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In this special report, JOHNSON IDOWU writes on how the abandoned Abesan Primary Healthcare Centre building in Lagos has become a haven for hoodlums, pushing the community into despair as residents find themselves cut off from essential healthcare services
Approaching the Akinyele Primary Healthcare Centre in the Abesan area of Ipaja, Lagos, it is impossible to miss the haunting silence and desolate look of a building that aimed to give life to residents of its host community who now look upon it with frustration and sadness.
For individuals who lack the resources to seek private healthcare, the dilapidated state of the hospital and its inability to render basic healthcare services means long, often unaffordable trips to distant facilities.
A resident, who identified herself simply as Mrs. Akande, told our correspondent how the majority of the residents had lost faith in getting any serious medical service in the facility as they now patronise private hospitals within the area while others travel several miles to neighbouring communities to access primary health centres.
She noted that those who still patronised the hospital do so for minor health challenges as it cannot attend to some essential healthcare services.
“This hospital is just like a figurehead because we cannot access basic healthcare services like delivery, diagnosis, treatment and others. The facility has no bed, no equipment and is in bad shape.
“Going there for serious medical issues is just like putting yourself at risk because you cannot get quality healthcare. Those you see going there are just going for minor health cases like antenatal, immunisation and few health issues that do not require much attention,” Akande said.
A retired civil servant, Baba Oluwo, said he no longer had a reliable place to access routine checkups and affordable medication, noting that he had resorted to paying higher fees by patronising private hospitals for routine checkups.
“If it is about this hospital, we have all given up on it because it has been abandoned for a long time. It seems they are playing politics with it. I am a retiree with underlying health issues, and because of the state of the hospital, I cannot access affordable healthcare.
“Some routine checkups that I often go for were done at a private hospital which means I have to pay more money and you know how a private hospital can be expensive compared to a public hospital.
“If the hospital had been functional, I wouldn’t have to spend large sums paying for hospital bills monthly. What can I do than to accept the situation as it is? It will be a great relief if this hospital can become fully functional at least in my lifetime,” Baba Oluwo narrated with a sober face.
WHO Declaration
Nigeria, along with other member countries of the World Health Organisation, adopted the 1978 Alma-Ata Declaration, which agreed to provide accessible and affordable primary health centres for the grassroots so that residents in remote areas and cities can have access to affordable and basic healthcare.
However, the over 35,800 residents of Abesan Estate in the Mosan-Okunola Local Council Development Area (Lagos State Social Security Exercise and Population Figure 2006, Population by Size, Abesan Estate Lagos State, 2006) are now at a disadvantage in terms of affordable and basic healthcare as the only government-owned hospital lies in ruins, denying residents their statutory right to healthcare.
Located within Lagos’s most populous housing estate lies Akinyele Primary Healthcare Centre, whose construction began in 2013. However, several years after its foundation was laid, residents of the estate have lost hope in the possibility of the two-storey edifice providing essential and affordable healthcare.
The hospital construction, which was welcomed by the community with hopes and optimism and the belief that succour had come in the area of healthcare delivery, was slowly abandoned. Over time, its state deteriorated, with broken windows, crumbling walls, and overgrown weeds replacing what was hoped to be a place of healing.
The deteriorating state of the hospital not only halted essential health services but also opened the door for unlawful activities within its premises.
Community laments insecurity
Approaching the hospital from the East side, this reporter was greeted with the presence of fiery-looking five young men with some holding sticks of cigarettes while a few puffed smoke of cigarette into the air. The wall betrayed any attempt to conceal the fact that the spot is a usual gathering spot for the hoodlums with several paintings and inscriptions written on the fence.
Very close to the spot where these hoodlums gathered is a pub. This reporter observed a few customers go in and out of the pub, which indicated it was rendering service to customers. The presence of these two situations contradicts the global standard of an ideal hospital environment.
Inside the hospital building, this reporter attempted to take the stairway to other floors but he was restricted by the abandoned wood used to guide the stairway indicating long years of use.
When he eventually gained entry into the first floor, the evidence of the activities of some hoodlums was visible as the remnants of smoked cigarettes littered the floor.
Also, some of the windows were shattered while parts of the plastered walls were peeling off indicating prolonged exposure to sun and rain.
On the last floor of the hospital, the aluminum materials used in the roofing had succumbed to the impact of wind, with some parts of the roof tattered while other parts had caved indicating long years of abandonment.
Lamenting on how hoodlums have taken over the facility, the President of the Abesan Estate Residents’ Association, Michael Kehinde, disclosed that the abandoned structure had become a haven for hoodlums who now use the place for their illicit activities.
He noted that some residents had lost personal property, such as money, mobile phones, and laptops, and had even sustained injuries from gunshot attacks.
