Editor's note: This is the second in a four part investigative series on Primary Healthcare Centres conducted by journalists in four newsrooms in Nigeria.
This is the story of how federal contractors in connivance with powerful Nigerians shortchanged the federal government and litter the country with abandoned Primary Healthcare Centres (PHC) projects to the detriment of the people, particularly pregnant women and infants in the host communities where these projects are expected to greatly improve access to healthcare.
In this report, Olajide Adelana traces a compelling pattern of corruption in the health sector and how it has added to the staggering statistics of 58,000 maternal deaths yearly in Nigeria.
It was a bright sunny day in July, 2015 and the weather was indecisive –difficult to say if it would rain or not. It is quite early in the day and many residents of Kombani Isa, Akko Local Government Area, Gombe state were relishing the clement weather –except one family, the Tukurs’.
Musa Tukur’s third wife, Amina, was in labour and there was nobody to turn to except a popular traditional birth attendant (TBA). This is not Amina’s first child and she and other members of Tukur’s family were already familiar with the drill.
Amina already has six children including Rabiu and Shamfiya who were birthed in a similar fashion. They were six times lucky and could not resist having a seventh child. Still in labour, they quickly gathered around and laid her on an elevated bed made of wood and covered with rice sacks just as the birth attendant arrived.
Minutes later, Dan Azunmi was born, filling members of the family with joy and excitement.
But it only lasted for 72 hours before they were greeted with silence and the scent of death.
Tukur says shortly after Amina gave birth, she began to experience chills, headaches, fever and convulsions. She was later taken to Tumo General Hospital where she was attended to by a doctor.
She died two days later.
Amina is one of 145 women of childbearing age who die daily in Nigeria and her story is one of 58,000 stories of pregnant women who die yearly from childbirth related complications – statistics only surpassed by India.
But to her bereaved husband, Amina is more than a number. “I really love her,” says Tukur as muggy air blows across his face.
How abandoned health projects litter northern Nigeria
The staggering statistics of women dying during childbirth has remained constant despite several government initiatives and the reasons might not be far-fetched.
Unknown to Tukur, the contract to build a model Primary Health Centre (PHC) in Kombani Isa to reduce home deliveries, its attendant consequences and other health issues ravaging the community was awarded five years ago to Associated Design Consults Limited at a cost of N9,792,255.65.
But years later when it is expected that the model PHC would have been concluded, it is yet to meaningfully contribute to improved access to healthcare in Kombani Isa.
“The facility is not functioning to full capacity as it should be. It is meant to be a model primary health centre but this is obviously not what was built,” says Musa Magaji, the officer in charge of the health centre.
The PHC appears complete but a tour of the facility proves otherwise and suggests the federal government might have being shortchanged. The concrete floor has started giving way, and other infrastructure that should give the facility its impetus as a model PHC are non-existent.
“They came and asked for land from the district head saying they want to build a model health centre. The land was given. They built what they wanted and left. We were not carried along in the project,” says a resident of the community who craved for anonymity for personal security reasons.
Surprisingly, Kombani Isa is not an isolated case where federal contractors obtain free landed properties from communities under the guise of providing accessible and affordable health care facilities only to dash their hopes halfway by building sub-standard facilities or, in most cases, abandoning the projects.
Investigation carried out revealed that majority of over 1250 contracts valued at N30.59bn awarded by the Federal Government for the supply of equipment and construction of PHCs nationwide between 2004 and 2014 have either been abandoned or not properly executed to required specifications.
Findings also showed that 13 percent of these contracts worth about ₦4.03bn awarded for the provision of affordable and accessible primary healthcare facilities in northeast and central Nigeria have been abandoned.
In 2010, Federal Government approved the construction of PHCs in Endehu and Ugwan-Aren/Ehai communities, Nassarawa Eggon local government area (LGA), Nassarawa State. The contracts for N25 million each were awarded to Yashmak Construction Nigeria Limited and Zara Engineering Limited respectively.
