BY KHALID IDRIS DOYA, Bauchi
The Basic Health Care Provision Fund (BHCPF), a programme of the Federal Government which commenced healthcare service delivery in 2021 nationwide to better the health needs of the rural communities, is yet to be fully imbedded in Bauchi despite the colossal sums of one billion so far spent on the scheme, which has in place a number of 323 primary healthcare centres across the twenty Local Government Areas in the state.
Our reporter, KHALID IDRIS DOYA went round some of the PHCs in Bauchi, particularly in five Local Government Areas of Bauchi, Bogoro, Katagum, Jama’are and Alkaleri in the state where he was confronted with some problems of the NHCPF and MSS implementation, and sought the opinions of some stakeholders of the two programmes.
The implementation of the much-needed BHCPF, people’s oriented programme, which accompanied or augmented by the Nigerian Midwives Service MSS scheme being operated since December 2009 with the aim of curbing maternal and infant mortality rate in the rural areas, are both having some setbacks as captured by a desk officer with PHC in Bogoro Local Government Area of Bauchi state, Dogara Ayuba who argued that, “We don’t have enough operational manpower in most of our facilities”.
Ayuba, who noted that sometimes the government would have a good plan in the health sector, but its implantation and sustainability are always the problems. “As I so much believe that if the government would take a very good strategy of supervision, the services would be sustainable. If there is no good supervision, you know the type and character of our people, we need close marking in virtually all our endeavours. So if there is no close supervision, I don’t think this programme could be sustained or put to stay on course.
Challenges of the Programmes
According to Ayuba, the major challenge to both the basic healthcare services and the midwives service scheme is the issue of manpower, because, as he puts it, the money the basic healthcare is sending quarterly N300, 750 into the various PHC account, the amount is not adequate enough to even take care of maintenance, let alone contracting the operational staff and other basic healthcare services.
“You know the PHCs are supposed to take care of delivery, postnatal care for pregnant women, immunization, treatment for malaria, antenatal care, pneumonia, dysentery for children under 5, measles, and family planning for adults, in addition to purchase of drugs and consumables, as well as other logistics that could pave way for smooth operations.
“So if you look at the money, it is helping, but in other ways, in terms of infrastructure, there are some facilities that we don’t have enough, we don’t have enough space as the facilities needs expansion, but because the funds are not enough for expansion, you see that they cannot expand.
Dogara Ayuba argued that ideally, and in accordance with the World Health System, the selected infrastructural facilities meant for the primary healthcare centres are to serve as the referral centres of the wards”.
He explained that the PHCs are supposed to admit patients, whereas if they don’t have enough space to admit patients, there wouldn’t be efficient and effective services, “So those are some of the challenges I’m talking to you about that we are having here in Bogoro.
Ayuba told this reporter that some of the PHCs doesn’t have structures on ground, giving an example with one community with Dazam PHC that doesn’t have structure, because it is too small to admit patients there for 24 hours.
Desk officer Ayuba said that the staff at Dazam PHC are using somebody’s house as a facility, and that was the main PHC in the ward. “So we are appealing to the government to come to the aid of the people here by at least raising up the structure to make the service 24 hours.
He explained that in terms of infrastructures and the facilities, the two wards he was talking about don’t have structures on ground, as what they have could not sustain admission of a patient for 24 hours a day.
Ayuba stated that the facility staff used to mobilize people whenever they were sick, that they should go to the nearby facilities so that they could access the services that the government has already paid money to them.
A beneficiary under the Dazam Primary Healthcare Centre, Tabither Musa described the programme as good which she said could help vulnerable people like her, especially the poor in their community, but the absence of facilities at the centre has made it less useful.
Tabither therefore appealed to the health authorities to provide necessary facilities at the Dazam PHC and to increase the number of beneficiaries as, according to her, many women including some of her family members cannot afford the rising cost of health services in both public and private facilities.
Ahmed A. Mandas from Gobiya PHC in Bogoro Local Government Area of Bauchi state said that the Basic Healthcare Provision Fund has great impact on the facility due to the availability of drugs, and patients are patronizing the facility more than before.
“Because of the availability of provision funds, we now have solar lights which enhance night delivery, so we don’t have women who come to deliver at night. We also have enough water supply because we have a source of water through a borehole, but because one of the overhead tanks was broken. But with the introduction of a basic healthcare provision fund, we were able to purchase another to replace the broken one”.
Problems of consumables and other materials/ working staff
Mandas added, “Formally, we don’t have registers like the DRF drugs, we don’t have some of the data tools like ANC cards, the post-natal cards, and we have now purchased them. And formally the facility did not have a signpost, but because of the introduction of a basic healthcare fund, we have now purchased the signpost for the facility”.
