PRIMARY HEALTH CENTERS: A Nation’s Nightmare An inappropriate delivery couch, in the labour room, at the Holy Trinity Health Center, Ikoto, Ijebu, Ogun State A!er visiting 25 primary health centres across the six in South West , ABIOSE ADELAJA ADAMS "nds that paucity of funds and government policy put them in a state of total disrepair, leading to a largely ine#cient healthcare delivery system at the grassroots Forlorn and distant, in Ori Ire local government area, Oyo seeing that it already closed by 4.00 pm. As the reporter at- State, stood a faded metallic signpost. Hardly could the let- tempted to knock on the door, three men who sat on the pave- tering on the post be deciphered as it had given way to harsh ment of weather conditions. But, looking at the building it introduces, the balcony of an adjacent house playing a popular Yoruba there is a clue that this is a health centre. game called ‘ayo’, volunteered help. Shouting posters with messages like ‘Immunization here’, Oyo “!ey have close,” a bare-chested dark man with a rotund belly State breastfeeding week and other educative health posters on said. tuberculosis, malaria, written in Yoruba language, all hung at “She was here in the morning,” another, also without a shirt, strategic points of the building, which desperately needed a said while the third, a slender man in a sweat-soaked singlet, new coat of paint. pointed in the distance and said “go there and ask for Mama !is local government area is home to about 150,628 people Islamia or Aunty Rashida.” whose main preoccupation is farming, and this health centre Aunty Rashida, as it turned out, is the community health is one of those meant to meet the people’s immediate health worker in charge of the hospital. She was not at home. needs. It was 4.00 pm at the time of reporting and the hospital was under lock and key, apparently closed for the day. Where do the women go? But some domestic animals like cats and a family of goats, had Wura Ojo, 28 year-old #rewood seller, who lives on the other taken over the corridor, resting from the scorching heat. side of the road opposite the facility, was stoking the #re on her Such health facilities are meant to be the bedrock of public stone mounted stove, when the reporter approached her. health services in many countries of the world. In 1978, Nige- With red and watery eyes, she looked up whilst also stamp- ria, along other World Health Organisation, WHO, member ing her feet and chanting a song to calm the eight months old countries adopted the Alma Ata Declaration instituting the daughter strapped to her back the traditional African way. !e primary health centres as the basic structural and functional baby coughed and cried inconsolably from the e"ect of the unit of the public health sector. Its aim is to provide accessible choking smoke. and a"ordable health for all, especially at the grassroots. “I have four children and all my children (were) But the health centre in Ori Ire is not accessible to the people, born in ile alagbo (herbal home),” she said with a thick Ogbo- “most times we refer them to another hospital (we have a bigger health centre or to the State hospital), because we don’t usually have much sta$ at night.

An unhappy patient, dissasti!ed at services rendered at a SURE-P assisted PHC, Ikogosi, Ekiti State

mosho ascent. When asked how it copes in the event of centre. “All this hospital (is) good for abere (im- a complicated birth requiring emergency Even at that, none of these primary munization).” obstetric intervention, she said “most health centres measure up to any stan- According to her, whenever she falls sick, times we refer them to another hospital dard, Reviewing the blueprint of a PHC, she uses herbs. She bathes her children (we have a bigger health centre or to the it ought to be headed by one or more (aged between eight months and 5 years State hospital), because we don’t usually doctors, and have a pharmacist, a sta" old) with herbs. have much sta" at night. But if there is nurse and other paramedical support “My mother, (that) is how (she) e born us, no complication, one person can take the sta". It ought to have su%cient sta%ng “ she concluded, returning to delivery.” to conduct outreach services such as im- her cooking. Giving a rough mental statistics, she munization, basic curative care services, Another woman who lives in the neigh- estimates deliveries taken in a month to and maternal and child health services, bourhood, 35 year old Shaki Isiaka, be up to 30. Although she was careful not preventive services, and monitoring and said the hospital attends to only minor to reveal fatalities, fear and concern was evaluation. ailments. palpable in her voice as she said: But the situation in the aforementioned “I don’t book there when I had my last “we don’t pray for complication but one facilities mirrors what obtains in several child (now 2 years old). I use General,” time when a woman was bleeding and we health centres across the country, espe- she disclosed, pointing towards the Gen- could not stop the bleeding, we referred cially in rural areas. eral Hospital, some distance away. Isiaka, her.” She didn’t state how successful !e federal ministry of health estimates a mother of three and a petty trader said the referral was and whether the ‘said that there are 23,000 basic health centres the General Hospital o"ers better and re- woman’survived. in the country, most of which are