SPECIAL REPORT: Benue communities feel the pains as government neglects PHCs

Juliana Innocent lives in Unwaba-Oju, a village in Otahe Ward of Otukpo Local Government Area of Benue State in the north-central region of Nigeria. Accessing health services for Mrs Innocent and other residents of Unwaba-Oju is difficult as there is no health centre in the village. The closest community with a primary health care centre to her village is Ogobia, which lies at the end of a 70 km unpaved road.

Road leading to Unwaba-Oju

“While going to Ogobia for antenatal care in March 2021, I had an accident that fractured my leg and hurt my back,” she narrated. Months later, when Mrs Innocent delivered a boy, the baby had tremor, an abnormal rhythmic shaking in the arms, feet, hands, head and legs of newborns.

“I took the baby to hospital in Ogobia and the doctor said that he was suffering from low blood sugar. We were on admission for two weeks,” she said.

However, she could not keep up with the baby’s treatment schedule due to the distance of the hospital from her home. “Because of the distance and financial difficulties, I was using herbs and, unfortunately, the baby passed away eight months after delivery.”

Juliana Innocent

Mrs Innocent said most people in Unwaba-Oju use traditional herbs when they cannot travel to the towns to access health care.

“Sometimes you may have money for hospital bills but you may not be able to pay for transport,” she said. Only two of her seven children were delivered in the hospital. “I had the two when Unwaba-Oju Healthcare Centre was functioning.”

Challenges of accessing healthcare in rural Benue communities

Mrs Innocent is a victim of the poor state of the primary healthcare system in Benue State. Accessing care can be a life-threatening ordeal, especially for people in the rural areas of the state where the burden of disease is disproportionately high. In many communities, pregnant women and their children travel more than 50 kilometres on motorcycles to access care. This undermines the Sustainable Development Goals (SDGs) target 3.8 and the Nigerian government’s commitment to Universal Health Coverage (UHC), a journey towards making basic healthcare services accessible to citizens through primary healthcare centres.

In May 2024, this reporter visited four local government areas in the state to assess their PHCs. The findings are depressing.

PHC Unwaba-Oju, Otahe Ward, Otukpo LGA

Mrs Innocent’s community of Unwaba-Oju once had a PHC. But residents said it has been abandoned for over a decade. Most of the windows of the dilapidated three-bedroom bungalow were either smashed or missing. The facility was covered with cobwebs, dirt and dust and had become a home for cats, lizards, rats and spiders. Inside the building were abandoned medical equipment, rusted metal bed frames and dirt-covered mattresses.

Abandoned PHC Unwaba-Oju

Abandoned medical equipments

‘Help us’

“Lack of access to healthcare has affected our community, especially pregnant women and children. When there’s an emergency, we take the patient to neighbouring communities but sometimes there are no means (of transportation),” Sunday Anyebe, the community’s youth leader, told this reporter. “Our women depend on traditional birth attendants and sometimes there are complications and fatalities.”

Mr Anyebe appealed to the state government to address the community’s healthcare challenges. “We are appealing to our governor, Reverend Hyacinth Alia, to come to our aid,” he said.

“This community has been without a healthcare facility for more than ten years. The government should pity our women and children and provide healthcare services and facilities to enhance their quality of life,” Mr Anyebe said.

Sunday Anyebe

PHC Tse-Indyer, Logo LGA

Zugwem Udoji, a 27-year-old housewife, lost her twins during childbirth at the PHC in Tse-Indyer. She said the facility “crushed my opportunity of becoming a mother of twins.”

Mrs Udoji said she was six months pregnant when she had a miscarriage.

“I woke up that morning in February 2023 to an intense pain around my lower abdomen. When my husband took me to the clinic, there was no medicine to relieve me from the pain.”

Mrs Udoji said before the miscarriage, she was going for antenatal but was not tested or checked. “Even if you complain about something abnormal, they will either give you an injection or recommend medicine for you to go and buy,” she said.