According to him, they are now planning to buy a desktop, desk pond, mattresses, and other things to mention a few, saying “So we are very grateful to the Bauchi state government for providing us with a basic healthcare fund. In fact, it has helped a lot in many other ways”.
Rising cost of commodities in the markets
The officer however spoke of some challenges and he succinctly puts it thus, “We normally have a business plan, the business plan that we met is what we follow, we cannot go out of the business plan. There are things that we estimate, but unfortunately when you go to the market, you find that the prices are higher than what you have estimated.
“So, the problems we are having are that the rising cost of prices of items you estimated to purchase reduces your purchasing power, most of the time you find that some of the items you planned, you cannot get them because of the fluctuations in prices.
Some of the would be beneficiaries were not aware of the healthcare services
The basic healthcare provision at the Tudun Gambo PHC in Bauchi Local Government Area of the state has at it initial stage suffered some setbacks as narrated by the officer-in-charge of the facility, Al-Amin Garba Ibrahim who said, “The problem we are encountering was that most of the programme beneficiaries were not coming to the facility to benefit, some due to distance, some were not even aware they were enrolled into the scheme”.
He said that it was through the commitment of ward development committee (WDC) that the registered beneficiaries were mobilized to attend the centre, they have to be mobilized through announcers to inform them about their enrolment into the programme.
Ibrahim explained that it was also during the WDC outreach that beneficiaries were issued identity cards, disclosing that the Tudun Gambo PHC already has enrolled155 beneficiaries, “We consider the less-privilege during the enrolment of the beneficiaries. We invite almost every less-privilege from each and every angle of the community”.
Demands for BHCPF services increases by the day
In Katagum Local Government, the BHCPF desk officer, Inuwa Wada said that the basic healthcare service scheme attracts more patients to the PHCs than the hitherto healthcare services where they have to pay for services being rendered or offered them, but however, the demands for the fund services far outweighs the stipulated number of beneficiaries to the scheme.
More and more would-be beneficiaries seeking enrolment bombards those PHCs on daily basis begging for their registration, as officer Wada made a plea to the relevant authorities to jerk-up the number of would-be beneficiaries of the scheme. He even called for reverting to the initial pegged beneficiaries number of 2500 people when the idea for the fund was mooted.
Inuwa Wada observed that patients are longer scared from the healthcare facilities as they go about receiving services free of charge, for those who were opportune to be enrolled into the programme, saying it was more of economical
He opined that based on the disbursement of funds to every and each facility on quarterly basis, the funds though grossly inadequate, would to some extent sustain the programme, saying so far there any complaint from any beneficiary of the scheme on the healthcare services being rendered under the fund in Katagum Local Government Area of the state.
According to him, every of these facilities from 21st July, 2021 to July 2022, has each at least 137 beneficiary thumping them up thus, 2, 740 beneficiaries across the twenty healthcare facilities in Katagum LGA, pointing out however that in the last month of August, 2022, each of the facility has no less than 155 beneficiaries, giving a total number of 3,100 beneficiaries put together in the LGA.
Other Challenges of the scheme in Katagum LGA
Wada recalled that one of the challenges the PHCs initially faced was the issue of proxy in seeking healthcare services, often by relative of a card holder or member of her household, because then there wasn’t any means of identification except the name of the holder, but with the issuance of a standard identity card bearing beneficiary’s own photograph, that proxy no longer exist today.
“Another challenge we have here is the issue of additional enlistments. Actually, from the commencement of this programme, many people who heard about it, and having seen its impact from family members or colleagues, people seeking enrolment into the scheme are now daily trooping to these facilities, so this is the challenge that most of these facilities are today facing, because PHC officials were not permitted or assigned to henceforth enroll any person or would be beneficiary.
Desk officer said, “This is another challenge that we are today facing in the health facilities, and we hope the Federal Government would critically look into this issue with a view to increasing the number of beneficiaries for enrolment into the programme, which is effectively making an impact into the lives of the vulnerable”.
Wada further recalled that when the programme was about to kick-start in 2019, the proposal then was to enroll a number of 2, 500 in each facility across the wards in all the 774 Local Government Areas of the country, but the initial plan was reviewed drastically downwards to negligible number of beneficiaries in the PHCs, thus depriving the teeming vulnerable to enjoy free healthcare services of the federal government.
Problems of Primary to Secondary healthcare cases referral
He explained that there are some certain cases that are not allowed for a PHC to attend to or administer healthcare services in cases such as hypertension and diabetes which they were ask to refer to the secondary institution, and the problem they have with secondary healthcare institution was that they don’t sometimes consider a client that is referred to them, that’s the General Hospitals”.
