A Pathway To Improving Rural Healthcare Service Delivery In The Fct
The health sector in Nigeria is one riddled with a myriad of problems, ranging from poor infrastructure, to inadequate funding, corruption in hospital administration, lack of power supply, insufficient number of qualified personnel, as well as, poor remuneration and working conditions for these personnel which in recent times, has led to mass migration of doctors and nurses to Europe, America and other parts of the world in search of greener pastures. As of 2020, the doctor to patient ratio in Nigeria stood at 1 doctor to as much as 2753 people instead of the standard 1 doctor to 600 people that is the WHO standard ratio1.
Primary health care (PHC) is the first port of call for people at the grassroot level when it comes to accessing health services. It is the community’s hospital and is tasked with providing health services tailored to the peculiar needs of the respective communities where they are located. Services rendered under the PHC system cut across preventive, curative and rehabilitative medicine, as well as, health information dissemination. Nigeria has a total of 30,000 PHC facilities and the FCT has more than 50 of such facilities, most of which are sadly, overburdened, unequipped and in a general state of disrepair due to negligence and poor maintenance.
Many of these facilities cannot operate on a round-the-clock basis as they ought to due to the absence of power to give illumination during the night hours. A good number of them are not even connected to the national electricity grid due to their location or owing to the fact that, with their poor funding, they are unable to pay electricity bills. Moreover, those facilities that are connected to the grid are not faring any better as the 5 hours or less power supply a day they get from the grid2 can hardly be relied upon, which has led them to turn to petrol generators to make up for the deficit in power supply. Many midwives in primary health centres have had to conduct childbirth at night using torchlights and kerosene lanterns.
Because constant power supply is at the heart of medical service delivery, it is important to note that the consequence of this shortage or unavailability of power does not mean well for community people who cannot afford to go elsewhere to get medical attention as most of them are both impoverished and live quite a-ways from alternative medical facilities. Also, the recurring cost of running these power generating sets are by no means cheap and more so in these times of fuel scarcity where the queues in filling stations are endless and the prices of petrol, diesel and other petroleum products have skyrocketed.
Sadly, it is the poor community members who come to these facilities that have to bear the brunt of these added costs at the end of the day. Also, there is the health implication of exposure to the emissions from these lanterns and power generating sets on the patients and staff of these facilities. Carbon monoxide is a deadly gas that is produced when fuel is burned and considering that sick people go to these centres to get better, the presence of these pollutants does not make the PHC facilities safe or conducive for their treatment and wellbeing.
Now, more than ever, there is increased need for government to consider alternative sources of power supply, that are not only constant and reliable but clean and sustainable, especially for the health sector where lives hang on a balance and can be easily lost when power is cut, absent or isn’t produced from a clean and health-friendly source. Medical laboratories, operating theatres, refrigerators for storage of vaccines and other medical perishables, computers for hospital inventories, medical equipment and even the wards need electricity for illumination and to power fans and other available cooling systems in order for patients to be as comfortable as possible.
Electricity is also needed to power water pumps where they are available, to provide clean water for use in the facilities instead of the reliance on local water vendors popularly known as “mai ruwa” that is obtainable in many health facilities in the FCT. Doctors, nurses and other staff need electricity for the day-to-day discharge of their duties. The place of power supply in the daily running of medical facilities is absolutely indispensable in this day and age.
According to a Situation Analysis of PHCs in the FCT2, there are currently 2 PHCs in Abuja: Karu and Dakwa that are enjoying constant power supply in excess of their electricity demands from their installed off-grid solar power systems. These facilities benefitted from well-meaning organizations and individuals who, as part of their corporate social responsibility, provided them with solar photovoltaic systems that have greatly impacted the rate of patronage of these facilities. Staff report that since the installation, there has not been a single instance of power outage. Now they can power all their equipment and have the privilege of deciding what to do with the excess power generated.
With these success stories, one would wonder why government has not hopped on the opportunity to try off-grid solar generated power for PHCs as it is cost-effective (with the estimated cost being between 2.5 – 3 million naira), clean, sustainable and can produce more than the required power output at no extra cost. Moving forward, there is a need for the government to look into investing in these power generation facilities. PHCs should also receive more government funding in the planning and budgeting for the health sector to facilitate these purchases and their subsequent installment and maintenance. These funds and their due utilization should be monitored to reduce the chances of them being misappropriated at any level. Also, security around PHCs should be beefed up to ensure that these infrastructures are not vandalized or stolen by unscrupulous elements in the communities.
On their part, corporate organizations and well-meaning persons, as part of their corporate social responsibility, can assist the government in providing and installing these solar systems, as well as, in their maintenance.
The primary health care sector in Abuja, Nigeria’s federal capital has its fair challenges not different from what is obtainable in States, however the peculiarity remains that the PHCs in Abuja serve mostly the indigenous people of the FCT who reside in rural communities and rely heavily on them for their medic-care and the lack or absence of electricity supply greatly impedes on the efficiency of medical personnel to provide quality services to the people thereby increasing out-of-pocket spending for a group of Nigerians who are already suffering other forms of marginalization and neglect.
Overall, Nigeria as a country is a work in progress and we cannot deny that we have a long way yet to go in the area of power generation. What the nation produces right now is far from sufficient to go round its teeming population. However, if this alternative means of power generation is employed across the PHCs in FCT, it would go a long way in bridging the gap in the health care provision sector especially for those in rural communities and the chiefdoms of the original inhabitants of Abuja.