She believes she would not have lost her pregnancy if the PHC in Tse-Indyer had been adequately equipped. “I know that a hospital is supposed to carry out tests on pregnant women but that clinic doesn’t do that. I would have been a mother to twins.”

When this reporter visited Mrs Udoji in her residence in Tse-Indyer, she was carrying a three-month-old baby she had delivered after the loss of her twins.

Zugwem Udoji

Death of a woman

69-year-old Isaac Toryina lives in a small village called Tse-Torazege, about two kilometres from Tse-Indyer. The village is located in Mbavuur North-West, 16-17 kilometres from Abeda-Shitile, a major town along the Abeda-Afia road in Mbavuur Ward of Logo LGA.

On 27 December 2023, Mr Toryina lost his wife, Ngodoo, ten days after she delivered a baby at home with the help of a traditional birth attendant. Early in the morning of 27 December, she stepped out to urinate but slumped and fell into a coma. Mr Toryina rushed her to the Abeda-Shitile on a motorcycle. Unfortunately, Ngodoo was pronounced dead by the health workers on arrival at the PHC.

Road leading to Tse-Indyer

“My wife delivered at home because there’s no functional healthcare centre in this community. When she was pregnant and unwell, we went to PHC Tse-Indyer but we couldn’t get drugs there,” he said, fighting back tears. “After delivery, we went to a hospital in Abeda-Shitile and extracted mucus from the baby.”

Giving a picture of what led to his wife’s death, he said: “We went into bed that night and she was fine. Around 4 a.m. in the morning, she stepped out to urinate and stayed beyond usual. I came out and found her lying unconscious. I couldn’t think of that clinic (referring to PHC Tse-Indyer) because even if we had gone there, we wouldn’t have found medicine.”

Mr Toryina said his wife might have lived if there were facilities for emergency obstetrics services in his community. “If there had been a good clinic in this area, her situation would have been managed, and she would have been alive.”

Mrs Toryina left behind a five-month-old child, who is being breastfed by nursing mothers in the community. When this reporter visited Tse-Torazege, Mr Toryina’s grief was palpable as he sat alone on a wooden chair at the entrance of his hut.

Isaac Toryina

PHC Tse-Indyer

PHC Tse-Indyer looked like a clinic from outside, but the courtyard was overgrown with weeds. Inside the building, there was no ceiling board, and the windows were broken. There was no waiting room. Two rickety beds complete the story of neglect.

PHC Tse-Indyer hospital bed

Philip Shingir, the consulting Community Health Extension Worker (CHEW) in charge of the PHC, said it had no electricity, potable water or toilets, adding that the facility had no security guards and staff quarters.

Mr Shingir said he usually bought water for child deliveries, but during the rainy season, the PHC staff use rainwater for cleaning, bathing, and drinking.

“Now that there’s no water, I usually send someone to a nearby town to collect water for the PHC.” Asked what he does in cases of emergency, he said, “I have a motorcycle. I will pick one gallon. From here to Abeda is about 16-17 kilometres, I will go there and get water.”

During the visit, the PHC was eerily quiet, without a power supply, fan or solar lights. The empty medicine stores suggested not much was going on at the facility. No rooms designated for male and female patients. A few metres away from the delivery room are two clinical toilets which the health workers have turned into their sleeping quarters.

Clinical toilets where health workers sleep

Mr Shingir said the government only supplies antimalarial drugs to the clinic. “We can only test and treat common malaria infections here, not severe ones,” he added. If there are patients here, sometimes I use my personal money to buy medicine in Abeda for treatment. But we don’t accept inpatients; we prefer bedrest because we lack the capacity to do so.”

When asked if childbirth occurred at night, he said, “We can use a local light or a handset that has light.”

“We only have one bed in the maternity section. “If there are two women delivering at the same time, we will look for a mat. The woman closer to delivery will stay on the delivery bed while the other one sleeps on the mat.”

PHC Tse-Indyer

Is the government aware?

