Executive Secretary of Enugu State Primary Health Care Development Agency (ENS-PHCDA), Dr George Ugwu, decries the state of the Primary Healthcare Centres in Enugu and other states. The Consultant in Obstetrics and Gynaecology at the University of Nigeria Teaching Hospital in Nsukka also talks about medical issues in this interview with Linus Aleke
The health insurance scheme in Nigeria, often targets those in formal employment, leaving out the informal sector, what specific policies have you developed to capture those in the informal sector, in the state?
The formal sector is often given an advantage over the informal sector because of a paucity of funds to capture everybody at once. The new legal framework, on health insurance, has converted the insurance scheme into an insurance authority. This new development will bring on board, more leadership capacity, more funding, and better services into the insurance arm. That is why we are improving our health care facilities, so, that we can provide quality services that insurance will be happy to buy into. It is a double-prong approach, and it is getting better. We know that over the years, primary healthcare services and access to health services were neglected. It was neglected for over four decades. In the last couple of years, especially as guided by our dear Governor, a lot had been done. Let me tell you, many of the type three health care centres, built by the incumbent administration are located where they can serve more than two communities. The state government carefully selected its locations, according to areas of need. For Instance, we have one in Nara, and those around Nkanu West will always have a good hospital in and around Agbani. If you come to the Nsukka area, one is located in Igbo-Eze South, because those in Nsukka local government area have the General Hospital and Bishop Shanahan Hospital. That was why Igbo-Eze South was selected so that the area will not be left out in the health facility equation. In Igbo-Eze North, there is a specialist hospital which is been rebuilt now, as well as primary healthcare centres have been refurbished in the area. In Uzo Uwani we have one type three primary healthcare centre, in Igbo-Etiti, the same thing, and in Udenu, we have one type three as well. With the support of the state government, the health architecture in Enugu State is getting better.
What is the level of Universal Health Coverage in Enugu?
We have gone far in Enugu State, under the leadership of our healthcare-loving Governor Ifeanyi Ugwuanyi, to ensure Universal Health Coverage for citizens of the state. There is so much improvement in the healthcare space in the state. We are tackling the issue of universal health coverage in two major prongs. One is improved primary healthcare delivery services, and the second is improved access through the agency, which we call the universal health coverage agency, in Enugu State, which, is in charge of healthcare insurance. From the primary healthcare angle, we have done two critical things. Governor Ugwuanyi has established what we called type three primary healthcare centres, which is a model that everybody is looking out to copy. Even at the national level, they are trying to copy this model because of its uniqueness. In that primary healthcare, we have one, a few kilometres from here, it is situated between Obukpa and Ibagwa-Aka. It is located in Igbo-Eze South, but it is so close to Obukpa Community. Each type three primary healthcare centres has two doctors, four nurses, and several other health workers working there. It has OPD for male, female, and children wards. It has a theatre, and it also has a borehole, which provides constant water for the facility. It equally has a separate source of electricity, and the doctors are residents there. This unique concept enables it to work 24 hours. These type three primary healthcare centres are located in some local government areas, in Enugu State. Seven are already, functional, three were completed recently and awaiting commissioning. Aside from this, through the basic healthcare provision fund, we have selected one primary healthcare centres from each of the 360 wards, in the state for improvement. It is not just for improvement and then nothing is going on. Each of them has a facility account, and they get no fewer than N300, 000, every quarter, for improvement. That is why in our primary healthcare centres, especially, those that have been selected, there are no issues of leaking roofs, availability of basic drugs, delivery packs, etc. The scenario where even cotton wool is unavailable in a primary healthcare centre is alien to us in Enugu State. Every ward in the state has this primary healthcare centres that attend to their health need. In 2022, each of these primary healthcare centres got up to 1 million each from the state government for improvement. To monitor how the money was expended, the state government involved the traditional rulers, town union presidents, and elected and appointed political office holders in each of these wards to monitor what the funds were used for. With this, there was an obvious improvement in our primary healthcare services. If you come to our healthcare programme, in terms of immunization, in terms of nutrition and other things, it was running regularly. When yellow fever and cholera rear their ugly heads in the state, it is quickly controlled and stamped out. This year, we were proactive, we started to do a programme on yellow fever, cholera, and COVID-19 to proactively stop its outbreak. Apart from this infrastructural improvement, in the area of human resources, Enugu State Government employed over 86 nurses and midwives and posted them to those selected primary healthcare centres to improve the issue of human resources. One was posted in a nearby community here, and that is how they were sent to the 17 local governments, across the state. That is not enough, as we are still pushing for more. From the National Primary Health Care angle, they have promised to give us another 30 in the coming months. That would also, improve our human resources. That is why we are happy in Enugu State, in other states, nobody is talking about employing people in the primary healthcare space but we are employing doctors and nurses for the type 3 primary healthcare centres in the state, as well as employing more nurses and midwives for the other primary healthcare centres in the state. In the primary healthcare space, we won an award, in August last year, and we were adjudged the best across the country, in terms of primary healthcare services. That is not all, in terms of Universal Health Coverage, the angle of health insurance has started mobilizing people to register to access health services, free of charge. In Enugu State, over 40,000 poor and vulnerable populations have since been registered and it is just as if they are just beginning. With the current legal frameworks, our job has been made earlier because of the legal frameworks. In the coming years, we are hoping to see better primary healthcare spaces in the state.