“The estate has experienced rising criminal activities, including kidnappings, robberies, and home invasions. Residents have faced incidents of theft, violent ‘one-chance’ robberies, kidnappings, and break-ins.
“One Engineer Kennedy, a resident of Sector 12, was on his way to work when he boarded a Lagos State-painted vehicle at the American Junction. Instead of reaching his destination, he and fellow passengers were driven to the Gowon Estate, near Dominion Cathedral, where they were robbed, beaten, and tortured.
“Similarly, a resident of Sector 29, Block 599, boarded a Lagos State commercial bus at the Akinyele Bus Stop. He and others were taken to Agege, where they were robbed of money, phones, and laptops. They were then beaten with iron rods, leaving some with permanent injuries and trauma. All these were due to the hoodlums taking shelter in the dilapidated hospital.”
Speaking further on insecurity, another resident, Bisola Ogunyanwo, noted that the security situation had worsened to the point where vehicles were stolen from the premises of the fire service station located in the community.
He attributed the security breakdown to the influx of commercial motorcyclists and scavengers operating illegally in the area.
Ogunyanwo said, “Borehole pumps are removed in broad daylight, flats are broken into, generators are stolen, cars are vandalised or stolen, and all sorts of damage are done. The Lagos State Fire Service fence was broken into, and two vehicles within their premises were vandalised. The estate is becoming more dangerous due to the lack of security and its porousness.
“The level of drug use, peddling, and related immoral activities is alarming. ‘One-chance’ vehicles operate around the estate at any time of the day. There is no monitoring system, and everyone does whatever they want. It’s like a no man’s land.
“Motorcycles, tricycles, minibuses, and Danfo buses operate illegally and drive on one-way roads without any caution. The main entrance to the estate is always congested and resembles a marketplace—the old Oshodi before Governor Fashola was even better than our gate.”
‘We are incapacitated’
The primary functions of a PHC, according to the World Health Organisation, include among others, promoting health and preventing illness, identifying and diagnosing diseases and disabilities early, treating patients and referring them to specialists when needed. Others are providing continuous and comprehensive care to patients, promoting health and education efforts and serving as the first level of contact that individuals, families, and communities have with the national health system.
However, the reality for employees of Akinyele Primary Health Centre is the opposite as the state of the hospital has rendered them incapacitated to deliver on their core mandate.
A nurse at the hospital who spoke with our correspondent on the condition of anonymity for fear of victimisation disclosed that the dilapidated state of the hospital had posed a constraint to effective healthcare delivery for residents of the community.
The nurse lamented that aside from the absence of necessary healthcare equipment that could facilitate their work, the poor state of the hospital had also left the staff members with poor working conditions.
She noted that from the rainy season, the ground floor had been filled with water, making it difficult to attend to a few patients who still patronised the hospital.
She said, “We don’t carry out much medical services here because of the nature of the facility. Each time there’s rain, this place will be filled with water.
“Also, there is no equipment here because there is nowhere to keep them. As you can see, there are no windows and doors that can guarantee the safety of the equipment.
“We often refer some patients who come here to another health centre that can handle them but we carry out immunisation, antenatal and other minor cases.”
Another nurse who does not want to be mentioned in print but corroborated the claim of her colleague said, “We only receive minor cases here because of the limited personnel and equipment available. Most of the healthcare cases related to maternity are often referred to other PHCs.”
Unending wait for solutions
Community members have repeatedly appealed to the local and state government authorities to either renovate the hospital or repurpose the space for community use. However, these requests have so far gone unanswered, with authorities often citing budget constraints or shifting priorities.
The AERA president, Michael Kehinde, stressed that the community had made several efforts to persuade the LCDA and the state government to see to the completion of the building but all appeals had been futile.
Kehinde noted that there were rumours that the integrity test fee requested had been a bone of contention in the handing over process.
“We also have a health centre that is meant for residents that is yet to be completed. The state government is to carry out stability tests on the three floors of the building, but the council has yet to pay the sum of N300,000 to carry out the test, which has left the building in a state of despair.
“I learnt that the disagreement over who should pay the fee has delayed the handover because the state government said they could not take over a building that they were not sure of its foundation.
“We have petitioned, written letters, and even staged peaceful protests, but our words seemed to fall on deaf ears. Our community deserves better than this.”
Similarly, another resident of the community who identified himself as Akeem lamented the delay in renovating the facility.
In his words, “Believing that they will complete this hospital soon is like someone waiting for the second coming of Jesus Christ that you don’t know when it will happen.
“It will be a delight if this building is completed because if not that our government is wasteful, how can they leave this gigantic building to rot away?”
