Aishetu in her wardroom, besides a non-functional oxygen tank. Photo: Amos Abba/ICIR

Power unavailability cripples operations at Nigerian clinics

Nigerians living in rural areas see access to healthcare services curtailed by lack of access to electricity.
Nigerians living in rural areas see access to healthcare services curtailed by lack of access to electricity.

Sitting on a bench in the waiting room at Wumba Primary Health Centre, located in Apo Resettlement Area, on the outskirts of Abuja, Nigeria’s capital city, Aishetu Audu fans herself with a light notebook.

The sweltering heat in her wardroom which she also shared with another patient was unbearable. That made her look for ventilation outside the wardroom where hours earlier she had delivered a baby boy after she was rushed to the clinic early that August morning.

From her wardroom window, she could see glowing light bulbs across some houses on the street, but the health centre had no form of electricity.

“Houses across the street at least have a few hours of power supply daily, but a clinic that should have lighting for patients is in darkness,” she said.

“Look at me running around the clinic looking for fresh air and cool breeze.”

The Wumba PHC, the closest to Audu, is about 45 minutes from her home. 

The ceiling fan in Audu’s wardroom had not worked since February 2019, after the private-owned electricity distribution company, Abuja Electricity Distribution Company, (AEDC) disconnected the community health clinic from the national grid. Outstanding electricity bills had accumulated to over N100, 000 ($262.5) becoming unaffordable for the health centre before it was disconnected by AEDC. 

Currently, the health centre depends on a petrol-powered 1.5kva generator, according to Mary John, the health officer in charge.

“We put on the generator mostly at nights or whenever there is an emergency, for instance, if a woman in labour is about to deliver or during cases where minor surgeries are performed at the centre,” she said.

Other patients at the hospital said when the generator comes up they can barely cope with the loud noise it makes as it is kept very close to the clinic’s building in the absence of special room to keep it.

However, the health centre spends N6, 000 (US$$15) weekly to fuel its creaky generator implying N24, 000 (US$62) is kept aside monthly, as fuel costs.

This explains why Mary and her medical staff of three at the Wumba PHC resort to spending out of their pockets to fuel the generators and charging patients extra fees to recoup their money.

“At the peak of the coronavirus pandemic, we had very few patients at the clinic because people were afraid of coming to the centre for fear of being labelled COVID-19 patients, though, there was little we could do here without power supply,” she said. 

“The generator we have cannot power the scanning machine for antenatal care or the refrigerator which we use to keep vaccines at a suitable temperature for immunisations, so we referred parents who came to the health centre to the Dutse health centre which is more than one hour away to vaccinate their children,” Mary said.

A health worker at Dakwa Health Centre talking with a mother. Photo: Amos Abba/ICIR

Audu will travel a distance of 34.9km from Wumba which would take more than two hours due to the poor condition of the road to the Dutse PHC, the nearest health facility if she wants to get her newborn baby vaccinated in the coming months for lack of power supply. 

Her struggle resembles the experience of millions of people in Sub-Saharan Africa who embark on a two-hour journey to access the nearest emergency health service and obstetric care, according to a 2018 study published by Lancet Global Health.

A resort to dirty energy alternative

In Gwagwalada, which is over an hour’s drive or a 65.6km distance away from the relatively up-scale part of at the Gwagwalada Primary Health Care, Phase 3, Adebosin Felicia, the deputy health officer in charge of the facility rummages through a medicine cabinet for a patient’s drug.

“It has been challenging working at a health facility without power supply because of the frustration associated with it. We spend about N5, 000 weekly to keep the generator running for us to maintain operations at the clinic which is exorbitant,” she said..

Several months after the health centre was inaugurated in 2019, burglars broke into the facility carting away with electrical cables and other items of value. Although the building was enclosed with a fence there was no security personnel attached to the health centre at the time.

“Since the clinic was vandalised, we always head to the cold-chain office in Gwagwalada whenever it is time to get vaccines for immunisation of children since we have no way of storing the vaccines because of power supply,” she said.