I understand that your agency supported free medical outreach in Obukpa Community, during Christmas festivity, what was it about?
Anytime we talk about improving the health of rural dwellers and citizens of the state, the Enugu State Primary Health Care Development Agency (ENS-PHCDA), often jumps in. Fortunately, this particular, free medical outreach is happening in my community, naturally, I got involved. If you look around, you will see several health workers, dressed in white, some are doctors, community health workers, pharmacists, nurses, as well as clinical medicine and nursing students. We assembled this team of medical professionals to ensure, that the health education component of the medical outreach achieves its intended objectives. We started with a health talk to educate our people, on the need to be attentive to their health, secondly, we did a lot of checks. We also examined the community members on diabetes, high blood pressure, hepatitis b and c, and many others. We also availed our people the opportunity of discussing and getting a free consultation from doctors that were selected to attend to them. We got a team of doctors from the University of Nigeria Teaching Hospital, (UNTH), where I worked before my current appointment. So, we are here to see how we can better the health of our people by increasing their health consciousness and awareness to dictate common medical issues and refer them appropriately to bigger hospitals for continued care. This is the kind of thing I had been involved in over the years, and this particular edition had been a huge success. Together with the Erudite Club, Emzor Pharmaceutical, and our umbrella body, the National Obukpa Development Association (NODA), we put it together. This is in line with the old aphorism that when forces are combined, it comes out stronger. This is why the outreach is happening in two centres simultaneously in the community. I must also applaud our people, particularly NODA and Erudite Club for their massive support. While we were pushing it from the medical end, they were pushing it from the end of the resource. We have enough drugs to attend to patients who had trooped out to receive treatment. I thank God that we are getting better by the day.
APC has lost about 80% of its support base in North –Jubrin
Can you give an estimate of the number of patients that had been attended to here this afternoon?
Our people kind of surprised me, when we came initially, there were about 200 people, requiring our attention. But as they were leaving the venue, more people were coming. Since morning, we had consistently had more than 100 persons waiting to be attended to, this is notwithstanding the number of medical personnel on the ground. We have over 8 different consultation spots that are attending to people simultaneously. Some are going home and others are coming in, as we are treating them, more people are coming. As of my last count, no fewer than 600 people had been attended to. By now, we should be nearing 800, if not more. We prepared for 1000 persons per location, so, we are on top of the game.
Because this outreach happens once in two years, what is your agency doing to ensure that it happens more frequently, in this community?
We would continue to have this as frequently as the resources and interest can drive. We have also, tried to weave it into our health system. We have two top nurses from Elu-agu Obukpa Health Centre, we have two doctors from the type 3 Health Care Centre situated between Obukpa and Ibagwa-Aka, excellently built and put into use by our health care-loving Governor Ifeanyi Ugwuanyi. We are, therefore, mindful of this because, if we come and do hit-and-run kind of outreach, without linking it up with health systems like Primary HealthCare Agencies, Health Centres, or type 3 Health Care Centres, UNTH, etc, then we have not done enough. There are people here that were referred to UNTH, with a letter to continue their treatment. There are those we have sent to the type 3 Health Care Centres to continue the management of their High Blood Pressure, through regular checks and medication when necessary. There are those requiring surgical operations that we have also, referred to the appropriate facilities. A woman came with fibroid and we have told her what to do to also benefit from this free medical outreach. It is a complete package, this is so because of our previous experiences. We have also, linked it to the health systems to make it effective. As the primary health care agency boss in Enugu State, I have keyed into the project by linking it to health systems, so, that it will not be a kind of hit-and-run kind of outreach, where the people would be confused about what to do next after the free medical outreach.
What are the challenges you have encountered in the course of this outreach?
The challenge is the need for more resources, and when I say resources, I mean more drugs, I mean more health workers, and I mean more specialized doctors. So, there is always that need and you know that this is the year when the people come together because of the festivities. A lot of people have complex programme and making time become a serious challenge. If we plan next time, we need to have more resources, we need to have more drugs, and we need to have more doctors. We need to have a section for ophthalmology that is eye care. A lot of people here have asked about the eyes, next year, we need to get a special table for those who will look at the eyes and provide glasses for those who need them. We will continue to expand it to other specialised areas.
Was this given adequate publicity for villagers to know that something of this nature is happening?
Two/three things were done, but they could still be improved upon. The programme was announced in the churches, and community leaders were informed. I met one community leader who said that he was informed but that the information came late. Some others said they were not aware until the town crier announced it. I think that the town crier would have moved around more frequently. The announcement in the churches would have also started early in November. These are the things, we are going to do better next time. We would have a local organizing committee to perfect this.
