SPECIAL REPORT: Manpower shortage cripples Kwara PHCs despite millions spent on renovations

At 11 a.m. on a Tuesday in 2023, Amina experienced her first contractions, marking the beginning of her labour for her first child.

General Hospital Okuta Signpost

Her husband, Abu, and neighbour Rufai hurriedly took her to the General Hospital in Okuta, Baruten Local Government Area of Kwara State, where they live.

Patients waiting at General Hospital Okuta

Unfortunately, the two doctors and other staff members had not reported for duty at the hospital and the delivery room was locked. Some students undergoing their industrial training at the hospital received the patient. However, when Amina’s contraction pain increased and there was no sign of help, her husband moved her to a private medical facility in the town.

An empty ward at General Hospital, Okuta

“The woman was in pain, but nobody was there to attend to her. The delivery room was locked, and it was after our arrival that the students we met went to call the staff member who held the key. But we had to leave to save the lives of the mother and the child,” Mr Rufai recalled to PREMIUM TIMES.

“It is sad that this is the state of the general hospital, and even thinking that the government just rehabilitated it is worrying,” he added.

The Kwara State Government awarded Hoak Turnkey Limited a ₦35,571,881.25 contract to renovate the General Hospital in 2020. It was one of four primary healthcare centres covered by a renovation exercise of the state government that year.

This reporter’s visit to the hospital in May 2024 revealed a transformed facility boasting some modern equipment courtesy of recent renovations. However, despite the upgrades, the hospital remains eerily deserted due to a crippling shortage of medical staff.

During a three-day observation period (Sunday to Tuesday), no doctors reported for work at the hospital. The hospital’s pharmacist attributed the doctors’ absence to their reluctance to reside in the town.

This general hospital was established to serve over 20 communities, including Wondu, Hero, Tewu, Bushikparu, Alafiaru, Gorobani, Temideley, Boriya, Shiya, Tembonu, Tenge, Bankubu, Fonfon, Subayo, Gwanaguru, Donoru, Nikkikperu, Kenu, and Kikparu.

However, when this reporter first arrived, the hospital had only two patients despite having more than ten wards and 20 beds.

Biliaminu Manne, a community resident, said the hospital’s low patient turnout was due to a severe shortage of medical staff and the erratic attendance of the few health workers.

Biliaminu Manne, resident of Okuta

He said the needed staff were not always around to attend to patients.

“I just concluded my undergraduate study and am preparing for my mandatory National Youth Service Corps (NYSC) programme, so I need a medical fitness certificate. But every time I visited this hospital for the test, they said the doctors were not available,” Mr Manne said.

Eventually, he travelled 196 km to Ilorin, the state capital, for the medical fitness test.

N117m Spent on Renovation But PHCs Still Below NPHCDA Standard

In 2020, the Kwara State Government renovated four primary healthcare centres (PHCs) in different communities at a total cost of more than N117 million.

Chart Showing Money Spent By Government To Renovate Four PHCs

Three firms executed the contracts. Akatech Construction Limited renovated PHC Gwanara Baruten LGA for ₦33,365,768 and PHC Kosubosu in Baruten LGA for ₦39,147,622; Dwa Construction Company Nigeria Limited renovated the Isanlu Isin Health Centre in Isin LGA for ₦11,153,246.62; and Olmash International Ltd renovated PHC Otte Oja in Asa LGA for ₦34,623,953.55.

Signpost of the renovation project at Otte PHC

However, none of the medical facilities meets the minimum standards set by the National Primary Healthcare Development Agency (NPHCDA).

According to the NPHCDA guidelines, PHCs are expected to offer 24-hour services, be fenced, and have staff quarters or accommodation for the workers within the community. They should also have essential drug supplies, a waste disposal system, equipped laboratories, and connections to the national grid.

List of personnel every PHC is expected to have, according to NPHCDA minimum standard

The PHC must also have a minimum of four nurses/midwives, nine community health extension workers (CHEW), a laboratory technician, a pharmacy technician and a medical officer (if available). However, this reporter observed an inadequate number of healthcare workers in the various cadres in the facilities during its visits.

None of the four PHCs has a staff doctor. Isanlu Isin PHC and Kosubosu PHC each had only two nurses, while only one nurse was attached to each of Otte PHC and Gwanara PHC.

Staff Shortage: Reason for low attendance of patients in Otte PHC

According to a community health worker who has worked there for eight years, an average of 200 patients from various communities used to visit Otte Oje PHC daily.

Otte PHC

However, as the medical facility lost qualified staff members, patient attendance declined and now stands at below 40.

“Many residents stopped coming after our doctors left,” the community health worker said.

An empty ward at Otte PHC

She continued: “When we had three doctors at this PHC, we used to perform surgeries, but now we are unable to do so.”

Otte PHC Labour Room

She said the PHC now refers maternity patients who need surgery to hospitals in Ilorin, about an hour’s drive from the town.

Locked Wards At Otte PHC

“This is because this is the only government-owned hospital in this community. The other one close by is a psychiatric hospital,” she added.

