#BudeshiWaka: The Plight of the Benue People
Mrs Kaase tossed and turned as she slept on a worn mattress in her room. It was a rainy night but she was sweating profusely because the windows were closed to prevent rain drops from getting into the tiny room she shared with her husband. She wriggled in pain from her hurting stomach till she couldn’t bear it anymore and had to alert her husband.
She was 7 months pregnant and was going to have her first child. She knew from the excruciating pain she felt that she needed to get to the nearest hospital. Her husband stood up looking confused; the nearest hospital to them was about 2 hours away and the only option was to take his wife to the traditional birth attendant (TBA).
He carefully carried his wife, put her in a wheelbarrow and wheeled her to the Nurse’s home in the rain. Mrs Kaase’s labour progressed quickly and it took her 25 minutes to push out her son’s head, but something was wrong. The baby became lodged in her public bone, a birthing complication called dystocia, the TBA tried frantically for several minutes to release him. This is how several fatalities arise out of similar situations.
This and more is the plight of the women of Yandev, Gboko in Benue state.
In 2014 the National Primary HealthCare Development Agency (NPHCDA) awarded contracts for PHCs to be built in some Local Governments in the state and Yandev ,Gboko, Mrs. Kaase’s community, was one of them. The contract which was awarded for the sum of ₦21,986,893 by Sataab Inv. Nig Ltd is yet to be completed.
These are the kinds of reports Public and Private Development Centre (PPDC) received as we embarked on a community engagement tour titled “Budeshi waka” to engage directly with the community members and determine the performances of these projects and how best to improve their functionality.
Here are some of the observations PPDC made from the tour:
Of the 5 communities present at the town hall meeting none of the PHCs built in 2014 was functional because they were not completed. Most of the district heads complained of not being informed about the projects, they said if they had prior knowledge of the contract they would be able to monitor the projects themselves and also hold the contractors accountable when the project is not completed.
PHCs Sustained by community Members : For the PHC in Adawa Mbaise Ullam Gwer East, the district head reported that the contractor constructed two buildings and left. He said that it is the collective effort of the community that has led to the sustainability of the PHC; the community contributes money to buy drugs and pay the nurses which is not sustainable as they don’t have the capacity to sustain the PHC. A health worker from the PHC who was also present lamented on her experience working there, she described it as “a terrible situation” because the lack of drugs and equipment prevent them from handling the simplest cases.
PHC structure Not suitable: The PHC in Agbaha Otukpa in Ogbadigbo which was contracted for ₦21,986,893 is almost complete but has not been handed over to the community. The community leader who spoke on behalf of the community said the structure of the building doesn’t fit that of a PHC so it was rejected and there hasn’t been any changes made. The community has had to convert one part of their community town hall into a health care centre, they complained about lack of basic equipments, drugs and adequate staff.
All the committees present complained of having no knowledge about the details of project before its implementation.
Recommendations by the community for improving health care include:
- Information on projects should be given timeously to the district/community heads before project commencement.
- The names of contractors and their addresses, and contracted amounts should be sent to the district heads and community heads
- Contracting information provided to district heads should be updated to indicate amounts released to contractors.
- There is need for more frequent town hall meetings to empower citizens on their rights and roles
- There should be regular spot checks on primary health contracts being executed.
Primary health care is the backbone of a health system and it’s under performance is dangerous to communities especially to women and children. If the primary health care delivery system is functioning well with effective synergy among the various stakeholders, the PHCs would be able to resolve a significant percentage of health problems faced by communities.
To break the pattern of PHC underperformance in Nigeria, there is need to create an integrated approach with coordinated and sustained intervention at various points along the healthcare value chain. Regular engagement among stakeholders including policymakers, providers and communities is encouraged to receive prompt feedback on the delivery of primary health care.
Nigerians need to take ownership and responsibility of the PHCs in their wards; we need to be more engaged and participate in government processes so that together we are able to live healthier lives.