mini- liable services as “they have more people A look around the facility, however, mally functional , due to long years of (health workers) there.” showed that it had no functional ambu- Some 30 minute drive away is another lance to aid referrals. Relatives of patients health centre in Okelerin, in Ogbomoso. have to provide their own transport in !is one is a beautiful duplex painted in the event of an emergency. lively lemon green. “We don’t have equipments. we want gov- With bold imprints on its walls, it is ernment to provide us with things like obvious the centre was refurbished and anti-bleeding drugs, circumcision kits, funded by the “2009 MDGs-NHIS Ma- etc,”she said. ternal and Child Health project”. But the She also drew the reporter’s attention to beauty is only skin deep. a rechargeable lantern which she and !e Community Health Extension Work- her colleagues use in the labour room er, who was on a$ernoon shi$, Cecilia at night as a standby for the frequently Taiwo, 29, said the centre runs three shi$s experienced blackouts. !e sta" strength - morning, a$ernoon and of the hospital is six community exten- night. But because it is short sta"ed, the sion workers, six adhoc sta", headed by night shi$ o"ers only skeletal services. a matron. “Only one person is here at night. Some- Taiwo said that the state supplies the times, (there could be) two. So our work health centre with family planning com- at night is mostly to refer patients,” she modities and women are responding to said. it. A functional borehole was seen at the

neglect since the days of the military and the country’s lack of a de#nite health policy. !is explains the high maternal, newborn and child mortality recorded in the country, as these groups die needlessly from lack of I’m newly transferred here, but I have heard stories of how they come to steal babies,” Oguntodu said.

A paraphenalia of delivery items kept under poor hygiene standards simple, cost e"ective interventions that rot in the primary healthcare system. heard stories of how they come to steal are missing in the centres. What #rst strikes a visitor on babies,” Oguntodu said. In 2007, some of the PHCs came alive coming close to this centre is the buckets In neighbouring Osun State, on No- a$er being resuscitated with funds from arranged under the roof edges to collect vember 8, 2013, the people of Osogbo the country’s debt relief gains. !is is still rainwater. received the gi$ of a newly renovated evident in some of the facilities visited by !is is a telltale sign of insu%cient supply PHC. It was the #rst to be renovated of our reporter. But that is about of portable, drinking water. 21 PHCs in Olorunda local government all that remains of what was meant to be On entering this facility, three women area. It was also #rst to be equipped to a new lease of life – a repainted building, were seen being attended to for minor provide emergency obstetric services, and a new banner/signpost hanging on ailments. One complained of sore throat, EmOC. the facility indicating the grantor’s name. the other fever and the third was an aged !ree non governmental organizations Hope kindled again when in 2012, when women with rheumatoid – Osogbo Asheville, Raleigh (US Sisters the federal government established arthritis. While a young boy who was Cities) and Xiangyang (Chinese Sister the Subsidy Reinvestment Programme being given ORS (oral rehydration salt) City), deemed it #t to overhaul the hith- (SURE-P), and made some investments for diarrhoea, lay weak in the emergency erto dilapidated structure to in social safety net programmes such as room, a community extension worker modern standard, providing it with maternal and child health, roads, youth was seen taking blood pressure instruments and beddings that would aid and women empowerment and so on. and writing a prescription for sore throat e%cient medical services and emergency SURE - P said it set out in 2013 to iden- to a patient. obstetric services. tify some 500 PHCs across the country “!e doctors are on strike and even when EmOC is a package of medical interven- to refurbish, rehabilitate and stock with they are not on strike, they don’t come drugs and equipment. here, they go to a bigger PHCs like Ala- !e pilot centres are in Anambra, Bauchi, kia” , said the community health worker Bayelsa, Kaduna, Niger, Ogun, Zamfara said, defending her apparently and FCT, where 1,200 facilities (less performing the role of a medical doctor. than 1 per cent of all PHCs), were being While interacting with the workers, the supported with drugs and personnel for community health o%cer in charge, a maternal and new born care. Our #nd- woman who imply gave her name as ings are that the thousands of other Oguntoduwalked into the clinic. centres which are not supported are in a According to her, they only work in total state of disrepair - few or no skilled morning and a$ernoon as they do not health workers, equipments, lab reagents, have the required sta" strength and constant supply of drugs, inadequate equipment to do night shi$s. funds as well as lack of simple necessities Deliveries are not common here for as water supply, electricity, thus making fear of hoodlums who come in to steal standard healthcare provision impossible. children, as the PHC is located in an A visit to Apete Health Center in unfenced school where miscreants hide council area in Senatorial District, out to smoke marijuana. , provides an