The Special Adviser on Primary Health Care, Lagos State, Dr. Olufemi Onanuga, in this interview withÂ Martins Ifijeh,Â spoke on the current multi billion naira renovation and equipping of PHCs across the state, plans to buy ambulance boats for riverine communities, increase PHC staffing, among others
How was kicking off as the Special Adviser on PHCs like?
I assumed office as Special Adviser on Primary Health Care to His Excellency, Governor Akinwunmi Ambode on the 19th of October 2015. We immediately afterwards made assessment of all PHCs and then had an advocacy visit to all the 20 local government areas and 37 LCDAs.While meeting with stakeholders, we were also doing evaluations to ascertain where to kick off from. You know I also oversee disease control, family planning, nutrition, pharmaceuticals in the state. But I discovered these other areas were striving very well except for the PHCs. That is why we are very focused on revamping them for the benefit of Lagosians.
How many PHCs do we have in Lagos?
In total, we have 320 PHCs, but the ones that are very functional are about 290.So after assessment infrastructure and medical equipment wise, we decided to renovate and equip the PHCs better. I discussed with His Excellency, who is also very vast in how PHCs are run, because he was once in the local government. We discussed and agreed on how to start the renovation and equipment in phases. We knew we could not do everything at once, so we decided to face the most important ones. We selected the ones which are centres of attraction and we made sure we include at least one in every local government and LCDA in the state.
We started with a partnership with the federal government, which enabled us renovate 14 PHCs, tagged the MDG PHCs. They are ours but we partnered with the FG to renovate and equip them. That was the first phase and it happened at the middle of 2016.
When you first came in and assessed these PHCs, how many were actually working?Â
Most of them were in a state of despair with infrastructural decay. The equipments were obsolete, and it was like there were no people working there. People were working there, no doubt, but it wasn’t to my satisfaction because that’s my field of specialisation. We concluded on taking the bull by the horns. After the first face of the FG partnership, we went ahead to pick another 37 PHCs, all scattered in each of the various local governments. We tagged them the comprehensive health centres.
Why are they called comprehensive health centres. Are they different from the others?
They are so called because they are comprehensive in package. You will find mother and childcare, antenatal care, deliveries, family health and nutrition, food demonstration classes and a lot of immunisation activities. So it’s a total package with the exemption of those things that we feel are for the secondary health facilities, like complicated deliveries or major surgeries.
These 37 were renovated and equipped by the state government. We also identified some areas without PHCs at all and built new ones there. We picked one in Ijegun, Alimosho, another in Badagry, while the third in Ori-Okuta, Ikorodu. In those places, we realised they were not having government presence in terms of healthcare delivery. The three have been duly completed and now in use.
When we decided to work on the 37 PHCs and build the three new ones plus their equipments, the governor graciously approved N1.4 billion, which was approved by the executives for this total renovation, out of which we spent N900 million for structural renovation, and N500 million on purchase of equipments. Those ones are near completion now, and 51 of the 57 PHCs have been equipped with state-of-the-art equipments. We equipped each with the cost of N11.5 million.
But we realised that we have not gotten to half of the distance that we are running. We are talking of about 290 PHCs and we are only able to renovate about 60. Although, we decided to first pick the ones that are not operating to our satisfaction. Others were at least still manageable, but now we are graduating to ticking another set. We are going to renovate about 20 more now, which I have discussed with His Excellency and he has graciously also approved about one billion naira again for renovation of the newly ticked 20 plus another 10 set of equipment and furniture in 10 PHCs, that simply means the total furniture we will be purchasing will be about 61.
When will the proposed 20 PHCs be renovated, equipped and delivered?
Within four months they will be ready. Health workers will be working there, not that we are abandoning or closing them down.
Comparing when you came on board and now, has the stateâ€™s health indices improved?
Health indices have improved greatly. People have now realised they can go to our PHCs and get health services. Maternal and child health has improved. Ante-natal and deliveries have improved. Mortality rate has generally reduced compared to when we came on board.
Some PHCs are in riverine areas and are not accessible to Lagosians and health workers. What are you doing about this?
To operate optimally in those areas, we are considering buying at least three ambulance boats. They will cover the coastal areas in all the senatorial districts. One in the Epe axis, one at the central, and one in the Badagry axis. From Badagry axis down, we have about 400 communities that are living behind the coastal area and there are different diseases that are prevalent in those areas. So they need our services.
Some government workers are usually known for their layback approach to work. How are you tackling this in the PHCs?
From the beginning we decided to face squarely the issue of workers in PHCs and primary healthcare services. We started with advocacy to all local governments and LCDAs, and told them what we want. After which, we went into monitoring, evaluating and needs assessment. While some people often say we are short of staff, we said to ourselves we need to evaluate those that are actually working.
When we came in, we noticed in situations where we were supposed to be having eight nurses on ground, only three will be seen. There was a lot of absenteeism. This affected patient handling. We then started going round the PHCs. Workers we do not meet on duties are punished.
Part of the punishment for some was that irrespective of their location, they must resume in our office in Alausa. They would stand on our corridors from morning till close of work, for at least one week. Even doctors who were absent during our monitoring were also punished that way. Now everyone has sat up. They now go to work on time and close as at when due.
But some people believe PHCs are understaffed in Lagos?
After we carried out this monitoring and evaluation, with staff having a renewed drive for work, we then realised truly we are short of staff but not as what people were saying. So we made our recommendations. Now the Head of Service is working on it. We have finalised the number of staff we need in the PHCs.
Did you discover ghost workers during your monitoring and evaluation?
So far, no. But absenteeism was high. All that has stopped now. There are times we go to PHCs as early as 8a.m., just to know those who resumed as at when due. We visit PHCs unannounced, and then evaluate what is going on. There was a day we went to Epe on a Sunday evening. We lodged in a guest house, and first thing Monday morning we stormed the centres. Those who were not on ground were punished. So generally, we have been able to bring sanity back to the system. There must be standard. In every PHC, there must be a minimum of three doctors, 10 nurses, eight community health officers (CHOs) which we don’t have for now. We know this is not easy for the government, but at least, instead of having eight nurses, we can have six to seven of them on ground, CHOs six to seven as well. And if they all work hard, they should be able to cope.
Some PHCs are not accessible because of bad roads. How have you tried to tackle this?
For sometimes now, one would have seen the difference in the road construction that Governor Ambode has been doing. He has done more roads than any other regime so far. He is not only doing Ssate roads, he is doing local government roads as well. Last year, he fixed 114 roads belonging to local governments. Two roads each in every local government. This year, he has fixed 181 roads. He is now fixing three roads each in the local government and LCDA areas.He is also fixing federal government roads. So the governor is very much ready to fix a lot of roads, and I am sure once we continue to do our monitoring and evaluation and discovered where roads will hamper our patients visiting our PHCs, we will inform the Ministry of Works and ensure those roads are fixed.
After completing the next phase of the project, which is the 20 PHCs, what next?
We will pick another set of PHCs and renovate them. But that will depend on the availability of funds. Because these renovations and equipping cost a huge amount. So it depends on funds and our allocation, but we will continue with out renovation notwithstanding. We will also continue with our advocacy,monitoring, evaluation and assessments.
What is your overall goal for PHCs in Lagos?
What we want to achieve is for the government to be able to have a very structural health system that will be driving itself from the primary care level, such that it will reduce the pressure on the secondary health system. By so doing, it will reduce immortality. So on sicknesses like malaria, no one would need to go to general hospitals. For secondary care to happen in such case, it has to be with a very good referral. We also must have a good feral system which we are already putting in place.