The Kwara State Government awarded Hoak Turnkey Limited a ₦35,571,881.25 contract to renovate the General Hospital in 2020.
On a Tuesday morning in 2023, at 11 a.m., Amina experienced her first contractions, marking the beginning of her labour and the eagerly awaited arrival of her first child.
General Hospital Okuta Signpost
Her husband, Abu, and neighbour Rufai hurriedly took her to the General Hospital in Okuta, Baruten Local Government Area, Kwara State. They joined hands and hoped for a painless delivery.
General Hospital Okuta
Unfortunately, the two doctors and other staff members were not at the hospital and the delivery room was locked. The patient was received by some students undergoing their industrial training at the hospital. However, when Amina's contraction pain increased and there was no sign of help, her husband moved her from the hospital to a private medical facility in the town.
Empty Ward Inside General Hospital, Okuta
“The woman was in pain, but nobody was there to attend to her. The delivery room was locked and it was after our arrival that the students we met there quickly went to call the staff that held the key. But we had to leave to save the lives of the mother and the child,” Rufai recalled.
“It is sad that this is the state of the general hospital, and even thinking that the government just rehabilitated it is worrying,” he added.
The Kwara State Government awarded Hoak Turnkey Limited a ₦35,571,881.25 contract to renovate the General Hospital in 2020.
SaharaReporters' visit to the hospital in May 2024 revealed a transformed facility, boasting state-of-the-art equipment courtesy of recent renovations. However, despite the upgrades, the hospital remains eerily deserted, as residents opt for alternative healthcare options, particularly for severe cases, due to a crippling shortage of medical staff.
During a three-day observation period (Sunday to Tuesday), no doctors were present on site. According to the hospital's pharmacist, the doctors' absence is attributed to their reluctance to reside in the town.
This general hospital was established to serve thousands of residents from over 20 communities, including Wondu, Hero, Tewu, Bushikparu, Alafiaru, Gorobani, Temideley, Boriya, Shiya, Tembonu, Tenge, Bankubu, Fonfon, Subayo, Gwanaguru, Donoru, Nikkikperu, Kenu, and Kikparu, among others.
However, only two patients were in the hospital, which has more than 10 wards and 20 beds.
According to Biliaminu Manne, a local resident, the hospital's low patient turnout can be attributed to two main factors: a severe shortage of medical staff and the erratic attendance of the few staff members who are available.
Biliaminu Manne
He said the needed staff were not always around to attend to patients.
“I just concluded my undergraduate study and am preparing for my mandatory National Youth Service Corps (NYSC) programme, so I need a medical fitness certificate. But every time I visit this hospital for the test they say the doctors are not available,” Biliaminu said.
Eventually, Biliaminu travelled 196 km to Ilorin, the state capital, for the medical fitness test.
N117m Spent on Renovation But PHCs Still Below NPHCDA Standard
In 2020, the Kwara State Government renovated four primary healthcare centres(PHCs) in different communities at a total cost of more than N117 million.
Chart Showing Money Spent By Government To Renovate Four PHCs
Three firms executed the contracts. Akatech Construction Limited renovated PHC Gwanara Baruten LGA for ₦33,365,768 and PHC Kosubosu in Baruten LGA for ₦39,147,622; Dwa Construction Company Nigeria Limited renovated the Isanlu Isin Health Centre in Isin LGA for ₦11,153,246.62; and Olmash International Ltd renovated PHC Otte Oja in Asa LGA for ₦34,623,953.55.
Signpost of the renovation project at Otte PHC
However, SaharaReporters found that none of the medical facilities meets the minimum standards set by the National Primary Healthcare Development Agency's (NPHCDA).
According to the NPHCDA guidelines, PHCs are expected to offer 24-hour services, be fenced, and have staff quarters or accommodation within the community. They should also have essential drug supplies, a waste disposal system, equipped laboratories, and connections to the national grid.
List of personnel every PHC is expected to have, according to NPHCDA minimum standard
The PHC must also have a minimum of four nurses/midwives, nine community health extension workers (CHEW), a laboratory technician, a pharmacy technician and a medical officer (if available). However, SaharaReporters observed an inadequate number of the various cadres of healthcare workers in the facilities during its visits.
None of the four PHCs has a staff doctor. Isanlu Isin PHC and Kosubosu PHC each has only two nurses, while only one nurse was attached to each of Otte PHC and Gwanara PHC.
Staff Shortage: Reason for Low Patronage of Patients In Otte PHC
According to a community health worker who has worked there for eight years, about 200 patients from various communities used to visit Otte Oje PHC daily.
Otte PHC
However, as the medical facility lost qualified staff members, patient attendance declined and now stands at below 40.
“Many residents stopped coming after our doctors left,” the community health worker told SaharaReporters.
Empty Ward inside Otte PHC
She continued: “When we had three doctors at this PHC, we used to perform surgeries, but now we are unable to do so.”
Otte PHC Labour Room
She said the PHC now refers any patient who wishes to give birth via surgery to hospitals in Ilorin, about an hour's drive from the town.
Locked Wards At Otte PHC
“This is because this is the only government-owned hospital in this community. The other one close by is a psychiatric hospital,” she added.
No Access To Maternal Healthcare Service In Isanlu Isin PHC
Muhammad Ali Pate, Nigeria’s health minister, says maternal health is a basic human right and that every woman, regardless of her socioeconomic background or place of residence, should have access to high-quality healthcare before, during, and after childbirth.