However, the World Health Organisation, (WHO) immunisation policy faces a huge energy challenge in Sub-Saharan Africa if it is to meet its target for vaccine refrigeration capacity expansion by 2025, and cater for the vaccine needs of the growing global population.

In April, when the COVID-19 pandemic was at its peak in the country, Adebosin said several patients refused to be admitted at the clinic but preferred to receive treatment at home owing to lack of power supply at the clinic.

At Manderegi PHC, the paint is fading and the ceilings are broken. Photo: Amos Abba/ICIR

Fumes from the generator would usually find their way into the wards making patients uncomfortable, prompting them not to think twice before exiting the clinic.

“So we’ve been losing patients on a regular basis especially during the COVID-19 pandemic early this year where the turnout of patients was very low because most of our machines were not working. Patients preferred other facilities where their needs would be addressed,” she said.

In 2018, Nigerians spent about N145 billion ($477 million) to import generators into the country. The country is ranked fourth in the world in deaths caused by air pollution, an offshoot of the use of dirty fuels while an estimated 114,000 Nigerians die prematurely from air pollution each year. 

PHCs across Nigeria’s capital city turn to dirty fuels for lightings and to power their medical machines, due to the failing national electricity supply.

The same PHCs which should be lifesavers by adopting the use of dirty fuels now serve as a conduit of death.

Still in the dark after 6 years

It was almost sunset, as Umar Sadiq prepared for the end of his shift which would commence in an hour. He had been away from home since 10 am, and his wife and five children were eagerly expecting him to return.

Umar was clearing his desk in the almost deserted Manderegi PHC in Abaji Area Council as there was no patient around for the one hour the reporter spent at the facility. There was hardly any medical equipment, or electrical appliance in the four rooms of the facility, which serves a population of 2,000 people. 

Speaking to the ICIR he said the lack of power supply had affected the quality of healthcare delivery at the PHC from vaccine delivery to the period of operations at the clinic. 

The clinic closes at 6 pm unless there is a medical emergency.

He has to embark on a 6km distance to reach the cold-chain office in Abaji where he would get the vaccines and return them before the temperature of the vaccine rises too much.

“We do not store vaccines here so we collect our vaccines from the cold chain office on immunisation days. We also return the ones we do not use to them. That is how we have been operating,” he said.

Since the Manderegi PHC was established six years ago, it is yet to be connected to any form of electricity and whenever there is a medical emergency at night the health workers make use of rechargeable lanterns or phones.

Nigeria has suffered over 206 grid collapses in nine years with about 12 breakdowns in 2019. Consistent power failures have made health workers continue to rely on rechargeable lamps and mobile phones as an alternative energy backup.

For Umar and his medical staff of six at the health centre, they continue to practice medical staff best practices like cutting umbilical cords with clean blades and keeping infants warm by placing them on their mothers’ abdomens learning to avoid anything related to electricity.

Praise Ogbebor, a renewable energy specialist, told the ICIR that the increasing energy demand in Nigeria’s healthcare delivery could only be bridged by a decentralised renewable energy solution.

“With the consistent power shortages experienced across the country due to the failing national grid, the solution will always lie with sustainable energy,” he said. “If you consider the amount spent in building healthcare centres a fraction of that money could get an off-grid solar installation running.”

Umar Sadiq, the health officer in charge of Manderegi PHC. Photo: Amos Abba/ICIR

Scaling up to turn the tide

Dakwa Primary Health Centre, located in Abuja Municipal Area Council, has been touted as a model health facility after the community health centre celebrated a two-year uninterrupted power supply in 2018.

For a curious mind, this feat looks unattainable for a rural health facility situated in Nigeria, where 76 million people do not have access to electricity according to a 2019 Price Waterhouse Coopers (PWC) report. 

However, when the PHC was built in 2014, it was in a blackout for the first two years of existence without any form of electricity, depending on kerosene and rechargeable lamps. 