exemplar of the “I’m newly transferred here, but I have No chairs inside, a pregnant woman peeps to see if its yet her turn We need a lot of equip- ments. For example, we tions developed to treat the #ve direct to make a long queue to get their children have only one weighing obstetric complications—obstetric weighed. !is syphg (Blood Pressure ap- scale, so on immunization hemorrhage, obstructed labor, septicemia paratus) is not working well. Even light; (infection), hypertensive disorders in we have not had light for a long time. We days the women have to pregnancy, and unsafe abortion which have been running on generator in the make a long queue to get combine to cause 75 per cent of night and when there is no fuel we use maternal deaths. torch,” the health worker lamented. their children weighed. WHO introduced this idea as a backup She added that the Utility (NEPA) bill %is syphg (Blood Pressure for pregnancies that turn out to be event- has not been paid for two months despite apparatus) is not working ful, as it has been found that around memos and reminders to the local gov- 15 per cent (one in six) of all pregnant ernment. well. Even light; we have women, develop a potentially life- Far away from Osun State is Holy Trinity threatening complication that calls for Health Center, Ikoto, in Odogbolu, a not had light for a long skilled care while some will require a semi-rural council area of Ogun State. time. major obstetrical A cornerstone indicating it was laid by intervention to survive. former bishop of Lagos, Rt Reverend Barely a year has passed since the grandi- A.W. Howells, in March, 1957 welcomes ose tape-cutting ceremony to launch the visitors. centre and the community health worker Only one member of sta" was on duty on duty during this visit said the hospi- when our reporter visited one early tal’s weighing scale is down to one. !ursday morning. Forceps (for manual vaginal assisted “My second is coming,” the middle aged delivery, a component of the EmOC), man, a health attendant, said. vacuum aspirator and Inside the facility, it is a battle against circumcision kits are lacking in the dust from the reception area to the labour hospital. room, wards, walls, kitchen sink, &oor. “We need a lot of equipments. For exam- Everything is dusty. ple, we have only one weighing scale, so Even the delivery apparatus had some Mrs Fajobi, matron-in-charge, Arakale health on immunization days the women have stains that looked like coagulated blood center, Akure, Ondo State Building as old as the colonial era which had been le$ unwashed. It would be noted that infec- were anti-malaria drugs (which is free for children under tion (septicaemia) is the second leading cause,of all age 6) and adult from 65 above, family planning commodi- maternal and new born deaths, accounting for about 17 per ties, which are also free, anti-bleeding drugs, 85 bags of free cent. MAMA Kits (which contains essential delivery things Apparently, residents shun the facility not wanting to add to for pregnant women) and intravenous &uids. their health challenges by atronising the centre. Not surpris- !e labour room appeared fairly clean, while the ward of ingly, the health attendant said the centre had had only one four beds looked dusty with cobwebs crisscrossing the ceil- birth in three months. ing. About 400 kilometers from Lagos, is Ipole, in Ekiti West lo- !ere had not been light in the facility for #ve months until a cal government area of Ekiti State. !e town is known for its week before the visit. Meanwhile, water is sourced from rain, eerie quietude, thus the reporter’s entry into the village was streams and rivers as borehole is nonfunctional. loud enough to draw anyone’s attention. Suluka, who introduced himself as a senior community While attempting to read the inscription on the signpost health worker complained that he works alone most times, introducing the blue bungalow, a dark complexioned man in but calls his colleagues from other centres when he faces an his early #$ies, revved the engine of his motorbike speedily obstetric emergency. by. !e health worker recounted one of the most challenging “Good a$ernoon ma,” he bellowed. “I am the one here,” he moments of his entire career thus: “One day a woman was said in Yoruba, alighting from his bike and hurriedly leading bleeding, I gave her ergot (ergotmetrin stops bleeding during the way to the Health Center which was under lock and key. or a$er birth). but she was not responding, so a$er a while, I “I am the only one on duty,” he repeated as though the #rst carried her on the bike and rushed her to statement didn’t register. It was 3.00 pm and he was seen Aramako (about 15 kilometers away).” signing in his name ‘Olatunji Suluka’, on the attendance reg- A community health extension worker is not a midwife and ister. !e “Basic Health Center, Ipole-Iloro” has 12 workers, thus needs to be trained to attend to an obstetric emergency. according to Suluka, but none else was on duty. Retraining to hone their skills is also important. In Suluka’s Guided by him around the facility, visible in the Pharmacy case, a$er working as an hospital “One day a woman was bleeding, I gave her ergot (ergotmetrin stops bleeding during or a!er birth). but she was not responding, so a!er a while, I carried her on the bike and rushed her to Aramako (about 15 kilometers away),” says a community health worker at a PHC in Ekiti West local government area.

