So far, Nigeria has built about 30,000 primary health centres (PHCs) across the country and yet the government is lagging seriously behind in the delivery of quality health services. In 2018, the World Health Organisation (WHO) ranked Nigeria’s health care system at 187th out of 190 countries, with countries like Afghanistan, Somalia and the Congo outperforming Nigeria on the index.
The deplorable state of the PHC system has taken a toll on the public health situation in Nigeria. A recent report showed that one in 13 women in Nigeria is likely to die during childbirth. The same report found out that about 58,000 women had died from childbirth complications in 2015 alone accounting for about 19% of global maternal deaths in the same year.
One can point to different reasons for the dire situations of PHCs in Nigeria; ranging from fragmented services to lack of qualified medical personnel to poor infrastructures. However, amidst all these, one of the fundamental issues facing PHCs is the lack of access reliable electricity.
Electricity is very important to PHCs for providing water supply, temperature control for medicine/vaccine storage, basic lighting, ventilation, and clinical processes; however, Nigeria’s erratic power supply has been one of the banes of primary health centres in Nigeria. In 2018, the Heinrich Boell Foundation sponsored a situation analysis study that was carried out among 60 PHCs in Abuja, Nigeria.
The study found out that almost half of the surveyed PHCs could not operate beyond 5pm due to unreliable access to constant electricity, meaning that they could not accept overnight admission and they certainly could not handle emergency cases at night. Meanwhile, the other half of the surveyed PHCs that could operate into the night often had to rely on alternative power source from petrol powered generators and other makeshift energy from kerosene lamps, candles and torchlight. One of the field monitors, during the study, reported meeting a midwife who had delivered a baby in the dark because the battery to the torchlight went dead in the middle of the delivery.
The lack of electricity is coming at a high cost to PHCs operations and it’s also a major barrier to quality health services. Certain PHCs in Abuja were found to spend as much as N500, 000 ($1,300) annually on petrol-powered generators, which are often paid for out of the pocket of the medical personnel. Meanwhile, the PHCs that could not afford to run petrol-powered generators, could not appropriately store vaccines and they lacked clean potable water.
Stand-alone solar power solutions have great potential to provide access to cost-effective and reliable electricity for PHCs, especially the ones that are situated in low-income areas and away from the national grid. A study done in India has shown that a solar-powered health centre treated 50% more patients, conducted 50% more safe deliveries and operated round the clock.
In Dakwa, Abuja, Nigeria, solar-powered PHCs is also operational, which has been responsible for providing round the clock electricity access to the rural-based health care centres. The solar PV system has been running for two years, thereby, increasing the patronage from zero to about 100 patients a month.
Responsible government agencies need to start considering how to provide the required funding to provide stand-alone solutions for PHCs. Here are some suggestions on how that can be done; increasing budgetary allocation for Health Care: Funding is generally inadequate in the Nigerian health system. The percentage of the budget allocated to health has been dropping consistently for the last three years from 4.23% in 2016 to 3.95% in 2018. Further analysis of the budgetary allocation to Abuja PHCs revealed that only about N12,000 annually is made available to pay for electric bills for each centre; a far cry from the N228,000 electrical bill incurred by some PHCs outside the cost of running generators. The budgetary allocation to PHCs needs to be reviewed with more funds directed towards providing solar powered electricity to the already established PHCs
Diverting funds away from frivolous and redundant project: Building new PHCs are usually driven by political motivation rather than actual needs of the communities, and this is the primary reason why 80% of the health centres are not functional because a lot of these so-called PHC buildings do not have equipment and staff. Between 2014 and 2015, over 91 contracts to the tune of N2 billion have been awarded to build new PHCs building, and according to reports, dozens of these buildings have remained unused. This N2 billion could have easily been spent on providing stand-alone solar systems to about 1,000 PHCs across the country.
Directing international donor funds to Solar solutions: There is a lot of international donor organisation that are spending millions of dollars into vaccines and health enlightenment programmes; some of these grants could be directed towards powering PHCs with solar powered energy.
Improved electricity for PHCs is equal to improved health services; therefore it is imperative to lay significant emphasis on ensuring that primary health centres get access to reliable, steady and affordable power supply.
Ebii, a communication expert HBS, writes from Abuja. 08092960591