INVESTIGATION: Healthcare In Northern Nigeria is Comatose, Wushishi A Case Study
For anyone accustomed to modern city comforts, a trip to the backwoods of any Nigerian state is not one undertaken without fully understanding its consequences. Some aspects of life in Nigeria cannot be escaped except in high-end boroughs where persons close to power take refuge from the harsh realities of the Nigerian environment.
The Journey Begins
As a newbie, unaware of the realities of a trip to Wushishi, in Niger State, I went searching for signs of life in the 11 wards of the Local Government. Of course, I got a guide to go along with me and double as my transportation. Bala Isah assured me I was set to experience a “bubbling town”, a pledge my gut kicked against, for good reason.
Wushishi is much like any LGA in Northern Nigeria, with low income earners, and a large supply of rural hospitality. Make no mistake; I was not there as a tourist, but as a seeker of the heart of the people.
Accommodation was anything but comfortable, and transportation was as bumpy as it comes. I had no idea what to expect with healthcare but I was willing to find out. Altogether, I visited a total of 15 health facilities across the 11 wards. Save for a few, the state of these facilities seemed more likely to throw up complications than succour for patients.
I was there for 3 nights which felt like 7, (I kid). My task was to find out how Ward Health Development Committees (WHDCs) fare in the LGA, with respect to their roles in the delivery of Primary Healthcare to their people.
WHDCs, more than just a fancy scheme
In layman terms, WHDCs, ideally, are structures that interface between a local health facility and the community. They play a crucial role in channelling community voices on health issues and demanding accountability for service delivery. They also close the feedback loop between government and the citizens as regards health issues. Set up by the National Primary Healthcare Development Agency (NPHCDA) 20 years ago; they make use of the electoral ward (The smallest unit of political organisation).
WHDCs are responsible for:
•Identifying health and social needs, planning for them.
•Supervising the implementation of developed work plans.
•Identifying local human and material resources to meet said identified needs.
•Forwarding all health/community development plans (village, facility and Wards levels) to the LGA.
•Mobilizing and encouraging active involvement of prominent and other local people in the planning, implementation, and evaluation of projects.
•Playing an active role in the supervision and monitoring of Ward Drug Revolving Fund (WDRF).
•Raising funds for community programs when necessary at their various facilities.
•Providing feedback to their communities on how the funds are disbursed.
•Liaising with government and other voluntary agencies in finding solutions to health, social and other related problems in the Wards.
•Supervising the activities of the Village Health Workers, Community Health Extension Workers, and monitor activities at their facilities and at the wards.
WHDCs have suffered greatly in the hands of many assailants over the years. Politicians have wielded them to score cheap electoral points at the polls, before routinely abandoning them right after. Quite understandably, local communities are pretty much running on a trust deficit for these committees.
Ideally, WHDCs are to strengthen the link between communities and service providers, create awareness, stimulate demand and help convince those that are hard to reach, encourage service delivery and coordinate all components of primary health care programs in their respective communities.
In Maito, Zungeru, Gwarjiko, Kodo, Sabon Gari, Lokogoma, Tukunji, Akare, Barwa, Kwata, and Kanwuri – all wards in Wushishi – WHDCs operate within a mixed bag spectrum of success. Truth be told, there is some potential in the mix but overall, the picture is a bleak one. The whole place screams out for some form of intervention. Clearly, with a properly targeted approach, the level of PHC delivery in the LGA can be drastically improved upon.
WHDCs function in the area of promoting routine immunization and increase the coverage rate in the communities. Tragically, they have failed to drive the accountability process and improve the feedback loop between government and the citizens as far as all wards in Wushishi are concerned.
On May 2nd, stakeholders gathered in the Niger state capital, Minna, to discuss a performance improvement framework designed by the State Primary Health Care Agency for WHDCs. This was as part of government initiatives to improve utilization and performance of health care service delivery at the grass root.
While everyone agreed that more needs to be done, one of the pertinent issues raised was the defining of the roles and responsibilities of WHDCs.
Wushishi’s current WHDC landscape
A key WHDC feature is how it should elicit a level of accountability from the healthcare system, and how in turn, that gives room for citizen ownership of health infrastructures in their communities. Well then, every single WHDCs in Wushishi save for Barwa, Kwata, and Kodo wards, has failed in this regard.
The facility in Gwarjiko comes to mind at this point. Bereft of any semblance of sanitation efforts, the lone health worker, a retired midwife, Jumai Musa who was only standing in for the head of the facility normally called the “in-charge,” was quick to point out that her hands were full and the absentee head was responsible for housekeeping in the facility. The secretary of the WHDC, Usman Abdullahi, curtly reaffirmed Jumai’s stance, letting slip a clear lack of understanding of the roles of his committee.
40% female composition
One can easily understand why the NPHCDA was particular about the female membership of WHDCs. Women and children formed a greater part of the population at all the operational health facilities I visited. However, the WHDCs in Wushishi lack the right number, and in some cases, have none at all.
