Hospital environments should be scrupulously clean. However, our reporters’ visits to primary healthcare centres in Lagos State show that basic amenities such as water, sanitation, hygiene, and proper waste management are lacking. LARA ADEJORO of The Punch Newspapers leads the series of reports
Primary healthcare centre is usually the initial point of contact for individuals seeking to access health care and providers play a crucial role in the healthcare model.
Among the eight components of primary healthcare centres is the supply of adequate safe water and sanitation.
Others are: Health education on prevailing health problems and the methods of preventing and controlling them; nutritional promotion, including food supply; maternal and child health care; as well as immunisation against major infectious diseases.
The remaining components are: prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.
All these basic requirements are incorporated in the SDGs for 2030 from Goal 2 to Goal 4.
Many Lagos State Government-owned PHCs visited by PUNCH HealthWise fall short of supply of adequate safe water and sanitation, however.
Igbogbo/Bayeku PHC without visitors’ toilet
Igbogbo/Bayeku Primary Health Centre is one of such. Indeed, no one would know the structure, overtaken by weeds, is a healthcare facility except for the signboard tucked beside a heap of sand announcing the PHC’s presence.
Igbogbo Bayeku LCDA, one of the 37 Local Council Development Areas in Lagos, was created in 2003.
The PHC facility looks unkempt, while dirty objects such as used nylon and empty pet bottles litter the facility. The environment is also dusty.
Despite being primarily devoted to providing medical services such as immunisation, antenatal, maternal and child care, the health centre has no toilet facilities for outpatients and visitors.
Visitors or patients who have the urgent need to use the toilet turn to the back of one of the buildings. Our Correspondent was directed to the back of one of the buildings by one of the nurses when she asked to use the bathroom.
Upon further enquiry, a reliable source at the centre said, “Most patients resort to the back of the buildings to ease themselves if they want to urinate, but we don’t allow defecation.”
Continuing, the source said, “Although there are toilets for nurses or patients on admission, there are no taps to wash hands. You can buy sachet water to wash your hands.
“For those that are not nurses, they urinate at the back of the buildings and we are used to it even though they are working on fixing our taps.”
Improper waste disposal
Our Correspondent also observed that waste is disposed of in an open bin beside one of the buildings at the centre.
The waste, comprising used needles, cotton wool, pharmaceutical products, and solid waste are thrown indiscriminately into nylon bags and a big garbage bin without a cover.
There was an overwhelming stench oozing out of the garbage bin, which seems normal for the health workers and their patients.
Overgrown grasses and refuse occupy good portions of the health centre.
According to the World Health Organisation, of the total amount of waste generated through healthcare activities, about 85 percent is general, non-hazardous waste. “The remaining 15 percent is considered hazardous material that may be infectious, toxic or radioactive,” WHO stated.
Ita-Elewa PHC without running tap
Even though there are two waste bins donated by the Ikorodu Doyen Lions Club, domestic waste is thrown into an open-top plastic hollow bin.
There are no running taps at the facility except for the washbasin in front of one of the buildings with an empty soap container.
A staff who pleaded anonymity at the facility said, “There is water, but it is not running now because there is no light.
“So, we store water in buckets in case there is no light. The inverter we have cannot pump water, so we rely on light to pump water. So, if you use the toilet, there is water in buckets for anyone to use.”
The toilet visited by our Correspondent was unkempt and there was no toilet paper or hand wipes.
Abule-Eko PHC with lone toilet
When our Correspondent visited the centre located off Ijede Road in Ikorodu, there are no basic infection prevention measures put in place.
There are infection control lapses as waste is disposed of inside nylon bags close to the entrance of the facility.
It was observed that there is an unkempt and haphazard consulting room while the chairs are dusty.
The centre has only one bathroom and one toilet at the facility, both of which serve both the staff and patients.
“That is the only toilet in this place for the staff and patients and there is water you can use there,” a female health worker explained.
She added that the centre lacks basic medical supplies and equipment.
A visit to Sango-Agege primary health centre shows that it lacks basic toilet facilities and water supply. However, there are water stands with bottles of watery liquid soap in front of two of the buildings at the centre.
Visitors and patients have the indignity of using the back of one of the buildings as toilet.
A nurse said the taps stopped functioning “recently” and that the management is working on fixing them.
“There is a toilet at the ante-natal section, but I don’t think they will allow you to use it.
“You can as well use the privately-owned toilet, but you will pay N30 if you want to urinate and pay N50 if you want to defecate,” she said.
Even the privately-owned toilet looks unkempt, with sickening stains on the wall.