In April 2016, Vaya Energy, a Nigerian renewable energy company which focused on the deployment of solar-generated electricity solutions, designed and installed a 12-panel solar-powered off-grid system for Dakwa PHC at an estimated cost of N3 million.

The initiative was part of its Corporate Social Responsibility and the solar power project was also replicated at the Karu Health Centre, on the outskirts of Abuja which was plagued with frequent blackouts.

Energy experts believe putting solar panels on the roof of every clinic is not the answer considering such projects usually get bad within a year. They, however, believe in building mini-grid systems to support communities and that starting with the health centres is a big step in the right direction.

When this reporter visited Dakwa PHC, the shuddering roar of a generator that Thursday afternoon took away the solitude of the health facility which was a contrast from what he had expected to see on the ground.

Martha Dikko, the health officer in charge of the centre refused to speak to this reporter when she was asked why the generator was still a major source of power supply to the health centre if the solar installation was still in good condition.

“I can’t talk to you without the approval of my superiors especially when the questions you are demanding answers for are very sensitive,” she said.

Enquiries made by the reporter showed that the solar installation at the Dakwa health centre currently powers the solar refrigerator alone while the generator and electricity from the national grid provide lighting and power critical devices.

The situation was also the same when the reporter visited the Gbagalape Health Centre, Nyanya and Karu, where they make use of a solar refrigerator which is the only appliance powered by the solar installation at the health centres.

Egwue Yunana, public health analyst, pointed out that the major impact of sustainable power supply in health centres would increase the productivity of health workers, especially in rural areas.

“Health workers usually take the responsibility of providing alternative power supply they need at their various health centres which comes from their personal funds, or the internal revenue generated from services offered to patients but the provision of a reliable power supply will make a huge difference by relieving the health workers of this unnecessary burden,” he said.

Will the fortunes of the PHC’s improve?

Chris Elemuwa, deputy director of the Laboratory and Surveillance, at the NPHCDA, Abuja said the response of the primary health centres in Nigeria to COVID-19 could be better if priority was given to improved energy access.

“During the pandemic, PHCs could not carry out contact tracing or laboratory testing because most of them were ill-equipped to perform that task,” he said.

“Power supply is a very critical aspect for laboratories if they are to function optimally because COVID-19 is a viral disease and part of the fight against it should come from the laboratories.”

In 2018, the Nigerian government accessed a US$350 million World Bank loan for building 10,000 solar-powered mini-grids by 2023 in rural areas, which is expected to bring power to hospitals, schools and households.

Elemuwa said the PHCs should always be at the forefront of fighting a pandemic because of their strategic role as first line of defence in healthcare.

“If there is an aggressive plan to provide reliable power supply to PHCs, then their fortunes will change for the better,” he said. 

A 2018 Heinrich Boell Stiftung Energy Report on PHCs in Abuja showed that their number increased from 234 in 2016 to 248 in 2017. 

The Federal Capital Territory Primary Health Care Board (FCTPHCB) disbursed N800, 000 to PHCs in 2016 to fund the purchase of fuel and maintenance of their generators while N947, 000 was approved for the same expenses in 2017. This translates into a paltry sum of N890 and N1, 008 monthly for each PHC in Abuja during the period under review, which is way lower than the expenses made by the health centres.

The ICIR sent Freedom of Information (FOI), requests to the NPHCDA and the FCTPHCB, to provide a financial breakdown of the expenditure made by both agencies, towards building PHCs in Abuja between 2015 and 2019, and the amount spent in providing electricity for the health facilities. 

The NPHCDA failed to respond to the FOI request after one month which is a breach of Nigeria’s FOI Act that stipulates that government agencies should respond to an FOI request within seven working days.

The United Nations (UN) projected that a sustainable development goal to ensure access to affordable, reliable sustainable and modern energy for all by 2030, renewable energy generated from solar could make the goal realisable in Nigeria where over 200 million people depend on less than 4,000 megawatts of electricity generated in the country.