Sabo Primary Health Centre, Ibadan, is one of the primary healthcare centres recently renovated by the Oyo State Government. Despite the renovations, Ajoke Bashiru recalls her frustrating experience when she gave birth at the centre on Monday, June 17, 2024. “I shared a small ward with three other women, and the staff seemed overwhelmed,” she said.
Ajoke’s story highlights a larger issue plaguing PHCs across Oyo State: an inadequate workforce and equipment shortages, leaving both patients and health workers frustrated despite massive investment.
N12 Billion Investment in PHCs
Since Governor Seyi Makinde assumed office in May 2019, the Oyo State Government has allocated over N12 billion to enhance service delivery at Primary Healthcare Centres (PHCs) across the state.
On March 15, 2024, the state government, via its Feedback Oyo platform, announced collaborations with local governments to construct or renovate 299 PHCs across the state’s 351 wards, as part of Governor Makinde’s Roadmap for Accelerated Development (2019-2023).
For instance, the government’s 2023 budget allocated N2 billion to the Primary Health Care Development Agency (PHCDA) to renovate 209 PHCs, purchase monitoring vehicles, and meet UNICEF funding requirements. In 2024, an additional N4 billion was budgeted for similar projects.
According to Oyo State Government Feedback Service, the contract for the renovation and upgrading of these primary health centres was awarded to Dominant Engineering Limited and Lanocks Construction Company Limited.
However, despite these investments, many PHCs in the state remain below the standards set by the National Primary Health Care Development Agency (NPHCDA). While the renovations have largely improved the physical appearance of the facilities, crucial issues such as staffing shortages and a lack of essential equipment remain unaddressed.
According to NPHCDA guidelines, a PHC should offer 24-hour services and be located on at least 4,200 square metres of land in a fenced standalone building with a minimum of 13 rooms.
The centre should also have staff quarters, essential drug supplies, equipped laboratories, and consistent electricity and clean water access.
Government neglects critical issues
During a tour of four PHCs- Ologuneru, Sabo, Agbowo, and Oba Adeyemi on June 2nd, 19th and 20th, 2024 respectively, it was revealed that government-funded upgrades prioritised aesthetics over functionality.
For instance, Ologuneru PHC still looks dilapidated, and many centres lack basic essential facilities such as labour rooms, functional drug dispensing units, and injection rooms. These shortcomings force residents of the areas to seek medical care elsewhere.
Many residents said they travel far or pay high fees at private clinics for medical care because their public health centres are dysfunctional.
This burden falls hardest on the elderly and vulnerable, who cannot travel far or afford the charges by private clinics.
Ologuneru PHC
“Imagine a mother taking a child with fever to the health centre only to meet a long queue and tired nurses juggling multiple roles,” a patient at Ologuneru PHC, Babajide Adeola recounted his experience.
“There is no pediatric ward and no doctor on the ground. The nurses are overwhelmed and lack proper equipment, so they can only offer limited care,” Babajide explained further.
Another patient, Ajibola Bolatito, said she had her baby at a private hospital. “The shortage of staff and inadequate facilities forced me to deliver elsewhere, and I only came here for postnatal care,” she held.
The government also seems to have overlooked people with disabilities (PWD), who are entitled to equal access to public buildings.
According to accessibility laws, public buildings must include features such as ramps and lifts to ensure usability for PWD. However, during a visit to Ologuneru PHC on July 2, 2024, our reporter witnessed elderly individuals struggling to climb the steep stairs due to the lack of accessibility aids.
Adedeji Ajibola, a resident of Ologuneru, shared that he opted for a private hospital because the local PHC lacks a doctor. “I came to the centre one morning when my child had a high fever. The crowd was overwhelming as it was parental education day for pregnant women and new mothers. I had no choice but to leave for a private hospital,” he said.
The matron at Ologuneru PHC, Ojo Awo, highlighted another issue: the lack of restrooms for both staff and patients, which impacts patient care. Though the Rotary Club renovated the toilets, they were soon vandalized, as the centre lacks a perimeter fence.
“When patients need to use the restroom, we prioritise quick treatment so they can go home and use their facilities,” she said.
According to the matron, Mrs. Ojo, security is a major concern, particularly at night and during periods of unrest, due to the absence of a perimeter fence.
Mrs. Ojo also mentioned that the clinic faced significant water access issues until June 26, 2024, when Senator Alli Sarafadeen of the Oyo South Senatorial District donated a borehole to the facility.
