Access to quality healthcare is one of the nightmares of communities in Ilaje local government area of Ondo State. Despite the revitalisation plan for Primary Health Centers in Nigeria, oil-producing communities in Ilaje suffer neglect. In this report, ADESOLA IKULAJOLU risked a journey to visit different Primary Health Centers in ILAJE and document the residents’ plights.
When 25-year-old Festus Monday visited Ilaje community, a coastal area in Ondo State, in November 2020 during the COVID-19 pandemic, only a few locals complied with the precautionary measures such as wearing face masks, maintaining physical distancing, and use of hand sanitiser.
The reality at the coastal area forced Festus to remove his own face mask.
“I was surprised to see people not bothered about COVID-19 but I realised I was the odd one, I pulled off my face mask so they wouldn’t stare at me like a stranger,” he recalled his experience on the first visit.
[Insert Ilaje visual illustrated map here]
The communities he visited were Mese, Gbagira, Molutehin, Odofado, Ilowo, Ilepete, Oju-Imole, Awoye, Obenla, Ogungbeje, and Ayetoro; they are oil-producing areas on the riverine area of Ondo State that connects to the Atlantic Ocean.
By the end of November 2020, Nigeria had recorded more cases of COVID-19 and more deaths too. According to the Nigeria Center for Disease Control (NCDC), the country at the time had 67,557 cases, 1,173 deaths, and 63,282 discharged.
Ondo State recorded 1,728 cases at that time. It was an increasing number, yet Festus said residents of the Ilaje communities were not bothered “neither were they complying with the safety guidelines and these communities don’t even have hospitals nor functional health facilities”.
“When the world was battling COVID-19, these communities in Ilaje had no access to health information. The health centers in all the communities are dilapidated, they are not working. How would they even detect any health crisis? The people are the ones treating themselves with traditional medicine since there is no health personnel to treat them,” said Festus while narrating his experience in the coastal communities.
“They have abandoned all the health centers, they can not treat ordinary sickness and not all of them will have money to travel to a hospital in another place to receive medical treatment. Who knows how many people might have even died from this ugly situation besieging the people of these communities.”
Same story 20 months after- no drugs, no medical personnel
Twenty months later, in the company of Festus, this reporter visited some of these Ilaje communities battling poor health systems.
Ilaje is one of the largest oil-producing communities in Nigeria with an estimated population of 391,200. Fishing and farming are the major occupations of the different ethnic groups in the area.
Residents have resorted to self-help and self-medication, most times using herbs for sicknesses that a primary health care centre would have attended to.
Tophas, 30, one of such frustrated people was involved in self-medication when he couldn’t get any medical attention at one facility in the Molutehin community. Tophas had gone to complain about a condition he was battling but he was referred to the hospital in Igbokoda.
He was neither given drugs nor asked to undergo any form of test to ascertain what he was complaining about. Since Tophas was unable to visit the hospital they referred him to because of the distance, he resorted to self-medication.
“When we go to the health center, they refer us to Igbokoda. The health center in Odu-Oretan has no doctor. The one at Molutehin, once they work small, they close. If not for God saving us and that our people here are strong, they would have been dying untimely,” Tophas said.
On June 11, this reporter visited the Molutehin PHC in company of Festus who went to complain about chest pain and stomach upset resulting from the borehole water he drank.
The only nurse available on duty that day at the health center asked Festus to sit for more than ten minutes while she attended to another patient. There were no other health officials at the health center.
When Festus requested a drug to suppress his pain, the young female nurse identified as Odunayo said: “there is no drug on the ground but I will write the prescription for you to buy, the doctors only come here once a while.” There was also no Vitamin C, one of the commonest drugs, to give Festus.
Josiah Olusegun is one out of the many residents of Ilepete community who said they “can not rely on the health center because they will say no drug”. “When we go to this health center to complain, they will say the government did not give them drugs, and sometimes we won’t meet anyone to attend to us.”
This reporter visited Ilepete Primary Health Center located on the opposite side of the community with Festus disguised to be battling a sore throat. That evening, at the health center, there were two female nurses. After listening to his complaint, one of the nurses referred him to Igbokoda for an X-ray.
“No doctor here, we only have nurses. There is no medicine that we can give you because only an X-ray can tell us what to do and that will be in Igbokoda,” Ms. Pelumi, one of the nurses said.
Residents also revealed that they are at the mercy of “quack” health attendants and chemists within the community. Meanwhile, communities like Mese, Gbagira, Awoye, and Odofado also have similar predicaments.
