Secondary health care facilities have become the first point of contact for residents of the Federal Capital Territory (FCT) leading to congestion and other attendant problems. In this interview with CATHERINE AGBO, the pioneer Executive Secretary FCT Primary Health Care Development Board, Dr. Rilwan Mohammed speaks on efforts at revitalising primary health care centres and make them a model.
You are the pioneer executive secretary of the FCT Primary Health Care Development Board. Can you give an overview of the activities of the board?
The board came into existence in July 2010 but actual activities started September 22 of the same year.? The reason why the FCT minister, Senator Bala Mohammed, established the board was to revitalise primary health care. All the primary health care centres in the FCT are actually in dilapidated condition and the staff were not there and the minister saw that most of the States had created boards or agencies and he saw the need to follow suit.
Before now, three former ministers had tried to establish the board but were not able to but the present minister took the bull by the horn and established the board.? When we came in we said since we were new, there was a need to know how many primary health care centres there were in FCT, how many health care workers we had and so on. So, we carried out an inventory of infrastructure and auditing and we found out that we have about 216 primary health care centres and also found that out of the 216, only 33 are functional according to the World Health Organisation (WHO) minimum package. We also found out that we had 1,348 health personnel as against 4,988 we need. This figure in our view was grossly inadequate.
We also found out that about 191 primary health care centres were functioning with only one staff. We carried out a baseline survey to ensure that these staff and health care facilities are in good condition, quality and quantity. We were surprised to find out that only 33 were in order with the requisite personnel and facility, while the remaining were not in order. In essence, the board was created to look at these issues and try to see how it can take care of the primary health care centre.
Nigeria itself has a health care policy, the whole world also has a health care policy. The primary health care centres must be five kilometres away from each other and that is the reason why primary health care centres were established. And we also found out that we have to go a step further to draw out a strategic plan of action after doing the base line survey to know where we are, where we want to go and how to get there. Then we drew up a plan of action for 2011 to 2015. In that strategic plan, we have a vision which is “health and productive FCT populace”. We also have objectives to actually move FCT primary health care board to the next level.
Now we realised that there is a lot of congestion in secondary health facilities because primary health care centres are not working and we tried to engage about 260 primary health care workers to at least try to take care of the areas where we have some gaps. Now we are still on the verge of getting approval for these health care workers.
We are worried because if there was any big hospital building anywhere without a health care worker, it is a worthless building. So the FCT administration decided to give us the opportunity to revive the primary health centres.
Secondly, we continued doing the polio to make sure we eradicate the six child killer diseases. We also carried out flag off to create awareness, together with the FCT minister and his wife who is the chairperson of the social mobilisation committee of the FCT so that we create awareness among people on how to stay healthy, take care of their environment and other things.
We have also carried out sponsored programmes in the electronic and print media to make people aware that the board exists and wants to make sure that primary health care centres are attended.
Do you think people find the primary health care centres attractive?
We are worried that people do not find them attractive but this is primarily because they are not in good shape and we want to make sure that they are revitalised. We went on tour to all the area council chairmen, telling them that the primary health care centres most of which are in their areas are not in good shape and we were able to get them to agree to renovate them. Some of them are at the verge of renovating and we are also going to renovation three in each of the six Area Councils in this year’s budget. We are also going to establish six standard laboratories in six primary health care centres this year and we have a new primary health care centre we established in the owner occupier estate in Kubwa, Bwari area council which will be commissioned soon. It is a model primary health care centre and we hope that others will copy from it.
Could you please explain the over crowding in secondary health facilities?
I agree with you that our secondary health care facilities are really overcrowded to the extent that some people even wait in their houses to get admitted because there are no bed spaces. The reason for this is because the primary health care centres are not in a good shape. You know as we came in, gradually, we are trying to revitalise the primary health care centres, we are based at the problems so that we can put everything in shape and you will be surprised that in the next two years, primary health care centres in the FCT will be functional and they will work better and residents will be happy when they visit them.
Where we have problem is the incentive; there is a need for government to give incentive for health care workers based in the rural areas so that even doctors will be eager to go to rural areas and work.
Have the area councils been very cooperative with the board in its drive to bring quality health care delivery to Abuja residents?
We have been working on areas of collaboration with the Area Councils to make sure that we get to where we desire. Some of the primary health care centres are still with the Area Councils and they are so many. So collaborating with them, is very important but one of the things we want to do is taking away the comprehensive health care centres away from them and leave the remaining ones so that they would be able to manage them, support them with staff and other necessary equipment so that people will have a reason to the primary health care centres once more.
