Tonigbo-Amobi, and Ojelana are two communities of Ijebu East Local Government Area (LGA), Ogun State, where bats infestation and dead infrastructure deprive residents of equitable access to healthcare services.
Investigations by Pharmanewsonline revealed that the health centres available for the use of people in the two communities are not only in deplorable conditions but also grappling with the challenges of dilapidated infrastructure, insufficient equipment, inadequate personnel, lack of power supply, filthy surroundings, environmental pollution from bat excreta and constant noise among others.
While some agile men still manage to cope by patronising the centres once in a while, pregnant women and nursing mothers in Ojelana community narrated their ordeals to our correspond, in travelling miles through dusty and deplorable roads to access basic healthcare in the town. Those who cannot face the troubles patronise traditional birth attendants, herbalists or nearby healthcare centres that lack basic amenities and staff.
Health centres plaqued by bats influx
One of the most obvious signs of bats infestation in the facility is the foul smell from their droppings. The feces have a strong odour mixed with urine smell, similar to ammonia. Also, the dark droppings tend to leave stains on walls, flooring, and ceilings.
On a sunny Thursday afternoon around 2 pm, this reporter walked into Ojelana Health Centre, a Public Primary Health Centre, located at Ojelana Community, Owu, Ijebu East LGA, Ogun State, which was established on 5 April, 1981 and operates on 24hrs basis. Suddenly, he halted his movement into the facility due to the foul smell oozing out of the centre, which he later understood to be the smell of the bat feces.
It however took the intervention of the lone staff at the centre, Mrs Bunmi Ibrahim, who persuaded him to come inside. Beaming with smiles, Ibrahim said she and others who use the health centre are used to the foul smell, adding that they have been battling with the challenge of bat infestation, which has damaged all the ceilings and rendered the health centre inhabitable for years.
According to her, “We do take delivery here, but many people don’t want to use this place. We do go to their houses to mobilise them to come around but they won't come as they prefer to go to the town, due to the unconducive nature of the centre. Meanwhile, as deplorable as this place looks, we serve 41 communities around.”
A pregnant woman sneaked out and ran away
Mrs Ibrahim, a health attendant by qualification, narrated further, “Due to the condition of this place, many don’t want to deliver babies here so we have only delivered one baby in the whole of 2023. I had a case of a woman who was brought down for delivery by her mother-in-law, but as soon as she got here, I informed the matron, Mrs Audu on the phone who in turn took the next available bike to come down here.
“Soon after the pregnant woman got here, one of our rickety beds was allocated to her and I dashed out to get one or two things to use in the delivery, but to my amazement, the pregnant woman sneaked out and ran away. I later went to her mother-in-law who brought her and I was told that she had taken a bike to the town for delivery. She complained that she is afraid she and her baby may not survive the delivery due to the condition of the centre, and we have had several similar cases like that”, she said.
Corroborating on the challenge of bat infestation, the Ekeji Ilu (second in command to the village head), Mr Azees Nurudeen, popularly known as Baba Ruka, noted that the problem of bat invasion is not only peculiar to the health centre, as it’s a major issue in the area, adding that the health centre's case has been poorly managed due lack of support from the government.
We have had several people who came here to assess the place with the hope of getting help from them, but none has come so far. I do tell people that this place is not even befitting enough for a dog to sleep in not to talk of healthcare provision, so it’s disheartening and worrisome. I don’t blame people who abandon the facility and seek healthcare elsewhere because this place is not healthy for even animals to receive healthcare not to talk of human beings.
Dangers of bat feces and urine
Bat droppings can grow histoplasmosis fungus, which can lead to severe respiratory problem for you and your family. The droppings have eggs in them, which can be inhaled and negatively impact the central nervous system of humans, leading to diarrhoea, dehydration, and more serious health issues. Bats are also frequent carriers of rabies, so it is usually recommended for people with such challenge to hire the service of professionals for the removal of such droppings.
Bat urine also contains high concentration of uric acid which is strong enough to corrode metal. If left overtime, it can begin to affect a building’s structure, such as the waterproof membrane beneath tiles or metal sheets of a roof, leading to structural damage.
Relatives of patients fetch water for the facility
The claim that the residents fetch water for the health centre from the stream is not true, said Mrs Oluwayemisi Igbosanu, a community health worker, and head of the facility, Tonigbo PHC.
