Health For All Rivers People, A Mirage?

“The principal objective of a health system is to improve people’s health, and the chief function a system needs to perform is to deliver health services using money, staff, equipment and drugs in different combinations to allow appropriate delivery of health interventions.

“Improving and scaling up service delivery depends on having key resources and on how those resources are organised and managed.”

This, in part, is the preamble of the Rivers State Ministry of Health (RSMOH) in its second anniversary account of stewardship in the health sector from October 2007 to October 2009.

The key question, therefore, is to what extent has the people’s health improved? And to what extent have health services been delivered using money, staff, equipment and drugs.

There is also the question of how much key resources are available? And how these resources are organised and managed in the 43 years of existence of Rivers State.

Shortly after the creation of Rivers State on May 27 1967, the only known state-owned Hospital, was General hospital Port Harcourt, which later became the  University of Port Harcourt Teaching Hospital (UPTH). The present Braithwaite Memorial Specialist Hospital (BMSH), then, was Braithwaite Nursing Home.

During this period, which, could be up to the late seventies, health care providers were known to render their services selflessly in accordance with the ethics of their profession.

Then, the emphasis visibly was not just on service delivery, but on effective service delivery.

Though the equipment used then is not comparable to what is used today, and common illnesses then cannot equate what holds today, it was rare for a patient to leave an hospital unsatisfied in terms of services rendered to him/her.

Apart from Port Harcourt General Hospital, there were also General Hospitals in the then Local Government Headquarters, though they were less equipped. However, they also rendered effective service delivery at that level.

At the level of communities also, the federal government in collaboration with state governments established health care centres which were also less equipped, and merely served as dispensaries.

By the beginning of the eighties, the emphasis on effective service delivery on the part of providers gradually diminished alongside the provision of equipment, while the quest for economic empowerment among health care providers increased.

The result, by the nineties, was an array of dilapidated health facilities, and mostly embittered health care providers. Even such laudable programmes as the “Flying Doctors Scheme” under late Dr Dima Deni-Fiberisima (the then health commissioner) could not improve the health sector.

Solace, however, came to the health sector in Rivers State with the return of democracy in 1999 under the governorship of Dr Peter Odili.

The Governor, who ruled the state for eight years, brought life into the health sector by building health centres in various communities and also modernised the BMSH.

However, while he built the physical structures, most of them, including BMSH, were not properly equipped, and adequate emphasis was not placed on human resources development in the health sector, hence the situation did not help the decay in the health sector. This was the inheritance, of the incumbent Governor, Rt. Hon. Chibuike Rotimi Amaechi.

On assumption of office on the 26th of October, 2007, the state government first held an health summit for all stakeholders in health on the 5th and 6th of February, 2008. The essence of the summit was to highlight the way forward in the health sector and also to determine the best option in its implementation process.

To ensure proper integration among all levels of health care, as was agreed in the summit, a bill for the establishment of Primary Health Care Board was introduced in the State House of Assembly and is at an advanced stage.

“The State Government first embarked on the construction of 160 New Primary Health Care centres as a step towards replacing the existing dilapidated ones and rebuilding the entire health system.

Out of the 160, the major contractors for the execution of the projects, Brunell Engineering Construction Company undertook the constructing of 105.

As at last October, 29 of the 105 were completed and were fully equipped, 18 were above 90 per cent complete, while 42 were above 70 per cent completion. The rest of the 160 are at various stages of completion.

In Secondary Healthcare, one of the major reasons for the failure of  Professor Olukoye Ransome-Kuti Primary health Care model was the non-availability of proper referral systems and centres.

The Health commissioner, Dr Sampson Parker said in order for Governor Amaechi’s vision not to have the same pitfalls, simultaneous arrangements have commenced to ensure massive renovations or complete rebuilding and equipping of the General Hospitals thus the Niger hospital (now Professor Kelsey Harrison’s Hospital) and Dental Hospital have been completely rebuilt.

In a bid to provide effective, efficient and affordable health service, he said, the radiology department and the chemical laboratories have undergone massive retooling, with Clinotech Group of Canada acting as technical partners.

The state government has also set up a surgical theatre unit, sterilising unit and an oxygen manufacturing plant, with an adjoining intensive care unit with state of the art equipment.

According to a document made available to The Tide, about 145 Rivers people benefited from Emergency Medical Service (EMS) on Road Traffic Accident Care, while about 489 non-indigenes also benefited from the scheme in November to April 2008.

Under man power development, the government said post graduate training of doctors in family medicine is in full swing as the BMSH is fully accredited to do so.

In the Ancillary Services, the drug stock level went from N12 million in 2007 to over N40 million as at May 2009.

“Monthly sale of drugs increased from N3million in 2007 to over N10 million as at May 2009, while the Central Medical Store has taken over the procurement of drugs for HIV/AIDS and Malaria Control Programmes.

An auto disabled syringe factory, which will manufacture intravenous fluids has also been completed and commissioned with technical partnership from Pan Africa Health Foundation.

In a bid to check the trend of malaria in the state, the Rivers State Government distributed one million long lasting insecticide nets from December 2007 to December 2008.

About 314,942 doses of anti-malaria drugs were bought and distributed from April 2007 to April 2009, just as the sum of N300 million was budgeted and expended for malaria treatment in 2009.

In HIV/ADIS programme, a total of N95 million was released in 2009, while about N23 million was given to the Rivers State Agency for the Control of AIDS (RIVSACA) for HIV/AIDS control and about N83 million was spent on Anti-Retroviral drugs for people living with HIV/AIDS.

Inspite of these achievements, however, the answer to the question of what extent has people’s health improved is not that favourable.

This is because even as there are modern health facilities, there are no doctors at several health centres and hospitals, especially in the rural areas because doctors posted often refuse to be in their duty post after honouring such posting.

Another worrisome issue is that while the government has spent huge amounts on drugs and other deliverables, there are no strict monitoring or supervision of government health projects.

The answer to the question of how much key resources are available and how these resources are organised and managed is nothing to talk about. This is because the rush for free medical care services and free anti-retroviral programmes has seen people from outside the state come to access the facilities. Often times, these deliverables are not properly utilised or given free to the appropriate beneficiaries. Health care providers now use the opportunity to sell the products.

It is hoped that with recent announcement by the Governor of the state, collaboration with the United Nations Development Programme (UNDP), government projects, including those in the health sector, will be  monitored in a bid to ensure that the projects are executed to the letter. However, this also depends on whether subsequent governments will continue the process.

Sogbeba Dokubo