“Yes. The government does come for supervision and we equally give reports on the status of the health centre,” Mr Shingir responded to the question.

The signage at PHC Tse-Indyer indicated that the centre was built by Logo Local Government Council and commissioned by George Akume, the state governor at the time, on 12 February 2012.

PHC Awulema, Ohimini LGA

Mercy Inalegwu, a mother of two, reflected on when newborns were checked for jaundice before leaving PHC Awulema. She said the lack of equipment at the centre to check their bilirubin levels led to the death of three of her children.

Mercy Inalegwu

“The first children were twins in 2005, a boy and a girl. I delivered at home because this hospital (referring to PHC Awulema) had nobody there. The girl passed at birth but the boy lived for four days and passed away,” Mrs Inalegwu recalled sorrowfully.

She did not know that newborns are supposed to be checked for jaundice before leaving a birth centre, until her sister told her.

“When I lost my first two children, I explained what happened to my sister who stays in Port Harcourt and she told me it was jaundice. In 2009, I had twins again – both boys. One died immediately. I then followed my sister’s instructions by placing the living boy in the sun every morning, and he survived,” she said.

“If there is a healthcare centre here in Awulema and there are health workers inside working, I wouldn’t have lost my children because it was just a similar case of jaundice. I am sure they would have noticed it,” she said.

In Awulema, Ohimini LGA, accessing quality healthcare service at home is a mirage. The inhabitants travel to Otukpo to seek care or use herbs at home.

Road leading to Awulema

The PHC Awulema is in Oglewu Ehaje ward, along the Otukpo-Enugu road. The desolate facility is evidence of the deterioration in public health services in Benue State. It is collapsing, and its unintended garden is growing wild.

PHC Awulema

The only signs of life within the PHC at the time this reporter visited were the sounds of mice scuttling and scavenging for what had been left in the building.

PHC Awulema

Clement Okwubi, the head of Awulema village, has lived in the village for over 40 years. He said residents depend on herbs due to poor health care services in the community. “When one is sick, there are herbs that we use for treatment – when it is above us, we rush the person to Otukpo.”

The retired agricultural officer said poor health care service in his community had caused deaths and suffering for his people. “Those who cannot afford to seek medical care in Otukpo are giving up on life,” he said.

Due to the deplorable state of the PHC, the health workers have been relocated to an abandoned federal government hospital project in the community. However, no one was seen at the facility when this reporter visited the place. Asked about their whereabouts, a resident of the area said, “They hardly come to work, and even when they come, they don’t stay long.”

PHC, Tse-Kpum, Vandeikya LGA

When this reporter visited Vandeikya in May, it was hard for him to locate PHC Tse-Kpum, as the facility is sandwiched between houses along the Adikpo Vandeikya express road. You have to pass through people’s compounds to access the centre. The first thing you notice is that the walls of the old decrepit buildings are crumbling.

The mud building was probably constructed in the 1960s, residents said and is one of the oldest buildings in the community. The facility has no laboratory, toilets or water facility. Patients and health providers use the pit latrines of the neighbouring houses when pressed by nature.

PHC Tse-Kpum

Wilfred Goja, a member of the Village Development Committee for the health centre, described the embarrassment patients face due to the facility’s lack of toilets.

“Once someone comes to this clinic, it’s assumed the person is infected and some people wouldn’t allow their toilet facility to be used.” Asked what they do in such a situation, Mr Goja said: “they go into nearby bushes for convenience.”

The Chairman of the Village Development Committee of PHC Tse-Kpum, Mark Ikpa, lamented the situation. “People rarely come to this clinic because there is a lack of resources. The healthcare providers do not have accommodation, water sanitation and hygiene. They seek permission from the surrounding houses to use their latrines.”

PHC Tse-Kpum

He urged the government to address the needs of workers and the community. “Government should help build this facility and provide more staff to provide access to quality healthcare services,” Mr Ikpa said.