Additionally, the local government occasionally provides drugs when the centre’s supplies run low.
Sabo PHC
At Sabo PHC, the Officer in Charge, Akinlabi Akande, reported that no doctor had been assigned to the centre.
The facility also lacks a laboratory, equipment and a standard pharmacy. “If we had the necessary resources, we wouldn’t need to refer patients elsewhere,” Mrs Akande said. “We often refer patients to Jericho or Adeoyo because we can’t manage their cases,” she added.
Mrs Akande said that PHCS can provide robust healthcare services at the community level if it is properly funded and managed. “If we had everything we needed here, we wouldn’t need to refer patients elsewhere,” she reiterated.
Bilau Kehinde, the tuberculosis supervisor for Ibadan North, and Ogundele Kafayat Motunrayo, a community health extension worker, echoed the same concerns about the shortage of staff.
The two officials stationed at Sabo PHC said the centre needed additional staff and basic medical equipment. It had only three permanent staff members, with a few others working ad hoc.
However, Nafisa, a Sabo resident who frequented the local PHC, said the public facility’s shortage of doctors and nurses was forcing many residents to seek care elsewhere.
Agbowo PHC
Despite it being part of the newly renovated PHC, it was discovered that some of the roofing at Agbowo PHC is in bad condition. Some sections have ripped off completely from the ceiling, while others are still hanging precariously.
The Officer in Charge, Mrs Olanrewaju Omolade, raised concerns about the damaged ceiling, the inadequate number of chairs for patients, especially during immunization and antenatal days and the shortage of staff to manage daily activities at the centre.
“On Wednesday, June 19, 2024, nearly 200 babies were brought for immunization due to the public holiday the previous week. We couldn’t provide enough chairs for them because we only have a few, and there wasn’t enough staff on hand to attend to all the patients,” Olanrewaju explained.
A resident, Mrs Ajibade Odunola, who gave birth at the centre, shared that during her delivery, pregnant women were once asked to bring petrol due to the centre’s inability to afford it, following the increase in PMS prices.
She also highlighted the staff shortage, stating, “Most times it might just be one or two people that will be on night duty. Even when I was in labour, it was only two of them that were on duty that day, despite the fact they had three pregnant women to attend to that night. During that period, they brought in some patients who had sustained injuries from an accident that night. How can just two people cope or handle all of these at a time,” Ajibade complained bitterly.
To corroborate with what Olanrewaju and Ajibade said, Aleju Kafayat, a registered nurse at the centre complained that the centre lacks some equipment like resuscitation devices for asthmatic patients. She also added that they only have a visiting doctor who comes twice a week.
However, Mrs Adewale Bolanle, who came to check on a patient, commended the centre’s efforts despite the staff shortages. “There was a time they were asked to stop working due to a strike. During that period, a parent brought in a faint child, and the staff did everything they could to resuscitate the child,” Adewale noted.
Although she complained that the centre has stopped providing free drugs, patients are now asked to purchase medication from the pharmacy, as the government is no longer supplying drugs to the centre.
Communities and NGOs bridge the gap
The Officer in Charge at Sabo PHC, Mrs Akinlabi Akande noted that community leaders have been providing support to her facility.
“What was once a six-hour clinic is now running 24 hours, thanks to community involvement. With their support, we are able to operate in three shifts- morning, afternoon, and night. The community helped employ four staff members, with me being the only permanent staff. The rest are ad-hoc, and Basic Health employs two,” Mrs Akande explained.
“Without the community’s assistance, we wouldn’t be able to sustain the three shifts. This centre was among those renovated by the government.”
A health technician at Oba Adeyemi PHC, Oyo town, Mrs Busari, highlighted the vital role of local leaders in public health initiatives: “For our immunization programs, we rely on imams, pastors, elders, and traditional rulers to encourage community participation. Some residents are resistant to immunizations unless they receive food, so the support from these leaders is invaluable in overcoming those challenges,” She stated.
She said some community-based NGOs also donated drugs for pregnant women.
Ogundele, another health worker, mentioned that the community has absorbed some voluntary workers. “The community development committee is doing commendable work, regularly engaging with political leaders. However, the feedback we receive is that the Oyo State government has yet to recruit additional healthcare workers.”
Efforts to contact Seri Ajetunmobi, the Oyo State Commissioner for Health, for comments on this report were unsuccessful.
The story was supported with funding from the Centre for Journalism Innovation and Development (CJID).