit to some of the secondary health centres in the FCT showed that many of the facilities were ill-equipped and overcrowded. The Nyanya General Hospital which was established by the Federal Capital Territory Administration in 1991 is a case study.

The failure of the administration to give it a facelift among the secondary health centres only reinforced its deplorable state.

The hospital has little space for expansion and performance of critical task while many wards are always overcrowded with patients in need of attention.

When our correspondent visited the hospital, the antenatal ward was brimming with pregnant women in dire need of attention.

The women waited for several hours before they were ushered into one of consultation rooms for appointment with doctors.

“I came here by 6 a.m. but and I am yet to be booked for appointment with a doctor and it is already past 10 now,“ lamented one of the patients.

Ogbole (first name withheld), who resides at New Karu, also moaned that Nyanya is not equipped for critical health cases.

He said that he was referred to Asokoro District Hospital after he brought his daughter, who required medical treatment for an ear infection.

He urged the FCTA to adequately equip the hospital so that its services can be expanded and improved to meet public expectation.

Our attempt to meet the hospital’s Chief Medical Consultant for her views on our observations was futile as she was said to be on annual leave when this story was investigated.

The situation was not different at Maitama District Hospital, where there was a surging crowd at the antenatal wards, children’s ward and family ward.

Some of the patients complained they had to wait for several hours before consulting doctors. In addition some patients decried the poor service at the cash points where they paid for drugs, tests and other services.

One patient, Mrs Chigoze Okwudili urged the hospital management to consider employing more hands at the cash points to reduce the long waiting hours and agony of patients.

A major observation at Wuse District Hospital was lack of bedding for patients that require treatment and admission.

A man seeking anonymity complained that his son died of malaria because the hospital management refused to admit him on the ground that there was no bed space.

He said after he was eventually checked after the stress of registration at the General Outpatient Department (GOPD), the doctor on duty advised them to try another hospital because there was no bed space.

He added they eventually tried a private hospital in Garki where his son died on admission for an unresolved plasmodium.

Failure of Primary Health Care

The Primary Health Care (PHC) is the foundation of healthcare system in Nigeria and functions as the level at which non-emergency, preventive health issues are resolved. But sadly many of the PHC centres in the FCT are poorly equipped, lacking well trained personnel.

The deplorable state of these facilities is one of the causes behind the congestion at the clinical wards in the secondary health facilities in the FCT where patients seek health care delivery.

Nigeria joined other countries to adopt the international declaration on primary health care in Alma Ata, the former USSR in 1978 as the key to health for all.

Sadly, after the declaration, the implementation of PHC has not been properly done in the country.

The immediate past acting Executive Secretary FCT PHC Board, Dr Ndaeyo Iwot put the crisis facing public health care delivery in the FCT in proper context while sharing insights on the issue.

He said not up to one per cent of the 243 public health care facilities in the FCT are functional because of poor funding and lack of law and governing structure for the realisation of the PHC care in the territory.

Dr. Iwot said the overwhelming pressure on general hospital facilities in the FCT stemmed from the inability of the primary health care centres to rise to the occasion.

He said patients prefer the general hospitals and private health sector to PHCs with the belief that such facilities are better equipped with drugs and personnel.

He noted that if PHC is working in FCT, only a very small number of pregnant women will need specialised care on referral at General Hospitals to deliver while 80/90 per cent of normal deliveries can be taken care of in the PHC.

Describing PHC asdemocracy of health for the people by the people and of the people, Iwot said the people should be part of planning and monitoring of PHC which should bea system thatboth government and communities can afford to sustain at every point of their development.

“The National Health Act of 2017 as amended is very clear that the National Health system shall include not the bottom to top approach that has been embedded there –community health system is paramount. Do we have community health system in this country? If you don’t have community health system why are you talking about PHC? The thing about community health system is when you have a village head committee for every village that is up to the population of 500 people then you have the permanent health clinic.

“That village head committee is expected to also have a health post of a room or two and volunteers they can train and put in charge of the community clinic. All these things are supposed to do but not doing in this country,” Iwot said.

He also cited the PHC bill which specified how many public health care facilities were required in FCT including the number of doctors, nurses, midwives. The bill also said N8 billion is required every year in the next five years to address PHC in the FCT for infrastructure, staffing, drugs and for community health system be put in place.

High Maternal, Infant Mortality Rate in FCT

A report by UNICEF said as at 2019 the maternal-infant mortality rate caused by malaria, diarrhea in the FCT was 46 per 1000 live births.

The report said many women delivered babies at home because there were no enough health care centres at the wards.

 Iwot noted that the only way to address that high rate is by focusing on PHC, using quality drugs to treat endemic and prevailing diseases that are killing pregnant women, particularly malaria fever.

“When you are having malaria in pregnancies it can lead to loss of blood for mother and her foetus, that will not have quality blood and many of our women go into pregnancy with no blood. Ninety percent of the complaints in the hospitals include women having fever.

” Malaria kills their blood quality and the baby in their uterus is already malnourished and is likely to have issues. And when the parasites are also cumulating in the placenta and other areas, you would see that baby may eventually die in the woman. The woman during delivery may lose small blood and die,” Iwot said.

He decried the treatment provided women who go for antenatal care in the general hospital and PHC facilities, describing as appalling a situation where a woman that is already having blood issue is given one tablet of iron and one tablet of folic acid.

“People are not given minimal optimal care that will save life. How do you expect the numbers to change? And this has been going on not just now but from since 1978 when PHC was launched, which should set up the structure to take off all this but we are yet to realise the structure. That is what is painful that we have the technology and the knowledge but we are not playing it.

 “The money that is required to do this can’t be provided by government alone. You will need about N8 billion that is required in PHC every year for the next five years in FCT. Government can bring only N2 billion and you need to fund the N6 billion gap by engaging corporate organisations,” Iwot said.

Lack of Health Insurance

Iwot also lamented that although the emergency case system has been launched in the country the health insurance is not giving access when it is supposed to alleviate financial burden of many and improve health care delivery.

 “They will go to the facility and confirm that it is up to date. You have health insurance, you go to a place, they don’t have drug, they don’t have staff and yet health insurance is not helping us because they are supposed to ensure standard because risk is involved. When risk is involved you must operate in an optimal level to minimize those distractions that can lead to risk increasing. 

“So the insurance companies involved in the health insurance in informal sector in any place that brought in staff to get healthcare services must be brought to standard before it is approved. That is the law. So, we have to enforce all these ones for us to implement health for our people. And people should be actively involved and ask questions and go to court because you have a law now that could be taken to the court.  If that is done against two or three persons involved in the health system people will surely change.

“But no one has gone to the court. When someone dies in the hospital you don’t ask for the review, no coronary, nothing is happening and people will just go that it is work of God. God does not kill you –it is human being that is destroying, so we want people to  read that Act, demand for justice and go to court , so that people will seat up and begin to do right things.

“You can sue government because it is the responsibility of government to provide infrastructure in general hospital, tertiary hospital. If it is not there you can sue government and I am very sure that will also lead to so many persons that they will be held responsible. And people will get to change,” Iwot said.

Quote

The overwhelming pressure on general hospital facilities in the FCT stemmed from the inability of the primary health care centres to rise to the occasion…patients prefer the general hospitals and private health sector to PHCs with the belief that such facilities are equipped with drugs and personnel