Years after the Ogun State Government handed over tricycle ambulances to Primary Healthcare Centres in the state to respond to emergencies in rural communities, PUNCH Healthwise investigation shows that the tricycles remain unused due to alleged failure of the government to provide drivers and fuel. SODIQ OJUROUNGBE reports
Residents of Ogun State were excited when the state government announced the provision of tricycle ambulances to primary health centres in rural communities in the state to promptly respond to emergencies.
Nurses at Adehun Primary Health Centre in Abeokuta North Local Government Area of the state in particular, were overjoyed and filled with hope that the ambulances would not only reduce the death of emergency patients but improve their services.
The tricycles, PUNCH Healthwise investigations gathered were intended to improve emergency response time and help deliver essential vaccines and other supplies to various PHCs in the state. During the unveiling of the ambulances, our correspondent learned that the state government promised to equip them with first aid supplies and radio communications to enable nurses to quickly respond to emergencies and transport patients to the nearest hospital during referral.
For the nurses, who had struggled to provide basic care with limited resources, the tricycle represented a glimmer of hope. But as the months passed, the excitement of the nurses turned to disappointment.
Several months after the tricycle was brought to the PHC, it remained unused. She explained, “There are times we need to move patients from our PHC here to a bigger facility in Itori or Ifo, but because the tricycle given to us was not working, we had to look for other means which often leads to delay and sometimes death of patients.
“The tricycle ambulance was towed here and it has not worked since it was brought here. Recently, somebody came from Abeokuta and he told us that the government wants to do something about it. The battery was removed and we are still expecting them to come and repair it.
“The mechanic told us that they would need to change some parts of the tricycle which had spoiled because of a long period of abandonment. We are hopeful that the government will repair it and provide us with a driver that can drive it.”
Donated to respond to emergencies in rural communities
In March 2021, the state government distributed 22 tricycle ambulances to Primary Health Centres across the State as part of efforts to improve the health indices of citizens as well as put an end to maternal deaths and health emergencies.
The commissioner for Health, Dr. Tomi Coker at the distribution ceremony held at the Obas Complex, Oke Mosan, noted that the government identified that 70 per cent of women who died during childbirth were a result of lack of access to intervention which usually arise due to lack of transportation and access from PHCs to general hospitals, saying the introduction of the tricycle ambulances would put an end to future occurrences.
“We noticed in our mortality review that 70 per cent of deaths that happened among our pregnant women happened because of lack of transportation from PHC to the general hospital when complications occur during childbirth. To address this issue, His Excellency, Prince Dapo Abiodun took the innovative idea of introducing Tricycle Ambulance to PHCs, particularly in the rural areas where road access is difficult.” She said,
Also in April 2023, Kunle Somorin, the former Chief Press Secretary to Governor Dapo Abiodun, revealed that the state government purchased 50 tricycle ambulances for PHCs as a way to tackle maternal and infant mortality and other emergencies.
Somorin in a statement made available to newsmen, added that the Office of the Senior Special Assistant to the President on Sustainable Development Goals donated 30 more tricycles while 10 more were donated by private donors to make a total of 90 tricycle ambulances. Somorin explained that transportation challenges have been a major cause of the avoidable loss of lives of pregnant women and elderly persons.
Despite the claim by the government that the tricycle ambulances were provided to make transportation of pregnant women and elderly persons easy during emergencies, an investigation by PUNCH Healthwise discovered that the tricycles are lying fallow and rotting away in many of the PHCs in the state.
During visits to PHCs in some Local Government Areas like Odeda, Obafemi-Owode, Ewekoro, Ijebu-Ode, Ogun waterside, Ikenne, Abeokuta North, our correspondents sighted red and white tricycle ambulances sitting unused in a corner of the parking lot of the PHCs. They said the tricycle stopped working about seven months ago.
A resident, Wole Olaitan said that the residents in many cases had to provide a vehicle when moving their relatives from the PHC to any referred hospital. “When the government just brought the tricycle here, we used to see them driving it from Abigi to Ibiade almost every day. But for more than seven months now, it is not working.