Agboyi PHC surrounded by swamps
This is the PHC that serves the people of Agboyi community, yet it is in a deplorable state surrounded by swamps, with high possibility of mosquito infestations.
Findings show that residents in the community prefer visiting the Traditional birth attendants than going to the health centre except when mothers need to take their children for immunisation.
On entering the facility, there were some weary women who had waited several hours to have their babies immunised.
“I have been here since 11am and this is past 1pm. We have to wait because it’s only a nurse that attends to everyone and you have to wait for your turn,” a young woman who brought her daughter for immunisation said.
PUNCH HealthWise observed that there is only one nurse and an attendant at the facility.
The facility is full of cobwebs, while the dirty ceiling is almost falling down. The louverare mostly missing from the windows whose nets are torn and dirty.
Tables are dusty, door handles are damaged and mattresses in the wards are dusty and unfit for use.
The centre has only one toilet for the two staff at the centre and none for patients.
The toilet serving the staff is one poky dirty room with no light, rusty water closet that is clogged with brown water.
Alapere PHC with no water or toilet
Though the health centre located on Adeyemi Street has no toilet or water facilities, health activities are carried out daily at the centre.
Our Correspondent learnt that patients answer the call of nature behind the stand-by giant generator at the centre.
Waste is disposed of in nylon bags. The waste comprise used cotton wool, syringes and other pharmaceutical products.
Ajegunle PHC: Water is a challenge
The sight of the unhygienic condition of the toilet at this centre can make anyone retch.
As a stopgap measure, the attendants fetch water for use at the centre.
One of the staff who spoke with our Correspondent on condition of anonymity said, “Water is a challenge at the centre as the borehole dug is non-functional. Sometimes, we pee on the floor of the toilet and sweep it away with water.
“For the waste, we have environmentalists who take care of that,” she said.
Government must prioritise health sector—Physician
A public health physician and Director, Policy and Advocacy at the Nigeria Health Watch, Dr. Ifeanyi Nsofor, says the three tiers of government must revamp the healthcare sector.
Speaking in an interview with PUNCH HealthWise, Nsofor called on the government to not just build hospitals but ensure that they are functional and well-equipped.
DON’T JUST BUILD HOSPITALS, ENSURE THEY ARE FUNCTIONAL AND WELL-EQUIPPED –NSOFOR TELLS GOVT
Concerning the lack of basic toilet facilities and water in the health facilities, the physician said, “It shows how we don’t prioritise those things that are important in the health sector.
“For instance, if you give N100m to improve healthcare in Makoko, I won’t build a mighty hospital. I will start with looking into what people need to prevent them from falling sick, by providing clean water, public toilet and other things people need.
“However, government at different levels will focus on building more hospitals despite the fact that the ones in existence are not clean and health workers don’t even have water to wash their hands.
“It means that we are yet to prioritise what is important. Prioritising what is needed in the hospitals, especially the primary health centres will benefit everybody, including the patients and the health workers.”
LACK OF BASIC TOILET FACILITIES AND WATER IN HEALTH FACILITIES SHOWS HOW WE DON’T PRIORITISE THINGS THAT ARE IMPORTANT IN THE HEALTH SECTOR –PHYSICIAN
The expert said when the necessary things are in place, it will boost patients’ confidence while they visit the health centres.
“If they go to the centres and they cannot wash their hands or use the toilet, that will discourage the people because the hospital is meant to be one of the cleanest environments and when these things are not in place, it will reduce the health-seeking behaviour of the people.
“This will worsen the status of the patient in the health facilities and that is when you hear things like hospital-acquired infection because this has to do with poor sanitation, lack of clean water, lack of toilet facilities.”
Nsofor added that some of the reasons there is brain drain and exodus of doctors to other countries is because of the lack of a good working environment and basic amenities.
“This is one of the reasons doctors are travelling out of the country because there is no job satisfaction. Even if they want to stay and the government cannot provide the necessary amenities, then the doctors will be discouraged.
SOME OF THE REASONS THERE IS BRAIN DRAIN IN HEALTH SECTOR IS BECAUSE OF LACK OF GOOD WORKING ENVIRONMENT AND BASIC AMENITIES –PHYSICIAN
“Before COVID-19, a lot of doctors have died from Lassa fever and this has to do with poor sanitation and lack of infection prevention protocols.
“Politicians need to understand that it’s not just about building health facilities but also ensuring that they have the basic requirements and the facilities are functioning,” Nsofor said.
This story is first published by The Punch Newspaper’s Health Wise