But more than five years after, residents of the community are still fraught with fear whenever a pregnant woman is close to her delivery date as the projects have been abandoned and the contractors have refused to return to site.
Grace Dauda is the Officer-in-Charge of the only functional PHC catering for residents in the axis. She recalls how pregnant women of Ugwan-Aren go through difficult times whenever they are due for delivery.
“People come from Ugwan-Aren and Uhai communities to this PHC for medical care because the facility closer to them is not functioning. A pregnant woman from Ugwan-Aren once went into labour at night and because of the situation of things she had to be taken to a hospital along Abuja road where she later died,” Dauda said.
Efforts to reach Yasmak Construction Nigeria Limited were futile. The company was not found when a visit was paid to its registered address obtained from the Corporate Affairs Commission’s website at No 4 Rimi Road, Old GRA, Bauchi, Bauchi.
The address belongs to a non-governmental organization called Fahimta Women and Youth Development Initiative. Further findings showed that the company was registered barely two years before it was awarded a N25 million contract raising questions concerning the capacity of the company to execute the project in the first place.
How contractors give frivolous excuses to frustrate project execution
Most federal contractors have also perfected the skill of frustrating the execution of projects awarded to their companies by giving flimsy excuses. One of such attempts is evident in the delayed completion of the contracts awarded for the construction of health post facilities in Garba Doho, Fudawa, and Sarkin Arab wards in Jos North LGAs.
According to the data obtained from Budeshi.ng, an open contracting portal, each of the contracts awarded at the same cost of N2, 292, 203 million to F.R Resources Limited, Bit Shelter Limited, and Tegiriti Proact Limited in 2009 are yet to be completed.
For instance, in Garba Doho, the contractor, F.R Resources Limited, had abandoned the project site despite pleas from residents of the community.
Alhaji Umaru Mija is a resident of Garba Doho. He recalls vividly how residents of the community approached the contractor on the shoddiness of the work done.
“The contractor promised to complete the project but he didn’t. We also complained to the contractor that he should correct the defect when we noticed that there were no pillars. He didn’t listen to us and the building finally collapsed.”
Despite these complaints, residents said the project manager whose name they could not remember informed them that he abandoned the project because of a crisis that engulfed Jos in 2009.
Till date, the contractor has refused to resume work even after peace and tranquility has returned to the city.
“He said he won’t come back to site because of a crisis that happened years ago. As you can see everything has been peaceful but the contractor would not return to site,” Mija said with bewilderment.
Although the project had already reached the lintel level before abandonment, residents disclosed that it collapsed not too long after as the contractor did not put support pillars. A search at the Corporate Affairs Commission came back with no results indicating that the company is either not registered in Nigeria or does not exist.
Questionable procurement processes and the influence of constituency projects
Improper management of funds and award of contracts by the NPHCDA has often raised questions on the credibility of the procurement process in Nigeria’s health sector.
In its 2014 audit report, Global Alliance for Vaccines and Immunization (GAVI), a public-private global health organization dedicated to providing funding to increase access to vaccines for children in the world’s poorest countries accused the Federal Ministry of Health and the NPHCDA of malpractices and fraud in the utilization of N4.5bn in funding given to Nigeria between 2011 and 2013.
The report revealed that a number of cash advances were used to pay staff allowances. Cash advances for staff training were also reportedly transferred into the bank accounts of NPHCDA accountants, amounts as high as N91 million ($600,000) going to individual staff members
Gavi requested reimbursement of the identified amount and this has since been fully reimbursed by the Nigerian government.
A couple of years down the line, there seem to be no tangible change.
In 2014 and 2015, the NPHCDA awarded 91 contracts for the construction of PHCs in many states of the federation. But the bulk of these contracts were awarded mainly at a uniform sum of N21, 986,893.00 to different contractors raising suspicions of whether NPHCDA carried out open competitive bidding on the projects and adhered strictly to the 2007 Procurement Act.
