Lack Of Autonomy Impeding Primary Healthcare In Ebonyi - Sphcda Official.

The importance of Primary healthcare Centres in delivering health services, especially to rural dwellers, cannot be overemphasized.

Apart from being the first point of call in management of most minor and serious health challenges, the PHCs provide swifter referal services for severe health cases.

Of utmost importance in the services provided by Primary health facilities are maternal, infant and newborn care; ante-natal and post-natal care, family planning and counselling services; immunization services as well as nutrition.

The National Primary HealthCare Development Agency, NPHCDA, is charged with the responsibility of ensuring that this important health segment performs to expectations. In doing that, the NPHCDA works with the State Primary HealthCare Development Agencies, SPHCDA domiciled in the 36 States of Nigeria.

In Ebonyi State, there are 449 Primary healthcare facilities, graded into Primary Healthcare Centres, Health Clinics and health posts, under the supervision of the SPHCDA. Out of the number, the USAID - integrated Health Program and other partners are collaborating with the State government towards strengthening at least, 171 PHCs, one in each of the 171 political wards in the State.

Meanwhile, it is worrisome that in spite of the number of facilities and the collaborative assistance of International partners such as the USAID sponsored Breakthrough Action Nigeria, and the Integrated Health Program, among others, performance indicator for primary healthcare services in the State is still low.

According to an evidence-based policy Brief prepared by the Health Policy & Systems Research Project Team for Ebonyi State Ministry of health, 2013, "the life expectancy at birth in Ebonyi State was 53.8 years for females and 52.6 years for males in 1991 but declined to 46 years for females and 45 years for males in 2006.

"The infant mortality rate (IMR) has remained high and is estimated at 99 per 1000 live births while the under age 5 mortality rate (U5MR) is 191 per 1000 live births.

"Ebonyi State has maternal mortality rate (MMR) of 602 per 100,000 population, which is one of the highest MMR in Nigeria.

"This is well above the WHO estimate of 800 per 100,000 live births..."

The report went further to identify some of the reasons behind the unimpressive statistics as low access to health facilities, inadequate human resources for health, ignorance/illiteracy, culminating in very high patronage of Traditional Birth Attendants and unskilled/untrained midwifes; dilapidated status of primary healthcare facilities and its infrastructures, corruption, among others.

The administration of Governor David Umahi has made frantic efforts towards addressing some of the issues militating against optimal service delivery by these primary health facilities, mainly through improved road infrastructure which has greatly increased access rate of facilities.

However, most of the other factors still persists, thus making Ebonyi highest in infant and maternal mortality and morbidity in the Southeast, according to recent USAID-Integrated Health Program report.

In a one day Stakeholders Health Sector Budget performance Analysis meeting organised recently by Development and Integrity Intervention Goals, (DIG) Foundation, a Civil Society Organisation, in collaboration with USAID-IHP, in Abakaliki, an official of the State Primary Healthcare Development Agency, identified yet another key issue militating against the performance of primary healthcare in Ebonyi State.

According to the official, who pleaded anonymity for fear of victimization, the major problem lies in the failure of the State government to allow the autonomy of Local governments, and by extension, the Primary healthcare in the State.

She maintained that the lack of autonomy has led to constant fund - starving of the Agency and the PHCs under its supervision.

The official explained: "For me to throw more light on these challenges facing Primary healthcare Development Agency in the State, I can really say, from the finding I made, that their major challenge is that they are not free; government has not granted them autonomy from JAC, that is, the Local government.

They want to be on their own, pay salaries on their own, do everything on their own like other States.

"Even when they propose budget, budget will not be released to them, and they find it irrelevant to continue proposing.

They are discontented and demoralized; they do not even know where they belong.

To me, that's the main reason why so many of them are not paying attention; not taking seriously many issues like budgeting.

"Promotions are even not forthcoming; they are having challenges of who should promote them: go to local government, come to Agency, will the State approve it, and so on?

"I have actually come closer to them and I find out that they are the real set of people that work tirelessly everyday.

"In fact, within this month, November, we have lost about four health workers due to stress of work: partner calling them, training here and there, leaving their families.

"Some of them are living in the health facilities, and at the end, they will not be promoted as at when due; they are not free...

" So, government should look into their matter, and see how to help them out for the health sector to move forward."

The Official noted that Primary healthcare Centres, under the supervision of SPHCDA were supposed to be directly under the Local government Council, by reason of granted autonomy. Under such an arrangement, as obtains in other States, they should have a distinct budget, be free to employ health workers, post and transfer health workers as well as promote them without undue political interference. So doing, they would be more focused, more interested in budget, and more motivated for excellent services.

She lamented that the SPHCDA with its health facilities are starved of fund under the present State of Affiairs in the State whereby the State control the finances of the local governments through the JAC.

The Executive Director of DIG, Oliver Aja Chima, in a presentation highlighted the budget trend in the State, especially as it affects the Primary healthcare sector for some past years.

He noted for instance, that over 50 items approved in the 2020 Budget for the health sector in general, and primary healthcare in particular were not released at all through out the fiscal year. While some of them were still repeated as it were, reduced or removed in 2021 approved budget, none has been released as the time of the presentation.

Chima pointed out: " For provision/ reticulation of water, and provision of alternative power source in 65 (5 per LGA), out of the 171 selected PHCs, the sum.of 30 million and 50 million respectively, were approved in the budget, but no amount was released for the projects, under Ministry of health.

"For reproductive health services and family planning, Vaccine security and cold chain logistics - pushing vaccines from State to LGAs to health facilities, the sum of 50 million and 30 million naira respectively, were approved in the budget under SPHCDA, but nothing was also released, and so on."

The Executive Director observed that field report showed that over 65 percent of PHCs in the State have no water, sanitation and hygiene (WASH) facilities, including toilets, while most have no security fencing.

He however commended USAID-IHP and other partners for their efforts at strengthening health systems and working towards securing community involvement in the affairs of PHCs.

He called on government, public spirited individuals to assist in repositioning healthcare services/facilities in the State, adding: "partners may withdraw anytime, and we should be able to self-sustain our health systems."

DIG Foundation, a sub - grantee of USAID-IHP has been leading campaigns and advocacy across sectors in the State for increased funding for health sector.