Free delivery bags for women, but they don’t come labourer/gardener, cleaner, driver, for of health centres on the shoulders of the now received nothing. nine years, he decided to go back to local government, but to be supported by On the other hand, Onigbinde John, the school where he spent three years study- federal and state director of the primary health centre in ing Health Technology at the Ijero School governments, but the blame shi$ing Olorunda local government area, Osun of Health Technology in Ekiti. game has been on for as long as this idea State, said there are 14 health centres in !us his career as a certi#ed health was conceived. the area and that some receive worker commenced. When asked, Suluka Local governments claim they have no a monthly amount of up N1,000 ($6) said he was last went for training over a money. N2,000 ($12), for its routine activities. year ago. !e federal government in an attempt to “A PHC receives N1,000 in a month; Notably, births attended to by unskilled intervene established the National Pri- some N2,000, while many don’t even attendants like Sukula is largely respon- mary Healthcare Development Agency, receive anything at all. !e money is sible for high maternal death records in NPHDA. A sum of N19.4 billion was not much at all and it may not even be Nigeria. voted for it in the 2014 budget to support regular.” By the WHO standard, the chances of state agencies responsible for primary He explained that the federal government survival of an emergency obstetric case healthcare. is supposed to give councils the in local community is very slim and gets !e matron-in-charge of Arakale Com- funds meant for primary health care slimmer if it occurs in the night, espe- prehensive Health Centre, in Akure, directly, but lamented that this is not so. cially giving poor sta%ng and the rural Ondo State, Florence Fajobi said the Speaking speci#cally in his own expe- environment. NPHDA started in 2014 in the state and rience, “In Olorunda for instance, we Nigeria’s Fourth National Development they had just concluded on giving health receive imprest of Plan of 1981-1985, put the responsibility centres a monthly allocation, which until N135,000 ($787) in a month. Out of this, Frontyard of a health center, at Osogbo, Osun State N55,000 ($333) is allocated for fuelling place as the onus lies on them to gener- uted money to #x this carpet, so that this the director’s ate money to cover running costs with or place can look a little bit presentable.” vehicle; N45,000($272) is for carrying out without funding. Asoro, who was met while on night shi$ routine activities such as family health, At the health centre in Ijebu-Ode local gave a month by month account of deliv- national program on Immunization, ma- government, the head of the facility, eries taken this year so far as 50. ternal and child health, health education , Bolanle Durodola Asoro, said the sta" “!is place is too small. We need exten- while N25,000 ($151) is contribute money themselves to raise sion,” she says adjusting her glasses. allocated to three deputy directors.” funds for operations. “We need a standby generator to power In Lagos State, the health commissioner, “NEPA has cut our light for seven months our fridge which we use for immuniza- Jide Idris, said the local government can- because we are owing N250,000. We have tion. !is place is central for immuniza- not do it alone though health centres are connected it illegally many times but they tion as we give immunization everyday directly under them. keep cutting it. We usually tell women unlike other centres that do it once or “Funding is a major constraint. It costs a who want to give birth to bring money to twice a week,” she stated further. lot of money to provide sta%ng. At least buy fuel for the generator.” Pointing at a cramped room, she said three trained doctors and eight nurses are Pointing to the carpet, which is now “you see that ward, is for both male and required to be on a 24-hour service,” the punctured by shoe heels, she said she and female; It is not supposed to be so.” commissioner observed. other workers “among ourselves contrib- As if seizing a long awaited opportunity Idris adds; “What we are doing now to pour out her anger and frustration, is to work with the private sector to Asoro opened a &oodgate of com- upgrade this sector. Our intention is plaints. to create a framework where we can “We only have four beds, it is too have the health insurance scheme.” small for the &ow chart of patients we !e public relations o%cer of the receive here; no baby courts, moth- Lagos Primary Healthcare Board ers have to sleep by their baby side said that the board “does not give on the same bed. We do not have any imprest to PHCs, but we are water, we used to beg for water from planning to give them from next one man opposite us there, who has year. It is already in the a bore hole. Our forceps and scissors budget which we will defend very are spoilt, no circumcision kits, no re- soon.” placement. We do not have consulta- For the heads of the health centres, tion room, so a patient cannot have it is between a rock and a hard con#dentiality.” Ghost workers....no sta", no patients “We only have four beds, it is too small for the &ow chart of patients we receive here; no baby courts, mothers have to sleep by their baby side on the same bed. We do not have water, we used to beg for water from one man opposite us there, who has a bore hole. Our forceps and scissors are spoilt, no circumcision kits, no replacement. We do not have con- sultation room, so a patient cannot have con"dentiality.”