Even then, dozens of PHCs, constructed in the last three years across the country by the federal government at a cost of over N2 billion have remained unused, in spite of desperate need for such health facilities to help reduce Nigeria’s static but high maternal mortality rate.
This is largely because funds were appropriated, contracts awarded to highly placed personalities and construction commenced on the PHCs, without proper liaison and linkages with state and local governments where they are sited.
A visit by our reporter to north eastern and central states of Gombe, Bauchi, Nassarawa, Abuja and Plateau revealed that many of the projects awarded between 2004 and 2016 by NPHCDA were constituency projects facilitated by members of the National Assembly.
A recent report by Tracka, a platform designed to engage citizens on budgetary capital expenditure monitoring found out that of the 852 constituency projects in 2016 budget, only 350 was completed, 118 was said to be ongoing, 343 was not carried out and 41 project locations could not be determined.
A Freedom of Information (FOI) request sent to NPHCDA for procurement records –inclusive of bidding method for the award of contracts and records of payments for some selected PHC projects between 2004 and 2014 was not made available even after the mandatory seven days required by the Freedom of Information Act, 2011.
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However, the constitutionality of constituency projects by the National Assembly members has also been debated in several fora. Nigeria has a federal government composed of three distinct branches: legislative, executive and judicial, whose powers are vested by the Constitution in the national assembly, president and the federal courts, including the Supreme Court.
To this end, experts believe that the primary role of the legislature is to make laws, and carry out oversight functions and not to implement the budget
Ifeanyi Nsofor, is the Chief Executive Officer, EpicAfric, a health consultancy group focused on providing in-depth understanding of the Nigerian health sector. He believes constituency projects “are rife with corruption and non-accountability and should not be inserted in the budget”.
Like Nsofor, Iheanyichukwu Maraizu, an Abuja based lawyer strongly believes that “releasing cash to senators for constituency projects could be counterproductive as it portends grave danger for probity, accountability, transparency and due process.”
But then is full PHC implementation possible in Nigeria?
Nsofor says it is possible and that government must realize that NPHCDA leading Primary Health Care in Nigeria is a misnomer.
“It is possible but must be led by the local government councils. PHC is located at local councils. NPHCDA leading Primary Health Care in Nigeria is a misnomer. There is so much an Abuja-based Agency can achieve in this regard.
“To achieve this requires ensuring that LGAs become functional and have financial resources to do so. Citizens’ advocacy must focus on the LGAs. It can also be achieved within the framework of Universal Health Coverage,” he submitted.
Nigeria operates a fairly chaotic healthcare system –largely decentralized, fashioned after its political structure and merely requiring the co-operation of state and local governments.
Prof. Shima Gyoh is a renowned surgeon and former Permanent Secretary of the Federal Ministry of Health. He believes government should come out with a decisive policy on the fate of PHCs being tied to local government.
But for, Seember Nyanger, the Executive Director, Public and Private Development Centre (PPDC), a non-governmental organization focused on ensuring accountability and transparency in government processes, it is beyond implementing PHCs at the local level. She opined that the “award of health related contracts be based on the prevalent needs in a certain constituency and depend on a system that enables public accountability.”
Seember also advocates strict adherence to rigorous procurement monitoring and dependence on a system that enable public accountability where award of health related contracts be based on the prevalent needs in a certain constituency.
“Furthermore, NPHCDA should provide its procurement data based on the Open Contracting data standards so as to enables us link contracts from their conception to the contract implementation and eventual service delivery outcome.
This enables anyone to look out for the service that have been provided and weigh it with the specifications of the contract.”
This investigation is supported by the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting.
Meanwhile, Legit.ng had previously reported that how Nigeria's primary health care agency was responsible for high maternal death despite government’s funding.
Watch what Nigerians say upon finding out that the budget for each citizen's health is N1,500