Experts express fears
Public health experts believe that dilapidated hospital buildings pose danger not just to the staff members but also to patients alike. They believe that the lives of health workers operating in the dilapidated structures are at risk because of the integrity of such structures.
Beyond the risk the structure poses to patients and workers, it is also believed that there could be a surge in infant mortality due to reduced access to PHC services.
A public health expert, R. A. Iyagba, in his inaugural lecture at the University of Lagos in 2005, stressed that patients patronising dilapidated health structures are prone to allergic diseases.
He added that workers in such environments are also prone to reactions such as dizziness and irritation among others.
Iyagba said, “Hospital buildings are places where care and cure should be available to the public, but due to lack of maintenance, public hospital buildings have become a place where people working in the built environment and patients have allergic-like reactions to unspecified stimuli: reactions like dizziness, nausea, irritation of mucous membrane, eye and/or nasopharyngeal irritation and sensitivity to bad odour from human waste, poor toilet facilities, and insufficient cleaning methods.”
Speaking on the negative impact a dilapidated and abandoned PHC could pose on the residents, a Consultant Community Physician at the University of Port Harcourt, Professor Best Ordinioha, stressed in a recent interview with our correspondent that denying community access to primary healthcare could spark infant mortality while hoodlums activities could fuel high blood pressure among residents.
“Dilapidated PHC structure can affect childhood immunisation rates, and percentage of skilled attendance at birth, death and outbreak of vaccine-preventable diseases can occur.
“The presence of hoodlums in such a facility can lead to insecurity and fear which can lead to increased blood pressure.
“Also, there could be a surge in the cost of treatment because services at the PHC are cheaper and when not available means higher cost of treatment. There can also be reduced access to important PHC services such as immunisation, antenatal care, delivery and treatment of minor diseases.”
Blame game
To ascertain the genesis of the current state of the hospital, this correspondent reached out to the ex-council chairman whose administration began the construction of the facility, Abiodun Mafe.
Mafe disclosed to our correspondent that the facility was 80 per cent complete as of 2014 when he left office.
He, however, decried its abandonment by successive administrations while stressing that despite repeated efforts to persuade his successors to complete the project, his efforts did not yield any result.
Mafe said, “Health care was the cardinal point of my administration, and the Akinyele Primary Health Centre construction started in 2010. As of May 2014, it was at 80 per cent completion. The facility, which is more spacious with ample car parking space, was designed to cater for health at the grassroots.
“We had the budget to inaugurate the project before my second term in October 2014, but internal saboteurs caused its delay. After my administration ended, my vice chairman was appointed executive secretary for one year and eight months, and she ought to have completed the project because she was from the same estate.
“The current chairperson abandoned the project deliberately for the past seven years. I made several pleas for the hospital to be completed because the laudable project would be for the benefit of all residents and its environs.”
Lagos promises renovation
Meanwhile, the Chairperson of the Mosan-Okunola Local Council Development Area, Olabisi Adebajo, when contacted on the state of the facility, told our correspondent that it had been handed over to the Lagos State Government for completion.
She, however, dispelled claims that an integrity test fee was delaying the handing over of the facility to the state government.
“We have handed the hospital to the state government and they have promised to complete it. I recently spoke with the commissioner who said they were working on it.
“There is no truth about any fee delaying the handing over. It is a rumour; please, disregard it,” Adebajo said.
The Lagos State Government confirmed Adebajo’s assertion, saying it had commenced the process of renovating the Akinyele PHC following its takeover from the LCDA.
Speaking in an interview with our correspondent, the Director of Public Affairs at the Lagos State Ministry of Health, Olatunbosun Ogunbanwo, confirmed that the ministry took over the hospital from the LCDA stressing that it would be renovated soon.
“The ministry has taken over the Akinyele PHC and we will commence the renovation soon. The process of renovating the facility has commenced,” Ogunbanwo said.
Private-public partnership
To restore the hope of the residents of having access to affordable healthcare, experts suggest that the government and the community should consider a Private-Public Partnership agreement that would fund the hospital project and get it working for the benefit of the community.
According to Ordinioha, members of the community could also consider liaising with companies and individuals within the community who could contribute financially through Corporate Social Responsibility programmes.
He said, “Government can embark on community ownership as part of an effort to engage communities and stakeholders in maintaining and improving primary healthcare infrastructure. They can also solicit help from companies as part of Corporate Social Responsibility and sourcing funds from philanthropic individuals.”
As long as this hospital remains in its current state, it is both a physical and symbolic barrier to the well-being of residents of Abesan Estate.
For a healthier future, residents continue to call on authorities to prioritise their right to accessible healthcare and a safe environment as they hope that their voices will finally be heard, bringing an end to years of neglect and restoring a sense of safety and health to their neighbourhood.
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