“It is incumbent upon us, as leaders and advocates, to uphold this basic right and work tirelessly towards its realisation,” the minister said.
However, maternal healthcare remains a challenge for residents of Isanlu Isin in Isin Local Government Area of Kwara State, despite its PHC being one of those the state government recently novated.
Isanlu Isin PHC signpost
SaharaReporters discovered that hundreds of women are being denied this fundamental right during childbirth due to a staffing shortage at the Isanlu Isin facility on which the Kwara Government spent N11 million renovating in 2020.
Isanlu Isin PHC
“We cannot take delivery because of a staff shortage. We don’t have doctors and midwives professionally trained in that aspect, and this is affecting our service,” a nurse told SaharaReporters at the hospital.
Isanlu-Isin PHC Pharmacy but no staff to manage it
The nurse said the situation has worsened because the council's general hospital, to which they often refer patients, currently does not have certified doctors.
“We are now referring our patients to Omu-Aran General Hospital (in Irepodun Local Government Area). The facilities are there, but without qualified and adequate personnel, the machines and the tools are useless,” the nurse said.
We Borrow Doctor From Private Hospital To Treat Patients In Gwanara PHC
On Monday, May 27, Children's Day, around noon, SaharaReporters visited the PHC in Gwanara, one of the districts of Baruten Local Government Area of Kwara State.
Primary Healthcare Centre in Gwanara
Following its renovation in 2020, the facility and medical equipment still appeared new. But the first thing noticed by our reporter was the quiet environment, which is unusual for Nigerian hospitals, especially on a Monday morning.
Primary Healthcare Centre in Gwanara
No patient was in the facility, and while that Monday was its Antimalarial Immunisation Day, only one child was brought there.
SaharaReporters learnt that the hospital has only three workers. The hospital is expected to provide basic health services to thousands of Gwanara residents and nearby settlements.
The three staff members are a nurse, who is the officer-in-charge, and two community health workers.
Speaking to SaharaReporters, the officer-in-charge, Ibrahim Mohammed Basheer, blamed the low turnout of patients on inadequate personnel, lack of electricity and water scarcity.
“We are facing two major challenges here. We don't have a qualified medical doctor and there is no electricity to pump water,” he said.
He continued, “If we have patients who need to see a doctor, we normally borrow from a nearby private hospital to save our people's lives.”
This situation is the same at the newly renovated PHV Kosubosu. Despite spending the sum of ₦39,147,622 to renovate this facility, the Kwara Government has ignored its need for personnel.
Primary Healthcare Centre in Kosubosu
The PHC has only two nurses and a lab technician on its staff. It does not have medical doctors or community health workers on its staff list.
Primary Healthcare Centre in Kosubosu
“People patronise the hospital, but not much because there's no doctor at the hospital,
The aspect where we have enough patronage is the immunisation sector. There are nurses and other sectional staff, but we need a qualified medical doctor and pharmacist,” Zainab Habu, a nurse at the, told SaharaReporters.
Kwara Has 900 Doctors Attending to 3.5m People
A Public Health Physician, Dr Bosede Rotimi, claimed that the state employed 900 doctors. In a state of about 3.5 million people, this translates to about one doctor for 4,000 patients, according to the 2020 indices.
The World Health Organisation (WHO) recommended doctor-patient ratio is 1:600.
Rotimi observed that the doctor-to-patient density, weak human resources and poor regulation of healthcare practices in the state needed to be addressed. However, SaharaReporters’ recent visits to one general hospital and four primary healthcare centres in the state showed that there is little or no progress four years after Rotimi’s recommendation.
Kwara Government Admits Inadequate Human Resources, Speaks On Solutions
When contacted for her reaction to our findings, the state Commissioner for Health, Dr Amina Ahmed El-lmam acknowledged that the state is facing significant issues with human resources in the health sector.
Dr Amina Ahmed El-lmam- Source: X (formerly Twitter)
She said, “On the challenges of human resources, this is a national and, indeed, global concern. One of the major issues is the difficulty in retaining health workers we hire. The state has mitigated this by the approval of 100% CONHESS and CONMESS and full hazard payment. This has drastically stopped the local brain drain of state personnel to federal institutions.”
She equally confirmed our findings that the General Hospital in Okuta has only two doctors, adding that five nurses, one pharmacist, two pharmacy technicians, four laboratory technicians, and three health attendants are also on the hospital’s staff lists.
She continued: “In General Hospital Okuta that you cited, we were already working on getting more doctors to deploy to Okuta. The community and Emir have been asked to help in this regard to recruit citizens of Okuta. In many instances, we have a standing offer of employment for willing professionals to improve staff strength.”
“There is continuous capacity building of health workers to enable them to provide quality care to the patients. We are also looking at increasing the intake of students (youth corp members) in our health training institutions.
“Significantly, we have created a huge specialist training pipeline by the recent assent to the Kwara State University Teaching Hospital KWASUTH law. This will facilitate the training of medical students from KWASU and the specialist training of doctors,” she added.
The commissioner also pledged to look into our findings about the two doctors and other staff's irregular attendance at the general hospital and to take appropriate action.
The story was supported with funding from the Centre for Journalism Innovation and Development, CJID.