Kaduna State unhealthy Health Sector – By Nasiru Jagaba
During a recent trip to Kafanchan to receive a Humanitarian award from ‘One Voice Foundation’, I used the opportunity to continue my survey the revitalization of the 255 Primary Health Centres (PHCs). Steven Magee cautions, “If you want to be lied to, all you have to do is believe everything that the government tells you”.
These are the strategic priorities of the State’s Development Plan (SDP): governance and stewardship; health services delivery; health financing; human capital resources. Compositely too are health infrastructure, management information systems, research and development, education and promotion, partnership, community ownership and participation; maternal and child nutrition are the strategic priorities of Kaduna State’s Development Plan (SDP). This strategic document has always been governed by a medium term expenditure framework (MTEF) which runs annually (after reviews) for the entire term at office to transition. On paper the initiatives are as laudable as the funds voted into this sector in fulfilment of the rights of humanity.
It is fast coming to the close of the four year social contract Governor Nasir el-Rufai entered with the good people of Kaduna State. Already over N690 billion has entered this state treasury from federal allocations. So to focus closely to where public funds are expended in the health sector where the foreign aids and donations are not involved, will point us away from the issue in discourse. A searchlight particularly on maternal and child healthcare will be just enough.
Kaduna state government claims that 255 PHCs were upgraded, these attracted stares of the media while the reality on ground isn’t commensurate with the publicity and government claims. What is visible mostly however, are dilapidated structures decorated with expired drugs and cob webs and have become in many places inhabitants for domestic animals (emphasis mine). The little that have been renovated are without health care facilities. The PHCs project was a sham and a rhetorical fraud. Contractors were duped through buying of tenders, while contracts were awarded to family, friends and cronies.
Kaduna state is in the eye of the storm for failing to provide basic healthcare services for its teeming population, in spite of the state government’s claim that it is meeting the expectation of the electorate. Matter-of-factly, Kaduna state under the present regime of Governor el-Rufa’i can only be hailed for not lacking in bulky policy documents, huge government brochures in beautiful prints, to the chagrin of the less-privileged who are daily battling to eke out a living. These documents mean nothing to that patient who cannot afford and access basic healthcare facility for the treatment of malaria!
The state approved Health Capital Budget for 2018, stand N17, 576,392,530 billion, no one can tell where such huge amounts have been sunk as the impact is yet to be felt by citizens.
Kaduna State Maternal Health Accountability Mechanism (KADMAM) Report on Spot-check and other reports in 2018 which focused on Maternal and Child Healthcare exclusively reveals much on performance of the state of public hospitals (30 hospitals) and equipment in the state as well as capital expenditure . The mid-year monitoring and evaluation report indicates the spending made by government which has failed to provide for adequate ambulance services in hospitals, non-functional enough to cater for emergency conveyance of patients and pregnant women with obstetric complications. Of the 30, only 23% have functional blood banks. Most of the hospitals have oxygen cylinder without oxygen.
The biggest hospital owned by the government which is currently being utilized as a teaching hospital for the state university was found to have recorded the highest of maternal deaths. This is a hospital located within the central metropolitan area of Kaduna’s city with access to all support facilities, infrastructure and supplies.
The most common feature in all the hospitals in the state, is inadequate power supply, despite the high overheads for power generators. Yet the state government is totally reluctant to create an enduring atmosphere for effective power distribution and generation. The huge debt owed by government institutions to energy distribution companies like KEDCO has had a very crippling effect on electricity supply.
From January –June 2018 capital expenditure in public health care for the Ministry of Health and Human Services, Kaduna State Primary Health Care Development Agency, Drugs and Medical Supplies Management Agency and Kaduna State AIDS Control Agency (KADSACA) totalling N 3.64bn got 0% releases. Needless to say that funds appropriated by law for drugs infant, child and maternal healthcare; diagnosis items and equipment; consumables for blood transfusion have received 0% funding.
The Saving One Million Lives (SOML) Performance for Results (P4R) used 6 high impact MNCH interventions as indicators to measure the performance of States in Nigeria. Kaduna State’s performance is very low, using the SOML P4R selected indicators, comparing 2015 and 2018. The state recorded 19.3% point increase and lost 68.8% points in the coverage of the 6 interventions in 2018 when compared to the 2015 baseline. This poor performance caused loss of lives. States of Yobe, Adamawa, Borno ravaged by Boko Haram achieved 145.4% point increase in 2018 and did not lose any point coverage in the 6 interventions, a mark of effectiveness and performance.
This is similar with the laudable intervention program of UNICEF and Canadian government free health care project, tagged “Hard to Reach Project” the program employed 450 staff for two and half years to offer free medical care to children, women and men on immunization, polio, nutrition, malaria and community mobilization on health matters.
Despite the humongous impact of the program, especially the uniqueness of its door to door health care service in the remote localities, it was discontinued in 2016. This was because the state government deliberately withheld the counterpart funding appropriated by law for the project even when UNICEF and the Canadian government agreed to provide free drugs for the project. And that is why 2018 recorded outbreaks of polio, high level of maternal death during childbirth. States like Taraba, Niger who committed funds still enjoy the program till today.
The state government also abandoned the Kaduna State Infectious Disease Control Center, one of the best in Nigeria. It remains understaffed. This the state of the Centre built in 2014 with state of the art equipment. With the recent news about Lassa fever’s outbreak in Kaduna and places like Abuja and Plateau all bordering the state one will say that the vulnerability of citizens in Kaduna is high, five years under el-Rufai’s boastful claims of running zero-based budgeting.
This level of underdevelopment in healthcare services delivery has in turn made rural dwellers that are being attacked at the mercy of self-help. Women and children have been at the receiving end being the most vulnerable in the society.
Contractors who are undertaking the building and renovation of the PHCs have not been able to make available 50 percent of the number of PHC projects awarded. Besides poor funding, there are rumours about non-payment of projects even after all clearances have been issued for such. Most of the projects undertaken by the state are mostly intervention programs where counterpart/full funds from the Federal Government, International Organisations and Non-Governmental Organisations.
My question here is, what has been the priority of governor Nasir el’rufai? As important as the public healthcare is to the citizenry, no serious attention has been given to it.
Kaduna State unhealthy Health Sector – By Nasiru Jagaba