Wada faulted, “They don’t give the patients maximum care, sometimes they used to suffer a lot before the hospital personnel could attend to them, dribbling them here and there before they attend to the referred patient (s) which is not good. So, this is a very critical challenge that we are facing in this matter of referral”,
Improved healthcare service delivery
At the Azare Kofar Fada PHC in Katagum LGA, the officer in-charge, Rukayya Bala Ibrahim, said before the commencement of the BHCPF, the turn-out to the facility was very low, but with the introduction of the programme, additional manpower was put to the facility and coupled with the fund’s beneficiaries, the turnout to the facility has multiply in folds.
Rukayya said, “Like I was telling you, before we had a shortage of manpower, that was the bottleneck in the service delivery in all the health facilities. But now, the programme will be able to at least allow us to contract at least two or three staff who will be able to run shifts in the facility, so if there are enough patients they will be able access services all the times”.
Also at the Kofar Fada PHC, Na’ima Inuwa is a staff of the facility who said that initially the beneficiaries of the scheme came with National Identity Cards for registration into the scheme, thereafter, they continue to enjoy free healthcare services of the fund.
Na’ima said that they were happy with the introduction of the scheme, particularly the beneficiaries who are mostly poor and could not afford to pay for their healthcare services, and expressed hope that the scheme would be sustained for the benefits of the vulnerable in the society.
Non affordability of patient to buy drug when out of stock at facility
She explained that beneficiaries of the scheme are normally coming to the facility on daily basis seeking for healthcare services on various ailments some of which lack the prescribed drugs in the facility, and as such direct them to purchase outside the shores of the facility.
“When we don’t have the servicing drugs for prescription to a patient, we normally prescribe for her to buy at the open market or medicine store. But the irony of such an expedition is that you find that the patient cannot afford purchasing the drugs due to her vulnerability or economic meltdown”.
Na’ima was of the view that the quarterly disbursement of funds be increased to cater for the purchase of more drugs that should cater for the healthcare services of some beneficiaries who may not necessarily be referred to higher health institutions.
She added, “Yes, such beneficiaries have to go buy the prescribed but facility out of stock drugs. Take for instance, a patient with high blood pressure, you find that a facility may not have one quarter of the prescribed drugs, so she has to go outside to buy it, it is just like elasticity of supply and demand”.
At the Makara Huta PHC also in Azare township, the officer –in-charge, Hajiya ‘Yan-Biyu Uba stressed the importance of the BHCPF to the people, especially the vulnerable or poor that hardly fends for a living, as they treat beneficiary patients with ailments such as catarrh and cough, PID, PUD, Ante-natal, and so forth. She however asked for an increase to the monetary service of a beneficiary from the N570 upwards, saying the money is grossly inadequate to cater for a patient’s healthcare service needs at a particular time.
‘Yan-biyu explained that the scheme is highly important because it immensely benefits the poor or vulnerable in the society, and we treat the beneficiaries accordingly without much problems in the areas of malaria, catarrh and cough, PID, PUD, and Blood pressure mostly people of old age, as well as pregnant women coming for ante-natal services.
Funding the healthcare services
“Before we withdraw money from the fund for services, meetings were being held with management such as signatories to the account, among others, which include IOC, Accountant, Pharmacy, WDC Chairman and Secretary during which amount to be spent on drugs and consumables purchase are determined. And purchases are being made from DMA and or Pharmaceutical as the case may be”.
She however stressed the need for more enrolment of beneficiaries taking into cognizance the increasing demand of the healthcare provision fund services which are free as conceived by the Federal Government, as well as increase in funds disbursement to cater for the number of enrolments, because people really the fund’s services.
At Alkaleri PHC in the LGA, the desk officer, Abubakar Haruna however told this reporter that beneficiaries of the BHCPF at the centre numbered 255 as the demand rises were enjoying the free healthcare services being offered to them. He commended the federal government for the initiative to evolve such a gigantic healthcare programme being targeted to help the poor.
Alkaleri WDC chairman, Maijama’a Ibrahim said that the BASHCMA services have great impact on the people, especially the aged, Under-5 children and pregnant women, as well as the less-privileged in the society, saying since his becoming a member of the committee, up till now when he subsequently rose to the position of chairman, he has never seen such a healthcare beneficial programme than this one.
Attitudes or Behavioral of facility staff
Also at Gwaram village PHC in Alkaleri Local Government Area of Bauchi state, a beneficiary of the Maimuna Sa’idu said she frequently has the facility whenever she feels abnormal in her body, especially fever which she often has been thrown into, and is happily enjoying the services.
Maimuna said however that there was a day she visited the facility for an ailment and was examined by one of the staff whom, she argued, looked like a prostitute by the way she sarcastically behaves to patients. such a staff, she lamented, used to frustrate people, and should therefore be called to order.
According to her, there was a day when a patient whom she came across with at the facility, also complained about molestation by that particular staff she was referring to, and therefore spoke of the need for the management officers to keep eyes on them.