The guidelines establishing WHDCs state that at least 40% of the not less than 16 members per committee should be women, the Chairperson/Patron should be a Clan head or most respectable village head while the WDC will have at least a representative from each Village Development Committee, VDC and a few more.
However, palpable cultural restrictions have not helped the people and their WHDCs. Take Lokogoma for instance, there was an unmissable demarcation between men and women in the ward centre, right in front of the palace of the traditional ruler. Women sat in clusters and were easily dispersed when informed that the leader was coming out, while the men remained.
Noticing this, I asked the WHDC chair why there were no women on his committee, and he explained that talking to the women in the area to join the committee would draw the wrong reaction from the people, a reality he said he was not willing to risk.
“What will I say if they ask me what I’m discussing with another man’s wife?” he frantically queried, making it quite obvious that both the WHDC chair and his community are oblivious to the need for female participation.
Lokogoma is not alone in this, Maito’s WHDC has no woman and the reason was the same, with the added issue of women working in a male dominated committee being frowned at.
The state of PHCs in Wushishi with respect to Maternal, Newborn and Child Health (MNCH) was reflected in the environment where Asma’u a first time mother had just delivered her baby. There was only one retired midwife present at the Gwarjiko facility to help her. She took delivery of the child in an inner room reeking with an odour so pungent, one could barely stay in it for more than a couple of minutes without getting nauseous.
The midwife left the swarm of flies that had found their way to the theatre behind, to speak to me out on the porch. All the while she was washing blood off her hands and the forceps she had just used, unto the ground beneath us. She explained that Asma’u was fortunate not to have developed any complications despite the absence of any antenatal care during the course of her pregnancy.
From my interaction with members of the communities visited, it was apparent that communal involvement in the decision making process of these committees is low. Communities need to be more involved to make a success of these structures otherwise any progress made would be one where these committees, by sheer providence defied the odds to get their PHCs to function optimally.
Barwa’s WHDC only 3 months ago, succeeded in getting its PHC facility built, but the level of involvement of the committee may have been exaggerated by its Secretary Hassan Innuwa. The facility is yet to be commissioned and while it has been equipped with an alternative source of power, the necessary drugs in the right quantity and trained workers preferably from within the community are still amiss.
Kwata in sharp contrast to Barwa, is one of the 2 wards left without a health facility in the ward headquarters. The latter obviously the worst hit in terms of healthcare. Without its own facility and a weak WHDC bereft of confidence and proficiency needed for its operations, the community is at the mercy of one private clinic without the capacity to handle the population.
Frustrated at the prospect of having to battle the LGA chair to reemphasize its plight, Mallam Jibril Wamabai the Chairman of the Committee, explained that at this stage the WHDC was only hoping to strike gold with a petition to its Representative in the State House of Assembly, Yerima Abdullahi Lokogoma. Especially as Mallam Jibril noted that without a facility, a health worker, from the community, or an educated person on the committee, drafting a petition to a personality they deem higher than their LGA Chair was a big ask for the community.
The likes of Kwata (another ward without a facility), Tukunji, Akare, Zungeru and Kodo are all posting impressive levels of accomplishment in their roles. With varying levels of success, members of these WHDCs displayed a level of awareness to their roles and responsibilities that were a source of relief.
Fundraising and bank accounts
One key responsibility, fundraising, is nowhere close to its best across the committees in Wushishi. The economic climate of the country has not helped, but it’s not solely responsible for the ineffectiveness of the endeavour. I asked most of the respondents if any significant funds had been raised before the current economic situation, and I was told that perhaps only “city people” know the difference.
I was made to understand that the rural dwellers are very reluctant to part with money for any reason at all.
As a result, Kodo, Gwarjiko, Zungeru, Tukunji, Kanwuri, Kwata and Barwa WHDcs have undertaken the challenge to address community projects. However, only Gwarjiko, Kwata, Barwa and Kanwuri claimed they provide feedback to their communities on how funds raised were disbursed.
In Zungeru, fund raising for the committee, mostly occurs during festive seasons, when most indigenes return home for the celebrations. Although the committee does not operate a bank account yet, Mallam Jibril Aliyu, the Ward Focal, says the process is underway.
Literacy level, accessibility, lack of incentives, working conditions and cultural limitations. At the heart of Wushishi’s PHC crises, are the preceding 5 contributing in varying degrees. The WHDCs are hardly made up of persons with the basic understanding of their roles and responsibilities.
Save for a handful which are easily accessible by road, other wards require perseverance to reach. Even when reachable, provisions and conditions need to be optimal for any significant intervention to be carried out.
The fact that the locals are low income earners often sees them seeking out alternative sources of income however, this is not the purpose of the WHDCs. As a result, members of the communities in most cases refuse to be bothered by related activities.
The poor state of most facilities in the region has contributed to the absence of health workers, and where they are present; they are in very short supply.
In Wushishi as with several areas across northern Nigeria, culture has inculcated in women a reluctance to participate in gatherings/interactions with members of the opposite sex. Men are reluctant to be seen trying to address womenfolk especially the married ones, to join the committees.
These five areas will need to be addressed first, before WHDCs in Wushishi can become the vital tools in PHC delivery.
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