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Introduction: several scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and personnel. This study was designed as part of an intervention program with the goal to improve the access of pregnant women to skilled pregnancy care in rural Nigeria. The specific objective of the study was to determine the nature and readiness of Primary Health Centres (PHCs) in two Local Government Areas (LGAs) in rural parts of Edo State, Southern Nigeria to deliver effective maternal and child health services. Methods: the study was conducted in 12 randomly selected PHCs in the two LGAs. Data were obtained with a semi-structured questionnaire administered on health workers and through direct observation and verification of the facilities in the PHCs. The results obtained were compared with the national standards established for PHCs in Nigeria by the National Primary Health Care Development Agency (NPHCDA). Descriptive statistics were used to analyze the data. Results: the results showed severe deficits in buildings and premises, rooms, medical equipment, essential drugs, and personnel. Only 40% of items recommended by the NPHCDA were available for buildings; 41% of the PHCs had facilities available in the labour ward; while less than 30% had the recommended facilities in the antenatal care rooms. Only one PHC had a laboratory space, with only one item (a dipstick for urine analysis) identified in the laboratory. None of the PHCs had ambulances, mobile phones, internet or computers. There was no nurse/midwife in 4 PHCs; only one nurse/midwife each were available in 8 PHCs; while there was no Environmental/Medical Records Officer in any PHC. About 26% of the essential drugs were not available in the PHCs. Conclusion: we conclude that PHCs in Edo State, Nigeria have severe deficits in infrastructural facilities, equipment, essential drugs and personnel for the delivery of maternal and child health care. Efforts to improve these facilities will help increase the quality of delivery of maternal and child health, and therefore reduce maternal and child mortality in the country.
Study design/setting: this study employed a cross-sectional descriptive design to assess the availability of essential physical facilities, equipment, staff/personnel and essential drugs in the PHCs as part of baseline research for an interventional study on increasing access to skilled pregnancy care in rural Nigeria. The study setting was two predominantly rural Local Government Areas (LGAs), Esan South-East and Etsako East in Edo State, Nigeria. Twelve PHCs were randomly selected from a list of 51 PHCs in the two LGAs. Edo state is one of the 36 states of Nigeria located in the Southern part of the country. The state consists of 18 LGAs with an estimated population of 4 million [25]. Data collection: data were collected from July 29 to August 16, 2017 with a questionnaire which was administered through a face-to-face interview with the Nurse/Midwife or Health Attendant in charge of the PHCs using a Computer-Assisted Personal Interview (CAPI). The responses were verified by direct observation. All the facilities, equipment, and drugs that were mentioned during the interview were sighted by the interviewers. The interviews and sighting were conducted by trained data collectors who were knowledgeable about essential medicines, dressing and medical devices. The questionnaire contained three major sections, with the content of each section drawn from the National Primary Health Care Development Agency minimum standard for primary health care in Nigeria [15]. Section 1 contained two sub-sections with 12 items on buildings and premises such as the requirement for a minimum land area of 4.200 square metres, whether the building was painted green, and the availability of a clean water source from a motorized borehole among others. The second sub-section fielded 14 items on availability of sufficient rooms and space to accommodate a waiting/reception area for child care, antenatal care, health education and oral rehydration therapy corner, adolescent health service room, and two consulting rooms among others. Section 2 contained questions about medical equipment and personnel. This section had 12 sub-sections: 36 items in female ward such as angle poised lamp, artery forceps (medium) and bed pan among others, 23 items in infant and child welfare ward such as basket with lid for ORS, ceiling fan and stainless covered bowl for cotton among others, 53 items in the labour room such as delivery couch, dissecting forceps, dressing trolley and fetal stethoscope among others, 35 items for first stage room such as stainless bedpan, bowls stainless steel with stand, ceiling fan, 25 items in antenatal/interview room such as examination couch, stainless galipot, latex gloves, 29 items in the laboratory such as kidney dish, centrifuge (manual), 15 items in cleaning room such as brooms, mops, 19 items in the consulting cubicle such as examination couch, hammer (reflex), 8 items in staff room such as chair, table, dust bin, 7 items in the record room such as table, plastic chairs, safe, 7 items for other requirements such as ambulance vehicle, computer, communication facility (mobile phone or communication radio) among others, and 12 categories of personnel. Twelve categories of personnel is the standard requirement in a PHC including 1 medical officer, 1 Community Health Officer (CHO), 4 nurses/midwife, 3 Community Health Extension Workers (CHEW), 1 Pharmacy technician, 6 Junior CHEW, 1 Environmental Officer, 1 Medical Records Officer, I Laboratory technician, and supporting staff comprising 2 Health Attendant/Assistant, 2 Security personnel, and 2 General Maintenance Staff. In all, a total of 24 staff/personnel should be in a PHC. Section 3 contained questions on 93 essential drugs which included anaesthetics, analgesics, anti-allergies, anticonvulsants, and antidotes, among others. Questions were fielded on the availability of the expected items according to the prescribed national standards and the response options were: 1) available (when the items are available and meet the required standards and 2) not available, when the items are not available or do not meet the standards. Where applicable, adequacy was assessed if more than one of a specific item is expected. For instance, the minimum standard for PHCs is two consulting rooms. In this case, we assessed both availability and adequacy. The full content of the questionnaire (site assessment) is available in a public open access repository, OpenICPSR. Data analysis: all the analyses were conducted with Stata 12.0 for windows. To identify the number of items available in the PHCs, the responses were aggregated. A dummy variable was generated for each item, available was coded 1 and not available was coded 0. The least number of available items in each segment is zero whereas the highest is equal to the number of expected equipment or item in the particular segment: 12 for physical facilities, 93 for essential drugs and 24 for staff/personnel among others. A test of significant difference in the availability of the items between the two LGAs was conducted using the Mann-Whitney test. The result was insignificant for all the segments and the probability that Esan South East is greater than Etsako East in the availability of the expected items was also insignificant. Thus, the results are presented without disaggregating by LGA. The results are presented using absolute number, percentage, mean with standard deviation (SD) and median with interquartile range (IQR). Ethical approval: the ethical approval for the study was obtained from the National Health Research Ethics Committee (NHREC) of Nigeria-protocol number NHREC/01/01/2007-10/04/2017. The purpose of the research was clearly explained to the Nurses/Midwives or Health Attendants and a written consent was formally sought and obtained before the data collection commenced. All identifiers for the PHCs are removed from this study.
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