!is facility is directly under the Ijebu Ode local government Egbeda local council of Oyo State. and has not received any allocation whatsoever, since her 30 “We are short of drugs, we are short of sta", we are short of months of heading the facility. money” she moaned. “!e running costs is higher, we don’t Another center, in Oke-ife under the Ijebu-East local council, make money because delivery in Oyo State is free of charge. We has a similar complaints. need fuel to power the generator, to keep the light running so “We have not had light for six months. Bringing out two blue we can do laboratory investigations both during the day and lamps, she displayed them saying: “See our lanterns, this is night. what we use when we are on night duty,” the community health So, how does the centre run its operations? With a shrug of the worker Sade Ogunoiki, told our reporter. shoulder, she said ruefully, Sometimes the community gives us Attesting to this is Ademola Talabi, director of primary health- monetary donations.” care in Ijebu East local government, said he had complained Le$ to their own devices and ingenuity, in some centres, the of- about the appalling state of things until he got blue in the face. #cers in charge have learnt smart ways of raising money. “I have put this matter forward many times, but government B.A. Adeyemi, the Matron-in-Charge of a SURE – P supported always says there is no money, that is why they haven’t got any facility at Orita Obele, Ondo State also said she does not receive imprest. !e sta" contributes money amongst themselves and any imprest, but had devised ways of generating money to run sometimes we have agencies like Global Fund supporting us.” the centre. According to him, there are 28 health centres in his local “We mandate any woman in labour to buy #ve litres of fuel. We government – 27 are functioning but with minimal manpower, also ask the women to make a voluntary donation once they put while one has closed down. to bed. !ey can give us soap, gloves, cotton wool or any equip- Reeling out similar feeling is Modupe Shodunke, the Chief ments we need. We also make money from minor ailments, Nursing O%cer in charge of the PHC at Alakia/Olode Ward in road tra%c accident which %e absence of enforceable right to health makes it di#cult to hold government accountable for its failure to provide life-saving healthcare services to its citizens especially pregnant women.

mothers and children’s lives. !e Abuja Declaration therefore ap- pears to be the main instrument through which government can be made account- able. Nigeria is signatory to this 2000 Declara- tion which mandates African Heads of State to spend at least 15 per cent of their annual budget on health. Instead of humans, a family of cats and goats seen at the terrace of a PHC, in Oyo State As a mark of improvement, spending on health in the 2013 budget is 6 per cent, we treat here. !e community health “70 per cent of the budget goes into the highest so far, yet this is less than the committee also gave us money, which we tertiary institution, meanwhile the health Declaration’s target. used to pay our centres which reach more people get Most children her age ought to be in 3rd NEPA (electricity) prepaid meter bills. I almost nothing,” he laments. grade of high school. also make money from circumcision,” she Apart from the big problem of fund- Implication o"ered. ing, there is also the legalistic di%culty A report by the National Primary Health- Seen in her o%ce are donations of diapers thrown up by the silence of the Nigerian care Development Agency, claims that from Procter and Gamble, a multina- Constitution on the rights of citizens to maternal mortality rate has fallen from tional manufacturer of product ranges in good health. 545 per 100,000 live births in2008 to 350 Nigeria. A look at the Constitution to ascertain per 100,000 live births in 2012. !ese #g- !e story appears to be a little di"erent at who is failing in its responsibility to pro- ures appear unrealistic given the realities LAUTECH primary centre in Olorunda vide funding which is critical to quality on ground. local government in Osogbo, Osun State healthcare provision makes this readily However, the story of Christiana Akodu, where, the Matron-in-Charge, Eunice noticeable. 15, who is still in a primary school, exem- Adeniran, said her Health was mentioned in the 2nd and pli#es the far-reaching impact of losing a facility gets an imprest of N10,000 4th schedule of the Constitution as well mother. monthly for running costs. as under social objectives in Section 17, Hope for her education dimmed when !is website was not able to determine subsection 3 (d) which says “the state her mother died ten years ago while giv- why or how some PHCs get subvention shall direct it policy towards ensuring ing birth to her fourth child. Ever since, for government while others do not. that there are adequate medical facilities she and her siblings have lived with their Who is to blame? for everyone.” 