The Head of facility Under 5 PHC, Jama’are, Ilya Mohammed Sani who this writer came across with in Jama’are, about 250 kilometers away from Bauchi the state capital, said that they wholeheartedly welcome the basic healthcare provision programme of the federal government which, before its introduction, have been receiving few out patients in health facilities of the town, unlike now when they were even trying to curtail the heavy influx to such centres.
Two beneficiaries with the facility, A’ishatu Mu’azu and Zulaihatu Mohammed Auwal said that they were very happy with the healthcare services being offered them, with the hope that the gesture would be sustain so that more and more clients would benefit from such services, expressing confidence that the programme has come to stay.
The Executive Secretary of the Bauchi State Health Contributory Management Agency, Dr. Mansur Mustapha Dada, whom this reporter sought his views on the programme, said the basic healthcare provision fund is divided into three categories namely the vulnerable, informal sector programme and the formal sector programme.
Dada said that the BHCPF implementation started with the vulnerable which are made up of categories of people that are within the society but cannot actually pay for the healthcare services, while the informal sector comprises people that are among the vulnerable but are not in the formal sector.
He explained that the informal sector are the ones that are actually doing the day-to-today work, earning salaries and they included the farmers, cattle breeders, businessmen, the butchers, Okada riders, taxi drivers, all of whom actually have their own different occupations.
The BASHCMA Executive Secretary gave the formal sector as those people that have monthly salaries being to them on monthly basis and they included the state and federal civil servants, the local government civil servants, as well as those working in organized private sector, saying the programme started with the vulnerable, while the informal sector is still waiting, to be followed by the formal sector later.
The federal workers have their programme to be implemented under the Basic Health Care Provision Fund (BHCPF) while that of the State and Local Governments are the State Equity Programme, and Local Government Equity Programme respectively, in the addition to the Adoption Equity Programme which comprised organizations mostly in form of communities, philanthropists, corporate social responsibilities, coming from citizens in diaspora or Zakkat Endowment as the sources of the fund.
According to Dada, looking into the Federal Government’s Basic Health Care Provision Fund (BHCPF) that has actually taken-off which is right now being implemented under the vulnerable programme, the federal government has paid the first instalment and the second tranche respectively, while the third tranche is being awaited to move up the spending to over one billion naira.
Dada disclosed that Bauchi state has Basic Healthcare Provision Fund, a programme which has 43, 675 enrollees, and it started in 2018, but the initial target was 44, 251 and it was increased to 52, 000. Services were started in July, 2021 and implemented the primary services for nine months, with the secondary services started in September, 2022.
“The category of the vulnerable that are actually covered are women within the child bearing age, children under 5, disabled, aged, and the poor of the poorest, as the programme or scheme is using 323 Primary Healthcare Centres (PHCs) across the twenty Local Government Areas in Bauchi state, the is one main PHC per ward”.
Dr. Mansur Dada explained that the state is also using the Bauchi Specialist Hospital and 26 General Hospitals that are in the different Local Government Areas for the secondary healthcare services, as more two hundred million naira were disbursed to the Primary Healthcare Centres since the programme started.
One of the major challenges facing the PHCs in Bauchi state was, based upon findings by this reporter, the dearth of staff or personnel to effectively and sufficiently run the facilities, especially the midwives to which the scheme significantly relied. In some of the facilities, you get one or two if lucky, at times none.
However, the seemingly dearth of personnel in the facilities is just like dying amidst plenty because such much needed staff, graduates of college of nursing and midwifery are just roaming the streets in the state capital, Bauchi without necessarily being employed by the state government.
Such graduates, as gathered from the Kofar Dumi Primary Healthcare Centre, normally collect ‘To Whom It May Concern’ letters from the Bauchi Local Government Council to serve as volunteers in those facilities at the capital, as the letters also pave ways for subsequent employment whenever the need arises.
But the Executive Secretary of the State Primary Healthcare Development Agency (BSPHCDA), Dr. Rilwanu Mohammed assured that this problem has already been solved with the recent employment of different cadres in the health sub-sector by the state government.
Dr. Mohammed puts it thus, “Because of the dearth of health workers, compounded by retirement going on every day in the health sector, the state government engaged about 1,064 new medical and para-medical health workers, nurses and midwives and other health-care workers”.
According to him, all the community midwives that graduated from the college of Nursing and Midwifery have their employment been individually approved and absorbed by the state government, in addition to the engagement of over 100 doctors.
But recent vox pop by this reporter indicates that the employment of medical staff to the hundreds of healthcare facilities in the state is yet to be felt, either the number engaged are grossly inadequate or some of them are event yet to take up the appointments due to what was perceived as meagre remunerations, hence the dearth of staff in the state healthcare sector still abounds.
This report is published with support from the International Budget Partnership, (IBP) and the International Centre for Investigative Reporting, (ICIR)