The PHC is located in the Mbagbera Council Ward of Vandeikya LGA. In May, when this reporter visited the centre, his first sight was a rusted zinc on two mud blocks sitting on 50 square metres of land. In the wards, there were two beds. One of the beds had worn-out mattresses while the other had nothing. The centre does not have a cleaner and no health workers were seen within the facility.

PHCs in Nigeria

According to the National Primary Health Care Development Agency (NPHCDA), a PHC in Nigeria should span a minimum land area of 1,200 square metres, have at least two rooms with cross ventilation, functional doors, and netted windows, along with separate male and female toilet facilities supplied with water. The facility should also have a motorised borehole for clean water, power supply, a sanitary waste collection point, a waste disposal site, clear signage visible from entry and exit points, fencing with gate and generator houses, and staff accommodation consisting of two units of one-bedroom self-contained apartments.

None of the Benue PHCs visited for this report met those requirements.

I don’t talk to the press – ES, Benue Healthcare Board

The Benue State Government, on 16 July 2016, under the Samuel Ortom administration, published that it paid N1.2 billion counterpart funding to access N2.4 billion for the construction and equipment of “Modern Primary Health Centres” across the state. Investigations, however, have revealed that many of the PHCs in the state lack the capacity to provide basic essential healthcare services. They are generally plagued by inadequate equipment, poor infrastructure, lack of essential drug supply, poor staffing, and no capacity to provide basic emergency obstetrics services.

When contacted for this report, the Executive Secretary of Benue State Primary Healthcare Board, Grace Wende, became hostile to the reporter after he asked for an explanation for the poor condition of PHCs in the state. “I don’t talk to the press. I cannot answer you. Go and meet the Commissioner for Health,” she said, dismissing the reporter.

Health Ministry and Human Services keep mute

This reporter then sent a Freedom of Information (FOI) request to the state’s Ministry of Health on the conditions of its PHCs and on how much of the N2.4 billion has been released, the works done and other budgetary releases from 2016-2023.

The reporter visited the ministry several times requesting to see the commissioner, Yanmar Ortese, without success. On 6 June, when Mr Ortese was in the office, Fidelis Igbang, his secretary, denied the reporter access to the commissioner.

The FOI request, despite acknowledged to have been received, was not responded to as of the time of filing this report.

FOI Request

Benue’s N2.4 billion primary healthcare projects

In 2017, the state government renovated selected primary healthcare facilities with financial and technical assistance from the United States PEPFAR Initiatives through Nigeria’s Centre for Disease Control (CDC) and the Centre for Integrated Health Program (CIHP).

Sign of a renovated PHC facility

The renovation took place a year after the state government announced the payment of N1.2 billion counterpart funding to access N2.4 billion for the construction and equipment of PHCs across the state. Investigation, however, revealed that none of the renovated facilities met the minimum standard for PHC in Nigeria as set by the NPHCDA. Most of the facilities are without source of clean water, functional beds, power supply, sanitary waste collection, perimeter fence, and staff accommodation.

Benue ranked low on subnational healthcare delivery

In 2023, BudgIT, a civic organisation that uses creative technology to simplify public information, demand accountability, institutional reforms and efficient service delivery, stated that Benue State committed only 9.67 per cent of its total spending for the period on healthcare (inclusive of capital and recurrent expenditure). In a document, titled “Subnational Healthcare Delivery for Improved Economic Development” BudgIT detailed that at 63.5 per cent, immunisation coverage for children aged 12 to 23 months in the state is the 14th lowest among the 36 States.

“One out of every 56 children born in Benue die within their first 28 days of life. In a similar fashion, 42 in every 1,000 live births do not live long enough to celebrate their fifth birthday,” the document states.

The report recommends that the state provides equity funding for National Health Insurance Scheme (NHIS), a gateway of the Basic Health Care Provision Fund (BHCPF) and regularise primary health facility bank accounts in all wards to enable access to the BHCPF.

This story has been produced with support from the Centre for Journalism Innovation and Development (CJID).