She said, “We don’t have a borehole at the centre, even the whole community does not have a borehole, so everyone relies on the stream water, so we are buying water with the little money allocated to us under the basic health scheme, and you don’t expect us to exhaust the water on the delivery alone, so we decided that the relatives would have to fetch water from the stream to take care of their delivery.
“It is not peculiar to only us but all the facilities around that have no boreholes. We spend almost all our allocation on fumigation because of the bat challenge.”
She added, “We do take delivery under solar light, but the greatest challenge has been bat infestation and it is quite challenging to the extent that it's affecting our structures and the foul odour that came with it is quite unbearable. We are constantly on fumigation to ensure that the place looks habitable a little. We do fumigation once in 3 months when it’s rainy season.
Residents Reactions
Mrs Yemisi Mathew (Iya Seun) said “We use the health centres and we gave birth to virtually all our children there since we don’t have any alternative. People came from faraway towns to give birth there.”
According to Mr Oluwatoyin Amusa, a farmer, “People are patronising our health centre but the place needs serious maintenance and upgrading so that it would meet up to standard. Imagine if someone is about to give birth here, the relatives or husband would have to walk several kilometres to fetch water from the stream before the delivery could be taken.
He added that it has happened to him before, “in a situation where there is no water, the delivery would have to be on hold, which is not the practice in the town, so this has to be looked into because it has become normal practice here”.
According to Mrs Odunayo Olatunde, a pregnant woman who registered at the health centre, “I am seven months gone, and so far it has been good and we have no issue with them. I am under the Ibidero Scheme of the government as well. As for the issue of water, it’s a challenge that we are all used to and I am prepared that when it’s my turn to give birth, the fetching of water is a debt that we all must pay, she said.
More worrisome cases
The sorry state of Nigeria’s PHCs is also reflected in Igede Alaro, a community in Ijebu North-East Local Government Area of Ogun State. The facility was almost taken over by weeds, while the centre was under lock and key for about 2 hours, while this reporter was around waiting for the arrival of a lone staff, whom residents confirmed had gone to the Local Government Headquarters in Atan for an important meeting. They also said she has been the only one manning the facility for the past 5 days.
The centre was overgrown by weeds and the surroundings was occupied by goats when Pharmanewsonline visited on 22 December, 2023, between 12 pm to 2 pm. The people of Igede Alaro had thus continued to rely on the centre as their only source of getting healthcare.
In a phone conversation with this reporter, Mrs Adegoke, popularly known among the residents as ‘Mummy Mary’, noted that the absence of her colleague who was supposed to run a one-week shift at the time the reporter visited was unusual and unfortunate, adding that although the job is stressful, they are always at work.
The 40-year-old mother of two said before the appointment of her partner, Mrs Awosanya, who was supposed to be on duty on that day, said she had been the only health worker at the health centre for months, adding that they have two communities, Idotun and Ijede under the centre.
“We don’t take delivery and we don’t have much drug as such. The ones we have we sell them. We resume at 9 am and close by 4:30 pm. Mrs Adegoke recounted to this reporter her experiences on each day how she closes late and struggles to get back home in faraway Ijebu Ode.
“We have issues with the security and bush around, so it took the effort of the community to help us clear the bush with the aid of chemicals. I had to fix the light by myself when we had no light”, she disclosed.
The Honourable representing the Igede Alaro Ward, Ijebu North- East Local Government, Hon. Idowu Michael, who observed the movement of our correspondent around the facility, noted that the two staff who were on weekly shifts have been discharging their responsibilities well and have never abandoned the centre in such manner they did before.
An ideal Primary Healthcare Centre
Going by the blueprint of the National Primary Health Care Development Agency (NPHCDA), a PHC should have one or more doctors, a pharmacist, a staff nurse and other paramedical support staff to provide outreach services.
It should also have a well-equipped open ward, labour room, children and female wards, doctor’s office and staff quarters, an ambulance for referrals and drugs and equipment for immunisation, preventive and basic curative care. The centre is also to provide monitoring and evaluation, as well as maternal and child health services.
The Civil Society Legislative Advocacy Centre (CISLAC) in 2020 reported that many Nigerians, especially those in the rural and semi-urban areas, rely on Primary Health Centres (PHCs) for healthcare services and that only 20 per cent of the 30,000 facilities across the country are functional.
Despite the policies of successive Nigerian governments and political leaders to improve and expand primary healthcare, the Nigerian PHC system remains in a deplorable state.
