Inadequate staffing, poor infrastructure and others pose concern to mothers, children and other residents in accessing basic healthcare in Enugu State. Okechukwu Onuegbu explores this in this investigative report.

On Wednesday June 15, 2017, when Mrs Anastasia Nworie was in labour at about 9pm, she sought for a local midwife or Traditional Birth Attendant (TBA) in her community, Nachi, Udi LGA. Luckily, she was successfully delivered of a male child, Chizaram. Nachi has one Heath Centre at Enugu-Ameke village serving her four villages. The health centre, which shares boundary with Community Primary School, Enugu-Ameke is an edifice with a waiting room, now turned to immunisation office.

It lies in the heart of the bush, far away from home, very lonely unless when the primary school besides it is in session. Although it currently has solar powered refrigerator for immunisation purposes, other facilities like water, ultrasound machine, alternative power supply, security and others were unavailable. It was not even fenced, making its workers non-resident.

It was learnt that the poor village women manage to visit the health centre mostly for immunisation or antenatal care purposes. But when it comes to delivery, they either seek help elsewhere like TBA, private hospitals or travel to Udi General Hospital. When visited on November 11, 2019, not even a signpost was found for easy location. The route to the health centre has only two signposts, Community Primary School, Enugu-Ameke and Living Christ Mission. The deplorable road took this reporter almost 30 minutes by trekking.

Two female nurses and a male in mufti were seen. The supposedly officer-in-charge of the facility, who introduced self as ‘nurse Ikeorah’ told our disguised reporter they report to work every day. But, during our repeated visit at 12.15pm on 18th November, the health centre was under lock and key. A woman farming beside it told our reporter they left ‘few minutes ago.’

Like in Nachi, most public Health Centres visited in Enugu state are inaccessible to pregnant women. At Ukehe, Igbo-Etiti LGA, a pregnant teacher, Mrs Tina Eze, complained that she was referred to a private hospital when she developed complication at Ukehe Primary Healthcare Centre in 2017 due to insufficient facilities.

Her two children were reportedly delivered in the health centre but the third one did not come out even after rupture of the membrane. She was subsequently referred to a private hospital where a baby boy came out through Caesarian Section (CS). She claimed to have spent about N20,000 for the CS instead of N3,500 the health centre would have allegedly charged her for normal delivery.

She might be lucky compared to Umulungbe (Udi LGA) where pregnant women seek medical care in neighbouring communities. In 2018, a woman was said to have lost two children to complication after a ‘successful’ delivery in one of the existing TBA in the community. Umulungbe parked into Akpato Health Centre, a building where work is in progress, in October 2019. The edifice, built by the community with support from the Enugu state ministry of health, was a shadow of itself when visited on November 14.

Likewise, Mrs Cynthia Chuks, who was delivered of a baby boy on May 21, 2019, at a private hospital in Enugu alleged that her husband relocated her to the city after receiving antenatal care at Awgwu health centre in Awgwu LGA due to inadequate facilities.

These were despite budgetary allocations to the health sector every fiscal year. The capital expenditure for the Ministry of Health in 2019 was N1,112,200,000; N212,400,000 for Enugu State Hospitals Management Board; Enugu State Primary Healthcare Agency (N300,300,000). Also the recurrent expenditure for the ministry of health in 2017 was N398,995,191; N472,371,131 for 2018; and N275,037,904 in 2019.

However, the recurrent expenditure for Enugu State Primary Health Care was zero in 2017, N96,900,000 in 2018, and N114,900,000 in 2019, while those of State Health Board stood at N1,283,299,426 in 2017, N2,367,664,084 in 2018, and N2,367,664,084 in 2019. In 2018, the detailed budgeted capital receipt of the state indicated that N50,000,000 was expected for Health Reform Programme (Free Maternal and Child Health programme (FMCH) but was probably not spent as the column for ‘Actual’ on the budget read ‘zero’.

Enugu state government, it would be recalled, claimed to be running FMCH at the state Health Centres and General Hospitals. According to a report published on the state ministry of health website, FMCH, which began in 2007 was a policy aimed at providing free medical, antenatal, delivery and post-natal care to poor women and children in primary and secondary hospitals, and those referred to tertiary hospitals in the State.

Governor Ifeanyi Ugwuanyi while presenting the 2019 budget estimate of N109, 199 billion to the state House of Assembly last December, said his administration was committed to sustaining and improving on it. He allocated N2.37 billion to health ministry. A total of N50,000,000 was allocated for the FMCH programme in 2019.

To find out how these budgetary allocations were utilised in improving the state of Health centres especially as concerned maternal care in Enugu State, prompted this investigation across 3 senatorial districts namely: Enugu East, Enugu West and Enugu North. Three LGAs were visited in each of these zones. They include Nkanu West, Enugu North, Enugu South, Ezeagu, Oji River, Udi, Igbo-etiti, Nsukka, and Udenu.

At each of these LGAs, the reporter accessed two communities or two health centres and General Hospitals (where possible). They were Nachi Health centre; Udi General (district) Hospital; Akpato Health centre (Umulumgbe); Basic health centre and maternity, Mile 2 Orji river; Oji River General Hospital; Agungu Health Centre; Isiagu-Umumba Ndiagu health centre; Agba Umana Health centre; Ogui Nike Health Centre; and Poly Clinic (Poly General Hospital) Asata.

Others include Uwani Health Centre; Akpugo Agu health centre; Ndiuno Uwani Health Centres and quarters (Akpugo); Ozalla Health centre; Umueze Health centre; Model Health Centre (Agbamere ward) Eha Alumona; Ukehe Primary Healthcare centre; Orba ward model primary health care centre; and Imilikenu Health centre.

