Bauchi's Neglected Health Centre: A Single Block of Struggle

The Sabon Garin Narabi Primary Health Centre (PHC) in Toro Local Government Area of Bauchi State is housed in a modest, single-block structure containing three rooms. It was originally conceived as a primary health care dispensary, intended to include a reception area, a storage space for vaccines and supplies, and an office.

Sabon Garin Narabi, a community that has evolved into a town with an estimated population exceeding 5,000 residents, is situated in Toro Local Government, on the border between Bauchi and Plateau States. Despite its increasing population, the town contends with a severely deteriorated primary health care centre that lacks essential health facilities and necessary equipment.

The current state of the clinic is alarming, with overgrown vegetation surrounding the building and a local pit latrine serving as its only toilet facility. The internal walls are cracked, and the general environment is unkempt, posing health risks to both the healthcare providers and the patients who seek care there, among numerous other issues.

During a recent visit by our correspondent, it was observed that numerous nursing mothers bringing their babies for routine immunisation were forced to sit on the floor for extended periods due to insufficient space within the facility to accommodate them and their children.

Khadija Abdullahi, a nursing mother who brought her newborn for care at the Sabon Garin Narabi PHC, described the immense hardship faced by mothers and their infants during antenatal, postnatal, and immunisation sessions, as well as for other child healthcare services.

"The PHC's size is inadequate for the number of mothers needing medical attention, as the building only has three rooms," Abdullahi explained. "The immunisation section is particularly small. Even today, you can see that over 150 mothers have come for immunisation. We have to gather under a temporary shade provided by the community."

She further highlighted the absence of benches or chairs at the health centre, compelling mothers with babies to either stand for hours or sit on the floor to receive services. Beyond space constraints, the critical lack of medications and other essential supplies presents a major challenge.

"We are pleading with the government to alleviate this severe hardship by providing seating arrangements like benches or desks," she urged. "There are only two benches at the front, and those at the back sit on mats. Many of these nursing mothers are still recovering from childbirth complications, and prolonged standing could lead to other health issues."

Abdullahi also pointed out that while routine immunisation services are free, along with a N1,000 stipend for mothers, all other medications, diagnostic services, and antenatal care require payment.

"I brought my newborn for immunisation and to address an eye condition. After the immunisation, they examined the eyes and gave me a prescription to buy eye drops. Previously, drugs were readily available for babies. For many years, when the government or partners supplied medications, we received them, but now they are scarce," she lamented.

Mariya Saleh, another nursing mother at the PHC, stated that the facility is unsuitable for pregnant women and children due to the unnecessary stress and the lack of necessary services for community well-being.

"The only service that attracts mothers here is immunisation, partly because women receive N1,000. Additionally, it's the only government health facility in Sabon Garin Narabi offering immunisation," Saleh noted. "The lack of space discourages women from accessing antenatal and postnatal services, as well as vital drugs and consumables."

She appealed to the state government to step in and improve the situation by constructing additional rooms and fencing the facility to secure essential equipment meant for public health protection.

Sadiya Adamu, a mother of five, expressed her distress that the sole government health facility cannot provide basic services, forcing many residents to travel considerable distances outside the town for medical attention.

"Three months ago, just before I delivered my fifth child, I was brought to the health centre during labour, but the staff declined to attend to me, referring me instead to the Tilden Fulani PHC, stating they lacked a labour room. I nearly gave birth in the vehicle en route to Tilden Fulani due to traffic congestion caused by a military checkpoint between Narabi and Tilden Fulani town," she recounted.

A staff member at the Sabon Garin Narabi PHC, who preferred to remain anonymous, confirmed the facility's challenges. These include insufficient space for patient care, the absence of a labour room and maternity ward, a shortage of medications and consumables, and a lack of laboratory facilities, test strips, and reagents. Even the few available chairs were community donations.

"We purchase test strips and reagents for antenatal services," the staff member stated. "We cannot admit patients due to the dilapidated and insecure nature of the health centre; we refer critically ill patients to the nearby Tilden Fulani health centre or Toro General Hospital. The ward has been repurposed as the primary waiting and consultation area. You can see the large number of women and their babies here today (Thursday) for immunisation, sitting outside under a makeshift shade because the clinic lacks adequate space to accommodate them. We have only three rooms: one for vaccine storage, the main reception for screening and administration, and the only office used for consultations, which requires privacy. We also conduct antenatal tests in the reception as we lack a laboratory."

She added, "We charge pregnant women N1,700 for antenatal care because we use our personal funds to buy necessary testing equipment. We also procure malaria medications, which we combine with micronutrients, charging only N200 for the entire period. Our pit latrine is in poor condition; it's partitioned for staff and patients, but patients rarely use it due to its state. The building itself is developing cracks. A kind individual from the town volunteered to repair the wall cracks."

Another staff member expressed concern over the facility's porous security, which prevents the storage of sensitive materials. "The security guard assigned to the facility has retired, and no replacement has been hired, so we take our valuable items home. We only secure the main entrance door, leaving our records and registers behind, as the community recently installed burglary-proofing on the windows," they explained.

"We serve over 200 clients during immunisation sessions, sometimes exceeding that number. Antenatal services also see a high turnout of over 100 women daily. Some women in town opt for the Tilden Fulani PHC, which offers comprehensive medical services.

"Furthermore, when pressed, patients use toilets in nearby houses, or return home and come back when the need arises.