“There is no hospital here to treat anyone. We are always running helter-skelter to save ourselves. Those who have money struggle to take their sick people to Igbokada and some even die before getting to Ugbonla for emergency treatment. The distance between Igbokoda is too far from us,” Mr. Monday Adebanwo, a resident of Gbagira lamented.
Data from the World Health Organisation (WHO) stated that the patient-to-doctor ratio in Nigeria is 2500:1 which is four times higher than the WHO recommendation of 600:1.
In Ilowo And Odu-Oretan: Facilities Underlock, Doctors Unavailable
The PHC at Odu-Oretan community is surrounded by stagnant water and bushes. At the entrance of the Health Center is a wooden walkway that leads to the door of the deserted building, but the facility was under lock with no health officials available.
A resident who spoke to this reporter said the doctor, Mr. Blessing Ogungbeje at the PHC locked the facility and transferred some of the equipment for personal use. This reporter also observed an abandoned building already collapsing beside the Odu-Oretan PHC- the source said it was to house a new health facility but was neglected halfway.
“Only one doctor is here, all the nurses have left because they said they cannot survive in the community. One doctor here is taking all the drugs away from the health center to go sell for personal use, he locked the government health center,” the resident who pleaded not to be named told this reporter.
At Ilowo, the facility housing the Primary Health Center has been outgrown by bushes and was underlock. A resident said the doctors are not always around and they have to resort to self-medication. There were no health officials available during this report.
Mrs Adeyin Ibiola lamented that the closure of the Ilowo PHC is making other residents patronise quacks. Ibiola said those who have money travel to Igbokoda hospital on their own.
“If our children have any sickness, we apply traditional means, since the health center is locked and doesn’t even have enough medicines. Pregnant women go to the health center, but most of them resort to the traditional ways. Anyone who has the money will quickly go to Igbokoda. A hospital is not supposed to be closed for any reason. What if there is an emergency?
Failed PHCs’ Revitalisation Plan
President Muhammadu Buhari, in January 2017, flagged off a scheme to revitalise 10,000 PHCs across the country to create qualitative and affordable health services for poor Nigerians. The revitalisation plan was to make at least one PHC fully functional in each of the wards across 109 senatorial districts of the country through the National Primary Health Care Development Agency (NPHCDA).
The NPHCDA guideline requires that a standard PHC should have a labour room, office and staff quarters, well-open ward, children and female wards, ambulance for referrals, preventive and basic curative care, drugs, and equipment for immunisation. But the PHCs in Ilowo, Ilepete, Molutehin, Odu-Oretan, Gbagira, and Odofado are nowhere close to having these facilities.
This investigation revealed that despite the annual allocations of the Basic Health Care Provision Fund (BHCPF) to strengthen, provide access, and emergency medical treatment, PHCs are largely underequipped and nonfunctional.
The federal government initiated a N28 billion health fund in December 2017, to revitalise PHCs, but the impact of the intervention fund allocation is not felt in Ilaje communities.
In Ondo State, there are a total of 811 health facilities. Of this number, 95 % (769) are Primary Health Care facilities, 40 are Secondary Health Care facilities, and two are tertiary healthcare facilities. Of the 769 PHC facilities, 60% (460) are government owned. The remaining 309 or 40% are private providers. At the secondary health care level, 48% (19 ) of 40 health facilities are public owned while 21 (52%) are privately owned. The two tertiary health facilities in the State are public owned.
Ilaje has 31 health facilities available with 26 public-owned PHCs, three private-owned PHCs, one public-owned secondary health facility, and one private-owned secondary health facility making it rank 11th out of 18 LGAs.
In a report published by SBM Morgen, the 36 states spent an average of 4.65% of their budgets on healthcare in 2021 which is a decrease to 11% in 2020. Ondo State was among the only two states whose healthcare budget was more than 10% in 2021 which is proof of Governor Rotimi Akeredolu’s commitment to providing access to health, but the impact is not reflected in some Ilaje communities.
Bababo Ikuemonisan, a public health advocate and indigene of Ilaje has challenged the Ondo State government to come to the aid of the people and not neglect their communities in terms of healthcare.
“Lack of a standardized health system for the riverine people in Ilaje will necessitate rushing of sick patients to faraway Owo, Akure, or Ondo. Some of these patients die before reaching the hospitals in the hinterlands. A state-of-the-art hospital should be built where people can access and all PHCs should be well equipped,” Ikuemonisan said.