76 year-old maternal Emmanuel Otolorin, a professor of Signi#cantly, however, while other rights grandmother. obstetrics and gynaecology, believes that and freedoms are guaranteed in Chapter “My father has a new wife. He send neither the health centres nor the work- 4 of the Nigerian constitution, the section money but not all the time,” said Christi- ers are to be blamed but the government is silent on citizens rights to health. !e ana, who was met untying bags of cassava of Nigeria. absence of enforceable right to health (for making garri). Her grandmother is “Health is on the concurrent list, mean- makes it di%cult to hold government famous for Garri making, a ing any of the three tiers of government accountable for its failure to provide life- business native to Ijebu-land. She added can take it up, but it is o$en arrogated saving healthcare services to its citizens that she and her two sisters have dropped as the responsibility of the local govern- especially pregnant women in and out ment,” he observed. and children, who mostly access the of school several times because of lack of Explaining further, Otolorin said: “Basic PHCs. money to buy books, stationery or pay healthcare is what people need; it is like “It means that we cannot really hold any for a romotional exam. a pyramid, where more people at the tier of government solely responsible, Still smartening from the death of her bottom need basic healthcare, a few will and that is why we are pushing for the daughter, the grandmother was reluctant require secondary, and then National Health Bill to be passed into to talk about it, but manages to say, “Sola very few will need to be treated at the law,” says Otolorin, who is also is not supposed to die, but we accept tertiary level, but in Nigeria, we have our country director of Jhpiego Corporation, fate,” biting her lips as she pyramid turned an a%liate of John Hopkins University, repeats the last words. upside down.” working to save !is is one of the long term socioeco- A mother and newborn curdle here a#er delivery, at Ikoto, Ijebu nomic implication of maternal mortality. %e absence of enforceable can we achieve universal coverage and !is is apart from the emotional trauma right to health makes it meet the millennium development goals. and psychological damage of losing a di#cult to hold government Already Nigeria cannot meet the MDGs loved woman or child. 4 and 5.” !e chief executive o%cer of the NPH- accountable for its failure to !e National Health Bill, #rst introduced DA, Mohammed Ado, admitted that provide life-saving in 2004 and passed by the 6th National Nigeria Assembly in 2011, aims to strengthen has made slow progress towards the 2015 healthcare services to its constitutional provisions for healthcare targets of MDG 5 – “Improve maternal citizens especially prergnant and mandates the federal government to health”. women. devote one per cent of its consolidated !e reality on ground remains that only revenue fund solely to #nance primary few of the facilities have drugs. health care. Asoro, head of the Ijebu-ode health !e Bill de#nes the rights of health centre said the hospital does not have Er- workers and users of health services/ gometrin and oxytocin. While the former facilities and thus provides Nigerians an is a drug administered during obstetric opportunity to hold government intervention to stop bleeding, the latter is ery. Sometimes, the woman herself goes accountable for their health, rights used to induce labour. Even some SURE- to fetch the water. including equitable access to healthcare. P assisted facilities o$en run out of stock. “For there to be a national impact in im- For instance at the SURE-P supported proving maternal and child health which Basic Health Center in Ikogosi, Ekiti begins from the primary healthcare, an West, when there is a stock out, drugs are innovation like the SURE-P must be in sold through the ‘drug revolving fund’ all 774 local government of the country, project. !e implication of this is that not just a few local governments,’ says women stay away from the hospital. Otolorin. At Fotedo Health Centre, Imobi, Ijebu Way forward East local government, relatives of “My recommendation is for the passage pregnant women are mandated to fetch of the National Health Bill and its proper drums of water to clean up during deliv- accountable implementation. Only then