COMMENTARY

Rivers’ free medical health care?

By Odimegwu Onwumere

"A joyful heart is good medicine, but a crushed spirit dries up the bones" - (Proverbs 17:22). The later was the mood of a caller who identified himself as Hon. Henry on the 18^th March 2012. He was crying on phone that his child was very sick.

 His peril was that he had gone to the Braithwaite Memorial Hospital, Port Harcourt, days before the call, but was directed to go to the Primary Health Centres. At the Health Centres, he said that the treat he rushed for was only a mirage. As a result, he is living on hope, on how to go about the health of his child.

We know as residents of Port Harcourt that one of the priorities of the Governor Chibuike Amaechi-led government of Rivers State was the Primary Health Care (PHC), which is seen as the main focus of health care delivery in the state.

The government had said that the vision was to empower individuals, families and communities in the state to take full responsibility for their own health. And the mission was to provide quality, accessible, available, affordable and effective health care services to individuals and families in the state where they live and work. Accordingly, PHC is the swivel from which all other health activities revolve in the state.

Whether “to take full responsibility for their own health” is in tandem with the promise by the state government that children under 6 years, adults over 60 years, pregnancies leading to caesarean sections and first 24 hours of emergency medical service are all free cannot be comprehended.

As an organ of the Ministry of Health of the state, residents are asking whether is the PHC department not responsible for achieving the goals, objectives and the direction of the state government in relation to Health care service delivery and doing its best in relation to the promises that were outlined. They are asking whether is the department coordinating and supervising all primary health care programmes and activities doing so conscientiously or controversially.

While the state had come up with the policy direction, it is expedient that the translation of this into reality or in operational terms become the unwavering function of the PHC department. Such functions, as the government had said, include situation analysis, identification of needs and priority setting; and the department takes into consideration the feasibility of identified interventions, the available resources, target setting, strategies to achieve targets and indicators to measure achievement.

The managers of the PHC would say that most of their programmes follow these basic concepts and are coordinated and supervised by the PHC department be it at the Local Government Area (LGA) or state level. And that the department collaborates with partner agencies: WHO, UNICEF, EU PRIME and other organizations to achieve set goals. The PHC department should also understand that it’s responsible for monitoring and evaluating all the activities of the various components.

Due to people’s different beliefs, it is evident that many do not take the issue of the health of their children seriously, and some who do, the health centres do not take them seriously. The issue of immunization is in the forefront. The PHC head of this unit is the State Immunization Officer (SIO), and it is responsible for immunizing children against the vaccine preventable diseases namely: Poliomyelitis, Tetanus, Diphtheria, Pertusis, Measles, Yellow fever, Hepatitis B and Tuberculosis.

According to Government Reports On The PHC Operation:

Immunization: activities are carried through. All the 354 primary health care facilities in the state, when caregivers take their children in specific days of the week to the health facilities to get them immunized, Women of child bearing age are given tetanus vaccine.

On The Index Of Immunization:

   1. Routine immunization: This takes place in all

   2. Supplemental Immunization: This is immunization campaign carried out periodically to boost routine immunization or when there is a threat of an epidemic. It is National Immunization Days (NIDs) when it is carried out at the same time throughout the country; State Immunization Days (SIDs) or mop up when it is restricted to a state and Local Immunization Days (LIDs) when the campaign covers a particular Local Government Area (LGA).

To make this programme very efficient, we were told that the state had a cold store which was well equipped to maintain the potency of the vaccines. These vaccines are also available all the time and can be accessed at the nearest health facility. The target immunization coverage for the state in 2008 is 80%. Dp3 coverage is used as the indicator to measure coverage and the state has recorded 79% by October 2008.

MATERNAL AND CHILD HEALTH/FAMILY PLANNING & SAFE MOTHERHOOD.

We were told that four interrelated units were involved in rendering maternal and child health services in the PHC department namely:

   1. Reproductive Health and Family Planning (FP).

   2. Safe Motherhood

   3. Women in Health

   4. School Health

The goal of maternal and child health/family planning services in the state is to ensure that:

    * Women remain healthy when not pregnant

    * Remain healthy throughout pregnancy

    * Have safe delivery

    * Have healthy babies

    * The child remains healthy and attains optimal development

    * The families control their fertility

We were told that the services also assist couples who have difficulty in having babies. These services are available to individuals, families and communities in the various primary health care facilities in the 23 LGAs of the state; and in 2007, the state recorded 2,408 normal deliveries with no maternal death and 706 accessed our family planning services. The state government was constructing 130 model health facilities, 5 in each LGA, which would be adequately equipped to improve services. Also health personnel were being reoriented, retrained and more staff employed to render quality services.

NUTRITION UNIT:

The general goal of this unit was to contribute to the reduction of morbidity and mortality of persons in the state through uplifting their feeding habits.

Functions of the unit include:

    * Nutrition education and public awareness.

    * Evaluation of nutritional status.

    * Food supplementation and fortification.

    * Dietary diversification and food production.

    * Nutrition rehabilitation and

    * Coordination

Achievements:

Growth monitoring was undertaken in 6 health facilities in PHALGA. A total of 9707 under 5 children were weighed during the first quarter, the result showed that 13.8% were malnourished and 5.9% were severely malnourished. Caregivers were educated on food habits and proper nutrition. Also between 23rd and 26th of February 2008, 756,435 children were administered with Vitamin A.

MONITORING, EVALUATION AND SUPERVISION UNIT:

This is the health information unit of the PHC Department. The goal of this unit is to develop a dynamic and responsive system that will provide information for planning, management and operational function of primary health care activities. As a result of the importance attached to this unit a consultant is appointed to head the unit. This has enabled the unit to undertake active supervision of activities in the 23 LGAs.