We want the primary health care centres to be attractive because it is the first contact of a patient and until it is above their level, that is when you move. Many of the out-patients in our secondary health care facilities go there because of malaria and these are things the primary health care centres can handle effectively.
You earlier talked about a five year strategic health plan for the board. Two years down the line, how much have you been able to achieve?
You know when you are doing something, at a point you have to stop and see how much ground you have covered and that is the reason for the inventory and baseline survey we conducted. The strategy is just a plan of how we can revitalise primary health care delivery in the FCT so that the whole world can see and know that the board is working. The strategy would involve all the stakeholders, including community members because community participation is very important to primary health care delivery. If we are carrying out programmes without involving the communities, it will collapse, they would see it as alien to them but when we involve them in planning, implementation and evaluation, they will take it as their own and at the end of the day; things will be alright for us.
At the flag-off of the 2012 immunisation plus days, you accused the elite in the FCT of frustrating the polio eradication drive. What is the situation now?
We were not accusing them as such, what we were saying is that they prevent us from assessing their homes to immunise their children but they are now cooperating. On the contrary, it is the health care workers that are blocking us, especially those in big hospitals. You know this is immunisation plus, which is like a follow up to immunisation that has been done before so that we will be able to take care of the remaining pockets of polio. We have type 1, 2 and 3. Type 1 was the only one that caused paralysis but now type 3 also causes paralysis so we have to do immunisation on and on to ensure that we protect our children. Nigeria is one of the three remaining countries in the world that has polio and the only one in Africa, apart from Pakistan and Afghanistan.? Now anywhere they find polio in Africa, they say it is the Nigerian variety so it is important that we all collaborate to eradicate polio. The elite are now cooperating with us after the initial problems.
What are the challenges before the board?
Some of the challenges we have here are funding and staffing, especially staff to man the centres. We only have one source of funding which is the FCT administration and a little support from UNICEF. The National Primary Health Care Board which is supposed to give us some funds are yet to access any fund to give us because the National Health Bill is still to be passed. We also have the problem of legitimacy because we do not have a law establishing us yet. The bill that establishes the board is in the National Health Bill and unfortunately, there are still a lot of problems with the bill. And I want to use this avenue to appeal to the National Assembly to revisit the bill and pass it. The national primary health care fund is set aside and domiciled in the National Primary Health Care Board and any agency or board can access the fund for its activities but this cannot happen unless the bill is passed.
We also have the Traditional Birth Attendants (TBA) who have been a problem to us. They do things beyond their limit. A good medical personnel is the person that knows his limit and once he gets there, refers to another person but the TBA’s do everything they like and people die on their hands and they say it is God.
But the Federal Ministry of Health has been trying to see how the TBA’s can be relieved. But they are within the community and are always there with the people so there was the question of how to do away with them and we decided that the best approach is to train secondary school drop outs and it has already started in Bauchi, Lagos and Katsina. What they do is that they pick those who have a little education within the communities and train them as modern TBA and they will be responsible for births within their communities. They are in the communities where they live and people are aware of them and they know where to stop and refer a patient.
We also have problem of office accommodation and how to reach the area councils to work together with them.
With the level of health care delivery in the FCT, do you think Nigeria is on the right path towards the attainment of the health related Millennium Development Goals?
I think we are on the right track but still far away from achieving the MDGs because we still have many problems, including that of technical know-how. Some of the people that are actually manning the MDGs still have problem of what to do, how to do it and what not to do. They still need to be trained on what is expected of them so that we will have people that have the requisite knowledge so that they will be able to move it. But as of now, considering the way things are, there are no visible signs to show that we are going to attain MDGs by 2015. The government has to show more seriousness and commitment to all the eight binding goals. Primary health care centres which are pivotal to the attainment of the health related goals are still not working. So ,saying we will attain the goals is not very realistic.
We are also not sincere to our partner agencies. Sometimes they bring money to us and we are unable to pay counterpart funding. Most of the State Governments drag feet when it comes to paying counterpart funding and we also have security challenges at the moment, which will scare away willing partners.
Type three wild polio virus was detected in Maiduguri where there is crisis but there cannot be effective control because of the security challenges there. Even during immunisation, people are afraid of going to certain areas. So, security is a big issue.
With the effort you have made so far, where do you see the board in the next three years?
If our strategy goes as planned, FCT primary health care will be a model for other states to follow. Some states are already asking us what is the magic and I say it is planning, knowing your objectives and working towards it with seriousness. You plan, implement and evaluate your activity, see what you are not doing rightly and adjust.
We are also making plans to employ over 200 health care personnel this year apart from the ones we expect to get from the Midwife Service Scheme of the National Primary Health Care Board so I believe we will get to where we desire.
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