"We have five official staff members on the government payroll: one Community Health Extension Worker (CHEW), one Junior Community Health Extension Worker (JCHEW), one Community Health Officer (CHO), one Environmental Health Officer, and an Environmental Health Technician. However, we do not have a nurse working at the clinic. The remaining four support staff are volunteers."

She further disclosed that patient numbers are declining due to the lack of space, equipment, and services, leading many to seek care at private hospitals or travel to Tilden Fulani PHC for complete medical services.

"We do not admit patients at the clinic," she stated. "The only time we see a large influx of women is during immunisation, when we record up to 150 individuals daily.

"Due to space limitations, we attend to family planning clients at the reception, and other patients overhear our consultations. Unfortunately, our antenatal services are also conducted here in the reception due to the lack of space. However, we perform the palpation of pregnant women in the store.

"Some women visit the health centre for various needs, including family planning or counselling.

"The only supplies we receive are RDTs for malaria and family planning provisions. There are no medications or consumables provided by the government or development partners to this clinic. We refer pregnant women with anaemia, severe malaria, high blood pressure, and diabetic patients. We also refer children with persistent coughs lasting over two weeks, as well as sick children presenting with convulsions, and critically ill patients."

When contacted, Umar Babaji, the secretary of the Village Development Committee (VDC) for Sabon Garin Narabi, acknowledged that the primary challenge facing the health centre is the insufficient space to cater to the volume of patients utilizing the facility. "To be honest, the health centre is far too small for the community, especially for services involving pregnant women, nursing mothers, and child immunisation. Over 100 women visit the clinic daily for various reasons.

"The Almighty has blessed Sabon Garin Narabi and its surrounding villages with a large population. As of now, the town alone has over 5,000 residents, not counting the smaller villages behind it. The health centre has qualified medical personnel working daily, but the building is too small to accommodate the number of people.

"The personnel are managing and doing their best under difficult conditions with limited space and equipment, as they lack a labour room for pregnant women and a ward for patient admission. Although the facility was upgraded from a health care dispensary to a primary health care centre, the building itself remains that of a dispensary."

Babaji revealed that the community, through the VDC, had previously submitted a complaint letter to Toro Local Government requesting an upgrade of the health centre. However, the committee was instructed to submit a formal letter.

"Following the letter we submitted detailing our needs, they upgraded the clinic to a primary health care centre and assigned more staff, but the building's infrastructure was not improved. This is the main predicament for the community.

"The community has shown its commitment to the health centre's development by contributing funds to construct the temporary immunisation shade, aimed at easing the suffering of nursing mothers who wait for hours under the sun for their children's immunisation. The community also donated benches for women and chairs for staff to support the facility's smooth operation.

"We are appealing to both the state and local governments, as well as development partners, to assist us by expanding the facility's structure, given its upgrade to a primary health centre. We desire the facility to become a standard health centre where patients can be admitted, pregnant women can deliver safely, and other essential primary health care services can be provided," Babaji added.

Muhammad Sani Aliyu, another VDC member and youth leader in Sabon Garin Narabi, stated that the committee has made numerous efforts through elected representatives, from the ward councilor to the local government chairman, commissioner, and other officials, to ensure the health centre is upgraded to better serve the community. He cited the rapidly growing population and the inability of the current building and equipment to meet the needs of the visiting patients.

Aliyu stated, "We have made significant efforts and will continue to push for the clinic to receive the necessary attention. We are urging the government to reconstruct the PHC and provide equipment. We need a borehole to supply clean water to the PHC, as there is no water source currently. We have staff, but the PHC lacks a laboratory, a labour room, and a maternity section. We require a completely rebuilt facility for the primary health care centre in Sabon Garin Narabi.

"We are pleased that the Minister of Health hails from Bauchi State. We are extending our plea to him as well. He needs to be aware that this health centre requires a complete overhaul to serve the hundreds of women and children in this community and its environs. Sabon Garin Narabi is an integral part of Bauchi State. We are using this medium to convey our message to the minister to intervene and rescue this health centre."

While the primary health centre remains in its current state, it is noteworthy that the federal government recently announced plans to procure emergency care helicopters and establish a nationwide air ambulance system to improve rapid medical response.

Professor Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare, stated in a release that President Bola Ahmed Tinubu has approved the acquisition of an emergency care helicopter for handling healthcare emergencies.

When contacted, Dr. Rilwanu Mohammed, the Executive Chairman of the Bauchi Primary Health Care Development Agency, clarified that the Sabon Garin Narabi PHC is not designated as a full Primary Health Care Centre but rather as a Primary Health Care Clinic, intended for approximately 15 beds, not 25.

Mohammed explained, "Unless we upgrade that facility to a primary healthcare centre, increase the number of beds and offices to accommodate laboratory and investigation services, expand spaces for medications and immunisation, and antenatal and delivery care, and also provide staff quarters for accommodation, the clinic cannot be upgraded to a full PHC centre."

Addressing the issue of drug shortages, Mohammed stated that the Narabi PHC is a clinic, not a full centre, and is not registered for the State Drugs Revolving Fund due to its patient volume. "The governor has allocated N500 million, and the number of PHCs benefiting from genuine drugs has increased from 300 to 600. We are revolving these funds to support the state's residents. The state government has entered into an MoU with nine pharmaceutical companies to supply effective and genuine drugs for distribution at PHCs."

Mohammed added that local governments select PHCs based on specific criteria, but the government intends to extend this to a thousand PHCs by the end of the year.