Other elements covered by PHC include:

    * Adequate supply of basic water and sanitation

    * Prevention and control of locally endemic diseases and injuries.

    * Appropriate treatment of common diseases and injuries.

    * Provision of essential drugs.

    * Mental health

    * Control of HIV/AIDS.

Inter alia. Apart from the above information, investigation have shown that like other states in the country, the provision of quality health care delivery to the citizens in Rivers has yet remained a discouraging task. With over 350 health centres, in addition to 10 general hospitals, they say that the state, in spite of its comparatively long history, had not been able to record appreciable progress in health care delivery to the people with all the above statements.

The UN Millennium Development Goals (MDGs) had specific objectives in health. But there is an objection that this might not be achieved owing to the state of misery the health care operation in the state is upon the grotesque huge sum of money that the government has invested in the sector.  

In Nigeria, it is believed that about one million children die before their fifth birthday, while 52, 900 women die from pregnancy-related complications in Nigeria each year. Not even this sum of money, which some states are also expending in making sure that healths projects are taken seriously, have delivered to the people.

This is evident in Rivers State, where Governor Amaechi, without doubt, has expended huge sums of naira on various health projects, to enhance Rivers State’s health care delivery, but this is with less fruition.

Observers say that this government has constructed many ultra-modern primary health centres and equipped them and that the governor was supposed to be receiving kudos, but for the operation of the centres’ managers.

Apart from the Primary level of health care in the state, the governor was said has recorded some feats at the secondary level of health care, with the reconstruction of Kelsey Harrison Hospital, the Dental Hospital and the Rivers State University of Science and Technology Medical Centre. But the Braithwaite Memorial Hospital, which was undergoing massive reconstruction and its radiology department and clinical laboratories had been re-equipped, with the Clinotech Group of Canada acting as technical partners, is yet to engage the people perfectly in health care delivery with the mindset of the government.

Amaechi’s efforts in health and education have been lauded. At the Braithwaite Memorial Hospital, the ultra-modern modular theatre complex, which has been said comprises three operating suites, a laundry unit, a sterilizing unit and an oxygen-production plant, as well as an adjoining intensive care unit, which were also been set up in the hospital, is indication that Amaechi is in to help the people, but the people assigned to Mann these infrastructures should show accountability and decorum.

The people have agreed that in the past, people hardly patronized the primary health centres because of the ruined state of most of their facilities. But now that the centres have been transformed into good health institutions through the Amaechi-led government policies, they must give services that must reach the primary health centres new outlook. Children, pregnant women, old people of over 60 years and nursing mothers must be given prompt attention, and not only with free insecticide-treated mosquito nets and anti-malaria drugs given to them.

The overhauling of the health sector requires that patients can see doctors without any form of irritation and parents must immunize their babies easily without preceding their daily tasks. It is not certain whether all the people who go to the primary health centres receive the attention they required. However, a source did not have a contrary view to the caller’s:  “Recently, my son fell sick and I took him to one of the newly constructed primary health centres in Port Harcourt. After consultation, he was placed on three days’ injection. They administered the first injection on him and asked us to return the next day for subsequent ones. It was, however, surprising to me that when we got there the next day, a security man on duty told me that nobody was around to attend to us. My husband had to make alternative arrangements for a nurse to continue our son’s treatment,’’ the source said.

Conversely, a source was quoting the Commissioner for Health saying that the state government had adopted a health care delivery system, which thrust was anchored on primary care that is based on the provision of quality health facilities, the provision of efficient, effective and affordable health services, the availability of well qualified and motivated staff and the provision of health care services to the vulnerable groups at government’s cost and government had funded specific health programmes to check maternal and child diseases such as maternal neonatal tetanus and polio, HIV and AIDS, malaria, as well as communicable and non-communicable diseases, as part of activities lined up.

It was noted that the government was handing over the primary health centres to gatekeepers in the communities to bring about community support, participation and ownership of these facilities, to watch over the activities of the health centres’ staff to ensure that government derives value for the money it invested in the projects, which include disease-control schemes, including malaria, HIV/AIDS, tuberculosis programmes, was to be handled by the health centres, and that plans were underway to come up with appropriate legislation for the health centres’ management.

Against that backdrop, we were told that child and maternal mortality was in decline in Rivers State as there has been a drop in the statistics by about 20 percent, according to a consultant gynecologist and fellow of West African College of Surgeon with the Braithwaite Memorial Specialist Hospital (BMSH). Investigations revealed that he, who quoted statistics provided by the World Health Organization (WHO), noted that before now there used to be about 1,000 maternal deaths to every 100,000 child delivery, but these days the figures show a reduction of 20% to 800 to every 100, 000 child births in the state.

His research was hinged on an explanation that drop in the figures was a result of increased drive by government to tackle the menace, as well as improvements in health seeking behavior of people in the state. He noted and said that maternal mortality is stem from hemorrhage, infections during pregnancy, bungled abortions and hypertension related diseases at child birth.

He opined that women who seek ante-natal care in medical health facilities are less likely to suffer maternal deaths than those who patronize traditional birth attendants. He worried about the need for the womenfolk to improve their health seeking behaviour before and during pregnancy, because such actions would curb maternal mortality.

Notwithstanding, people are asking that when something is free, was it not to be gotten without hassles.

Odimegwu Onwumere, Poet/Author, Media/Writing Consultant and Motivator, is the Coordinator, Concerned Non-Indigenes In Rivers State (CONIRIV); and Founder, Poet Against Child Abuse (PACA), Rivers State.