Decaying facilities litter the locations visited in the state, despite an allocation of N300, 000 to each of the 236 PHCs in the state every quarter, as confirmed by the Executive Secretary of the Primary Health Care Development Board, Dr Elijah Ogunsola, for the maintenance, and procurement of healthcare equipment and provision of transportation facilities under the Basic Health Care Provision Fund.
Ogun State still has PHCs with dilapidating and deplorable infrastructure. The public-owned primary healthcare facilities suffer from delays in budget flows, which slows down repairs and investments in infrastructure and services.
Local government denies knowledge of the situation
Ijebu East Local Government under the Chairmanship of Hon. Adetutu Elizabeth Oyesanya, is the largest LGA by area in Ogun State, with an area of 2,234 km2 and a population of 110,196 at the 2006 census. Some of the major towns in the LGA include Itele Ijebu, Ijebu Ife, Imobi, Ijebu Imushin and Ogbere where the LGA's secretariat is located.
Recall that the chairman was sworn in September 2023 after her erstwhile boss, Hon. Wale Adedayo, was impeached by councilors for alleged financial misappropriation and diversion of council funds, among other allegations made against him.
Fielding questions from our correspondent, the new chairman explains the LGA’s position and effort towards ensuring a functional and well-equipped facility under the current administration.
“We have a new government and all that needs to be addressed will be put into proper perspective to see that all PHCs in Ijebu East get the best attention they need. We were never aware that these PHCs you have mentioned are in such terrible conditions, although we know there are pockets of challenges here and there, the issue of bat infestation has never been presented as a major challenge, notwithstanding, we will act swiftly.
She continued, “My administration is relatively new because I took over barely some months ago, but the conditions of some of the health centres in the local government have been a burning issue in my mind, and the Governor has not relented in ensuring that the issue of health takes the front burner. I want to assure you that the Ojelana Health Centre and Atoyo Centre will receive attention from the beginning of 2024, as work on its renovation will begin in earnest”.
Govt heap blame of inadequacy on PHCs officers
Reacting to some of our findings, the Executive Secretary of the Primary Health Care Development Board, Dr Elijah Ogunsola, disclosed that the governor pays an impress of 300, 000 every quarter to all the health centres across the state, which is 100,000 monthly, wondering what they used the money for if there is no water.
“I can tell you authoritatively that each of the 236 health centres in the state got it three times in 2023, which is close to one million naira each, so what did they use it for? So, if you do not have water, you should ask yourself what happened to the water that was there before, so we should ask them.
“Apart from the infrastructural development that the Governor is concerned about, he also made sure he pays to the tune of almost one million naira to the health centres, not to talk of the money they also make on their own from patients, so what are they using the money for, does any country develop that way?”
Speaking on the issue of ‘inadequate personnel’, especially as regards the issue of one health staff per centre, Ogunsola, said the Ministry of Health (MOH) at the LGA are in the best position to ensure they distribute human resources very well, noting that some health workers have been reposted in the various LGAs to beef up human resource issues.
“As you know the issue of human resources is not only peculiar to Nigeria but it’s a global challenge and people are migrating every day in the name of ‘Japa’, so probably in those places, we have the issue of people that have left, but I expect the MOH to have move people to beef up the shortage in the affected centres.”
Bat infestation and other challenges are not peculiar to Ijebu East
In his reaction, the Administrative Officer of the Ministry of Health, Ijebu East LGA, Dr Kazeem Oladipupo, noted that every LGA has its peculiar challenges, adding that for Ijebu East, it is not different from others.
According to him, the issue of bat invasion is more of a natural challenge than man-made, saying that the Ministry of Health at both the local and state governments are presently on measures to rid the health centres of the challenge.
Speaking on other challenges facing the primary healthcare provision in the local government, Oladipupo noted that rural-to-urban migration, which usually leads to reduced population has rendered some centres useless, saying fewer people patronise the PHCs.
Demoralised workforce
One major thing that unifies all the health facilities visited under the Ijebu East and Ijebu North East Local Governments is that, while patients voiced their frustrations about the deplorable conditions of the centres as well as inadequate skilled personnel, staff, especially the junior ones, complained of doing more than they were paid. One personnel explained, “The high number of patients looking for the attention of few workers who are stretched and overworked is a major problem”
The standard practice observed at the three health centres is that one staff is placed on a weekly shift, and they are mostly forced to do other work, not originally meant for them, including the night shift.
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