Dr. Rilwanu is the Executive Secretary of the Federal Capital Territory (FCT) Primary Healthcare Development Board.
The Consultant, Physician and public health expert speaks with Time Nigeria Magazine on the transformation that the board has witnessed under his leadership, the strategic importance of sustainable primary healthcare system in Nigeria and FCT in particular as well as challenges facing his board. Excerpts.
What are the roles of FCT Primary healthcare Development Board?
The role of FCT primary Healthcare Development Board is actually to coordinate all activities of primary healthcare centres at the local government and at the state level. Now, we have 250 primary healthcare centres and out of this we have 15 comprehensive health centres and three mini-clinics, all are under our watchful eyes. Since we started in 2010 this was included in the National Health Bill but it was later removed because they say that FCT is like a state so we must send our bill separately.
When we came in we realized that we needed to find out how many healthcare centres, how many facilities, how many personnel, how many equipment, and the essential drugs and ambulances we have. We carried out what we call inventory. We went to all the primary healthcare centres in the FCT and even some general hospitals because family planning and some other activities of the general hospitals are under our department.
That was when we got to know that we have 250 primary healthcare centres and 1,038 staff as against 4,098 staff, so you can see that the gap is much, that we do not have staff at all. We do not have ambulances, essential drugs are not there.
Immediately after the inventory, we had to carry out what we called baseline survey. This is to find out where we are? Where do we want to go? And how do we go to where we want to go? We did that in order to find our direction. When we finished that, we carry out what we called strategic plan of action. This will run for five years. We set up our vision, mission and core values to know where we are going to and how to go to. Where we want to go, and how the primary healthcare will function according to the WHO.
We are supposed to have 4,000 primary healthcare centres in the FCT because the rule is that each primary healthcare should be 30 minutes walk or 5km from each other, but unfortunately we have only 250 and most of them are not working. Only 30% are working according to WHO of all the primary healthcare centres we are having in the FCT.
After two years, the Hon. Minister of State for the FCT said we should rejuvenate all the primary healthcare centers in the FCT. When we went in, we checked the primary healthcare centres for any improvement and there was little improvement actually and we found out that we have about 35% working according to WHO.
So you can see that we have 5% increase and the reason is because there is little funding. The FCT administration is helping and developing general hospitals which are under them exactly. And the primary healthcare centres are supposed to be under the local government. But nobody is taking charge of that.
But the National Health Bill is supposed to handle that but unfortunately the National Health bill has been passed and approved by the President but FCT primary healthcare was not covered. So we do not have legal backing to say that we are on our own. But as a department we are still working with the local government to carry out number of activities like immunization, like family planning, like maternal and child healthcare, we also carry out nutritional services and health education. This are some of the activities we carry out, not forgetting water and sanitation including public toilets.
As at now FCT has 14,000 internally displaced persons and they are even more from Maiduguri, Taraba and Yobe. We need to be very careful, we need to make sure we give them the best we can give so that they will not infect our people. They are coming from war zone and we have to be very careful and we have being going there to cater for them; we deworm their children because we know that they are going to mingle with our children. We need to give them Vitamin A to boost their immunity and we are doing it. Even now as I am talking to you we are out there with them to treat them. And these are what we are doing in the FCT.
Running primary healthcare system effectively entails adequate funding, what are the measures put in place to attract funds?
In the year 2012, we stared having outbreak of polio in the FCT. The President was not happy at all because it is an embarrassment to the nation that the nation’s capital is still harboring polio. So what we did was to get money from the Joint Committee Allocation (JAC) of the local government. We gave it directly to the HODs of the Local Government to carry out the immunization process. Since 2012 we did not have a single outbreak of polio because we have taken measures.