We prefer traditional birth method- Women
According to UNICEF data, Nigeria has an under-five mortality rate of 113.8 per 1,000 live births; the infant mortality rate is 72 per 1,000 live births; only 35% of children under age 5 have their births registered.
The World Health Organisation (WHO) highlighted that Nigeria accounts for over 34% of global maternal deaths. Figures show a maternal mortality rate of 576 per 100,000 live births, the fourth highest in the world.
Atike Faroye is one of the oldest traditional birth attendants (Agbebi) in Ilepete community, Pregnant women from nearby communities visit him for child delivery or during pregnancy complications. Faroye in his 70s said he has delivered more than 400 births within and outside his community.
Though he delivers more than four births in a week, some of them pay as low as N500 while some cannot even afford it.
“I didn’t learn this work from anyone. There is traditional medicine we give pregnant women to help their pathways open and some will even give birth on the way since they have used their medicine well,” he said, adding that “The health center here used to bring people to my place once they can not handle birth delivery because there are no midwives.”
“At night, when they bring pregnant women, we deliver them here.”
When Mrs Adeyin wanted to give birth to her first child, her preference was the traditional birth attendant.
She cited the belief she inherited from her parents and the inaccessibility of health centers as reasons for patronising traditional birth attendants.
Another woman from Ogungbeje community told this reporter that “rather than go for antenatal care at the health center, they prefer to visit the traditional birth attendants.”
She added that hardly will pregnant women decide to go to the health center because of the fear of being neglected and mostly no means of transportation during emergencies.
This reporter observed that there were neither midwives in all of the health centers nor were there any ambulances to convey patients when there is an emergency.
We are not aware- officials react
Ondo State Primary Health Care Development Board (OSPHCDB) is the agency in charge of all the PHCs. This reporter reached out to the Permanent Secretary of ONDOSPHDB, Dr Francis Akanbiemu, to confirm if he was aware of the findings that health facilities in Ilowo and Odu-Oretan were under lock.
“I am not aware of that, maybe you have to call the PCH coordinator. I oversee the local governments, we have over 600 health centers and there is no way I will be at all the places simultaneously. The best person to call is the PHC in Ilaje – his name is Dr Ayelaje,” he said.
“There is no way I can confirm because I am not a machine, there is no way I can be in all the health centers at the same time- no health center is supposed to be under lock and key. We have a PHC authority in Ondo State, each of them headed by the Medical officer, they are the ones that directly supervise what happens in those health facilities.”
He was not aware if the health facility in Odu-Oretan was under lock but highlighted that an investigation will be conducted.
Dr Francis added that after the investigation, “whoever is found wanting will be punished, we don’t cover anybody who does not do well. We have to document your findings because if we want to punish anybody for doing wrong, you have to provide evidence.”
In another conversation, the PHC coordinator in Ilaje through the Permanent Secretary revealed that the health facility in Ilowo has been taken over by OSOPADEC. But he was silent on the status of the Odu-Oretan’s facility.
The present condition of the Primary Health Center in Odu-Oretan now locked and abandoned. Photo credit: Adesola Ikulajolu – 11/06/2022
“We don’t lock our facilities, he made me believe that the Ilowo PHC has been taken over by OSOPADEC and they refuse to work with the PHC authority. So the PHC authority is no longer in charge of the Ilowo health center.We don’t lock our facilities, if you see anyone, just know that it is not under our care”, Dr Francis said.
The Director of Research, Planning, and Statistics at the Ondo State Ministry of Health, Dr Uche Odionyenma, also expressed surprise over the locking and shortage of staff at the health centers.
“I am not aware. I was told during my trip that some PHCs are non-functional, I don’t know what that means but I wasn’t given the name. From this inquiry you are giving me, I will find out why exactly it is under lock or there is no staff or the building is collapsing, there must be a reason for locking such a place. The only way I can do this is to get across to the PHCDA. We will investigate this,” Odionyenma said.
When confronted with the shortage of staff at some of the PHCs in Ilaje, the Director of Nursing at OSMoH, Mrs. Alice Ogundele noted that it is not only in those areas.
“It is all over. That is why the government keeps employing. An advert is out. Partners are helping too. We are trusting that things will be alright,” Mrs Alice said through SMS.
Access to quality healthcare is still a challenge, especially for the residents of the oil oil-producing communities in Ilaje. The government and concerned agencies must rise to salvage the situation to save the lives of these people with adequate medical infrastructures and revitalization of the PHCs.
This story was supported by the Africa Data Hub Community Journalism Fellowship.