No Access To Maternal Healthcare Service In Isanlu Isin PHC

Muhammad Pate, Nigeria’s health minister, says maternal health is a fundamental human right and that every woman, regardless of socioeconomic background or residence, should have access to high-quality healthcare before, during, and after childbirth.

“It is incumbent upon us, as leaders and advocates, to uphold this basic right and work tirelessly towards its realisation,” the minister said.

However, maternal healthcare remains a challenge for residents of Isanlu Isin in Isin Local Government Area of Kwara State, despite their PHC being one of those the state government recently renovated.

Isanlu Isin PHC signpost

Hundreds of women are denied this fundamental right during childbirth due to a staffing shortage at the Isanlu Isin facility on which the Kwara Government spent N11 million renovating in 2020.

Isanlu Isin PHC

“We cannot take delivery because of a staff shortage. We don’t have doctors and midwives professionally trained in that aspect, and this is affecting our service,” a nurse told this reporter at the hospital, asking not to be named for fear of victimisation.

Isanlu-Isin PHC Pharmacy but no staff to manage it

The nurse said the situation has worsened because the council’s general hospital, to which they usually refer patients, currently does not have certified doctors.

“We are now referring our patients to Omu-Aran General Hospital (in Irepodun Local Government Area). The facilities are there, but without qualified and adequate personnel, the machines and the tools are useless,” the nurse said.

We ‘borrow doctors’

On Monday, May 27, Children’s Day, around noon, this reporter visited the PHC in Gwanara, a district in Baruten Local Government Area of Kwara State.

Primary Healthcare Centre Gwanara

Following its renovation in 2020, the facility and medical equipment still appeared new. However, the first thing the reporter noticed was the quiet environment, which is unusual for Nigerian hospitals, especially on a Monday morning.

Primary Healthcare Centre Gwanara

No patient was in the facility, and while that Monday was its Antimalarial Immunisation Day, only one child was brought there.

There were only three workers in the hospital established to provide essential health services to thousands of Gwanara residents and nearby settlements.

The three staff members are a nurse – who is the officer-in-charge – and two community health workers.

Speaking to this reporter, the officer-in-charge, Ibrahim Basheer, blamed the low patient turnout on inadequate personnel, lack of electricity and water scarcity.

“We are facing two major challenges here. We don’t have a qualified medical doctor and there is no electricity to pump water,” he said.

“If we have patients who need to see a doctor, we normally borrow from a nearby private hospital to save our people’s lives.”

This situation is the same at the newly renovated PHV Kosubosu. Despite spending the sum of ₦39 million to renovate this facility, the Kwara Government appears to have ignored its need for personnel.

Primary Healthcare Centre Kosubosu

The PHC has only two nurses and a laboratory technician on its staff. It does not have a medical doctor or a community health worker.

Primary Healthcare Centre Kosubosu

“People patronise the hospital, but not much because there’s no doctor. The aspect where we have enough patronage is the immunisation sector. There are nurses and other sectional staff, but we need a qualified medical doctor and pharmacist,” Zainab Habu, a nurse at the hospital, said.

Kwara had 900 doctors for 3.5m residents

A public health physician, Bosede Rotimi, said in 2021 that Kwara State had 900 doctors on its payroll. In a state of about 3.5 million people, this translates to about one doctor for 4,000 patients.

The World Health Organisation (WHO) recommends a doctor-patient ratio of 1:600.

Mr Rotimi observed that the doctor-to-patient density, weak human resources, and poor regulation of healthcare practices in the state needed to be addressed. However, three years later, nothing seems to have changed.

Kwara govt admits inadequate personnel

When contacted for her reaction to our findings, the Kwara State Commissioner for Health, Amina El-lmam, acknowledged that the state is facing significant issues with human resources in the health sector.

Amina Ahmed El-lmam- Source: X (formerly Twitter)

She said, “On the challenges of human resources, this is a national and, indeed, global concern. One of the major issues is the difficulty in retaining health workers we hire. The state has mitigated this by the approval of 100 per cent CONHESS and CONMESS and full hazard payment. This has drastically stopped the local brain drain of state personnel to federal institutions.”

She also confirmed our findings that the General Hospital in Okuta has only two doctors, but said five nurses, one pharmacist, two pharmacy technicians, four laboratory technicians, and three health attendants are also on the hospital’s staff list.

“In General Hospital Okuta that you cited, we were already working on getting more doctors to deploy to Okuta. The community and Emir have been asked to help in this regard to recruit citizens of Okuta. In many instances, we have a standing offer of employment for willing professionals to improve staff strength.

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“There is continuous capacity building of health workers to enable them to provide quality care to the patients. We are also looking at increasing the intake of students (youth corp members) in our health training institutions.

“Significantly, we have created a huge specialist training pipeline by the recent assent to the Kwara State University Teaching Hospital KWASUTH law. This will facilitate the training of medical students from KWASU and the specialist training of doctors,” she added.

The commissioner also pledged to look into our findings about the two doctors and other health worker’s irregular attendance at the general hospital and to take appropriate action.

The story was supported with funding from the Centre for Journalism Innovation and Development (CJID).