Before then, the local government do not do that, they will tell them that they are giving them N50 million but will end up giving them N3 million and workers will not be paid and they also will not do their work. Since workers are being paid and logistics support is there, there has not been any outbreak of polio in the FCT. One of the achievements is that the routine immunization was 36% but as at now it is 99% and there have not been outbreak for over three years now. In the whole country for over 10 months there has not been any outbreak of polio. That means Nigeria is working very well to kick out polio and government is supporting us, traditional and religious leaders are supporting us and the media are also doing the same to talk to the people that prevention is better than cure.
The state of primary healthcare in Kawu Village at a time was a sorry state, why?
(Cuts in) if you go there now, we have renovated the centre and SURE-P has built another one for the village and the one you saw now serves as accommodation. We have renovated it and there is a lot of improvement.
Does this cut across all other centres?
That is what I was telling you, we have 250 primary healthcare centres and only 30% are working according to WHO. We require some number of staff we need essential drugs, we need ambulances, we need water supply, electricity, waste disposal system, because these are the things you look at in primary healthcare. If the hospital or primary healthcare centre do not have water the patients will have to run down to one stream to get water and then get diarrhoea again and contaminations and that is the reason why there is lot of improvement in some of the things we are doing. But still we need to do more because primary healthcare centres are still not working according to WHO specifications.
Some primary healthcare centres have been constructed through SURE-P. There is a lot of improvement but the improvement is not much.
With the incoming administration what are you looking forward to?
Now that the president has assented to the bill, we want the new administration to implement the National Health Act. We want them to look at healthcare as the bedrock of the society because Human Development Index indicate that any country that has high maternal and infant mortality, poor literacy level and the agricultural level is very low, poverty is high, the country is not developed. When women die during child birth, it is unfortunate, that is not good at all. We want the new administration to look at healthcare and make sure that the citizens are healthy.
They should boost agriculture and make sure that education is going on and at the end of the day when you find out that when citizens are in perfect health, productivity will increase both in private and public sectors.
People may say malaria is ordinary but it cost the country $480 billion in terms of man hour loss, in terms of consultation at the clinic, in terms of payment of services to the hospital particularly paying for laboratory services, people will not go to school or farms because they are sick. If you add these in terms of economic evaluation you find out that the country is losing a lot just to malaria alone. We are not talking about HIV and other infections that are out there.
If government will do their best and make sure that they implement the National Health Act there will be direct funding for primary healthcare development.At least 45% of the fund will go to the National Primary Healthcare and that is a basket of fund. Then the state primary healthcare would go to the national with their work plan and get the fund. The more you do the more you get the fund, the less you do the less you get the fund.
At least 5% of this fund will go to the National Emergency Unit, through the National Emergency Management Agency. The fund will be utilized at both state and the federal level to take care of emergency like flooding, crisis of displaced persons.
The one for the primary healthcare centres would help to pay staff, get essential drugs get ambulance and others. The role of primary healthcare centres is that there is a level it can attend and then refer. When you are referring the ambulance should be there. But as for now nobody cares about primary healthcare or the rural centres.
Then 50% of the fund will go into the National Insurance Scheme. Do you know why National Health Insurance Scheme is very important? The 50% would be used to treat those that are disabled, pregnant mothers and children under the age of 5 who should have free treatment. It would be a compulsory thing to be registered with NHIS whether it is formal or informal. The government should make sure that health insurance is made compulsory.
What is your relationship with development partners?
We have excellent relationship. Even this morning, Helen Keller International came in today to support us during our MNCH which we carry out twice in a year, that is in June and November in order to give the children Vitamin A, deworm the children and give them vitamin A to boost immunity and also treat some common ailments and carry out immunization.
Usually it is carried out all over the country. UNICEF supports us during immunization and other activities, WHO is always there, they have their office here, and they are always there to give us technical support and sometimes financial support.
We also have UNFPA that is working on family planning and with the support of the Federal Government they are giving free family planning commodity. Also the NURHI, they had always supported us. For nutrition activities, UNICEF is always supporting us. With this we usually have the work plan of how we want to do our work. Through the board, they support the local government to carry out most of the activities.