Findings:
The investigation revealed that most of the state health centres fall below the minimum standard for the primary level of health care facilities approved by National Primary Health Care Development Agency (NPHCDA, Ward Health system 2018) which include that building and premises must have two rooms with cross ventilation, walls and roof must be in good condition, functional separate male and female toilet facilities with water supply within the premises, a waste disposal site, be clearly signposted, among others.

It was also learnt that the workers demand registration fees of between N1000 to N2000 despite the claim by the Enugu state government that they were running FMCH. This enrollment fees allegedly cover opening of folder, cards, and prenatal laboratory tests such as hepatitis, genotype and malaria, blood group, HIV, Sphilis, routine drugs, others.
Some nurses and pregnant women allegedly pegged N3500 to N5000 as charges for normal delivery. Some of the nurses equally claimed that the FMCH programme was suspended three years ago owing to the fact that the state government was no longer supplying them with free drugs.

But women do not really bother about the payments. All they want is optimum service delivery. Mrs Georgina Madu, a volunteer labourer at Isiagwu Umumba-Ndiagu Health centre lamented that the only public Health center in the community of five villages, was in shamble.

“It has only two old beds, no light, no water and useful drugs. Only two nurses work there. And they don’t live in the vicinity because of bushy environment. This is why my children took my husband to Enugu for treatment two days ago. They have no toilet and bathroom. So, you see why pregnant women come for immunisation there and seek better place while in labour,” added, Mrs Madu.

The entrance gate into the Health Centre was locked when visited at exactly 12noon on Friday 15th November. A notice pasted on the gate revealed that the nurse on duty travelled to Aguobu-Owa, Eziagu LGA headquarters for a training since 14th November. The phone numbers on the post was called three times without response.

A Short Message Service (SMS) “Hello, my wife is on labour and I can’t see you. Do you advice I wait or take her to somewhere else,” was sent to it. No reply. But at 4.38pm she returned her calls. This reporter, who was indisposed, contacted her back at 5.20pm only for the receiver (a female voice) to say she had been on a training since 14th November.

At Agba Umana Health centre, no one was sighted as at 2.15pm on November 15. The two phone numbers found on the Health Centre’s nurses’ duty roaster hanged on a wall were switched off as at 2.49pm. The documents further showed that two nurses manned the facility on shift basis.

It was equally observed that the Health Centre was last renovated in 2010, while its perimeter fencing was abandoned halfway for a year or more.
Also, there were no accommodation for nurses in the environment full of grasses. The ceiling and window (glass lobes) of the building suggested that they had security threats. A peep through some vandalised windows showed that it has ten old beds, no power supply, among others.

The story was the same at Ukehe Primary Healthcare centre, where every pregnant woman desiring to be delivered of her baby, reportedly supply power and water. Their power generating set and borehole allegedly stopped working less than a year after its construction. It was also learnt the centre has nine staff, all work in two persons pay shift. Their solar powered refrigerator for immunisation was dysfunctional.

“This place leaks whenever it rains. This uncompleted perimeter fence had been here for over six years. As you can see, the alternative power supply machine installed about six years ago had been overtaken by bush. It was not used for once because the contractor locked up the equipment alleging he was owed by government,” a junior staff of the health centre bemaoned.

The health centre has no signpost, even as its nurses and doctors quarters were not inhabited due to the bushy environment and unavailability of doctor. The two elderly security men working in the centre were appointed by an undisclosed politician on salary scale of N5000 each per month.

Basic centre and maternity, Mile 2 Orji river; and Ogui Nike Health Centre (renovated on October 3, 2000), visited on November 11 and November 12 respectively, although fenced, have untidy environment as well as lack security, alternative power supply, among others. Agungu Health Centre visited on November 11 was still inhabiting an old building situated in uncompleted perimeter fence abandoned about five years ago, with no nurses and doctors' accommodation. Thus, its staff leave office from 6pm daily and could only attend to women in labour at night if previously arranged for.

Similarly, Ndiuno Uwani Health Centres and quarters (Akpugo); Ozalla Health centre; Umueze Health centre; and Imilikenu Health centre, all lack perimeter fence, security and water supply to boost their works. It was gathered that these health centres including Model Health Centre (Agbamere ward) Eha Alumona have insufficient staff. A source at Model Health Centre (Agbamere ward) whose entrance gate had dilapidated, added that power supply, solar refrigerator, security and drugs were their major concern.

A nurse met at Imilikenu health centre said they fetch water from someone’s house close to the institution as their water facility had gone moribund. The water scheme sited at the health centre by the Enugu state government as a client with the assistant of Water Aid had been overran by grasses. At Akpugo health centre (Akpugo Agu) fenced with doctor and nurses accommodations, lack alternative power supply having allegedly lost one to hoodlums. Also, it seemed to be lacking renovation after been commissioned on April 29, 2005.

As a result of these challenges noticed in rural health centres, urban based general hospitals like Udi hospital, and Poly Clinic (Poly General Hospital), including the newly renovated Orba ward model primary health centre and Uwani Health centres, were observed to be usually busy and crowded during immunisation and antenatal cares. This was the case with Poly Clinic where a mammoth crowd of pregnant women and nursing mothers were seen either sitting or standing on November 13.

Attempts to speak with the Enugu state Commissioner for Health was futile as this reporter could not see him in office when visited on November 12, 14, 19, 21, 26 and 28. However, when contacted, the Executive Secretary, Primary Health Care Development Agency, Dr George Ugwu, said he was appointed recently to head the agency, which according to him was recently assigned a supervisory role to all the health centres for optimum service delivery.

Ugwu, who said the state government recently re-positioned some health centres in the state as model primary facilities namely those in Abakpa, Uwani, Oji River and Obollor, said the state government was doing everything necessary to revamp primary health care centres in the state with a vision to take health care need of people across communities.