“If you take your relative there and there is an emergency, you will need to look for a vehicle, they will tell you that the tricycle has been abandoned for some time now and it is no longer working. “On several occasions, I have transported people on the bike from Abigi to Ibiade. So, it is a lie if they tell you they are still using it. How can they be using it and it will look like that?” he questioned.
Just some miles away from the Abigi PHC, another tricycle ambulance was sighted in front of a local shop. When our correspondent inquired about it, a woman claimed it was brought to the area about a month ago by a government official.
She also revealed that the government official who reportedly owned a kiosk beside her, brought the tricycle for repair.
She explained, “The person beside my shop bought it for repair and it has been here for over a month. They are still doing something on it. I think it is not working and they are trying to repair it.”
PUNCH Healthwise was unable to ascertain which of the PHCs in the local government that owned the tricycle because the said government official was not in his shop during the visit.
It was a similar situation in PHCs where the tricycle ambulances were sighted in Owode in Obafemi-Owode LG, Wasimi and Elere in Ewekoro LG, and Adehun in Abeokuta North LG.
Nurses and residents in some of these LGs also confirmed that the tricycle ambulances have never been put to use in their communities.
Maternal and infant mortality still high in Ogun
According to the 2018 Nigeria Demographic and Health Survey, the country’s Maternal Mortality Ratio is 512 deaths per 100,000 live births.
The United Nations Children’s Fund report titled ‘Situation of Women and Children in Nigeria’ revealed that the country records 576 maternal mortality per 100,000 live births, while approximately 262,000 babies die at birth every year.
According to the report, infant mortality stands at 69 per 1,000 live births, while under-five deaths is 128 per 1,000 live births with more than 64 per cent of the deaths caused by pneumonia, malaria, and diarrhea
UNICEF noted that at these mortality levels, one Nigerian child of every 13 born dies before reaching age one, while one in every eight does not survive to their fifth birthday. Meanwhile, a UNICEF report released in 2022, revealed that Ogun State recorded the highest number of children’s deaths in the southwestern part of the country.
The survey conducted by the Nigeria Bureau of Statistics in collaboration with UNICEF and other partners indicated that Ogun recorded the highest figures in neonatal mortality, infant mortality, and postnatal care for newborns, among others in the region.
The Social Policy Specialist of UNICEF, Mohammed Okorie, while speaking on this at a two-day media dialogue on the 2022 Multiple Indicator Clusters, explained that the estimations were “part of the MICS 6 results released by the NBS on August 16, 2022.”
Quoting the NBS, he said, the survey estimated that 56 out of 1,000 children between the ages of zero and 11 months died after birth in Ogun State. They narrated the pain they usually go through trying to take emergency patients to a nearby general hospital due to lack of an ambulance.
“We want them to give us an ambulance because it is more useful here because we are in rural communities. There was a case of one woman who just gave birth and she needed to be referred to Isara General Hospital with her newborn, but we couldn’t do that. We were stranded for hours and it took the grace of God to save the woman. If the tricycle was here, it would have been easier for us to take her to the secondary facility.
“Many of the patients always come on motorcycles, including pregnant women. Two out of 100 people brought here will come with a vehicle. The other 98 will come on motorcycles.
“We need it here because if we have it, it would be easier for us to go and pick up some of our patients when they call us. We have their contacts and they have ours. So, if the tricycle ambulance is here, it would be easier for us to get across to them and pick them up,” one of the nurses stressed.
Igbokofi in Yewa North LG is known to be one of the communities with high maternal and infant mortality rates in the state. Recently, PUNCH Healthwise reported on how the agrarian community continues to suffer access to healthcare which has reportedly led to an increase in maternal and infant deaths in the community. It was reported that Igbokofi, a town with about 9,000 people, which borders the Republic of Benin, has witnessed decades of deaths, while residents face an uncertain future.
Some of the residents told our correspondent that they have lost count of the number of people who have died from preventable diseases and childbirth-related complications due to the absence of a primary health centre.
PUNCH Healthwise investigation revealed that pregnant women and their unborn infants are at serious risk due to a lack of healthcare facilities and the absence of competent healthcare providers.
A community leader in Igbokofi, Pastor Kunle Garb argued that if the tricycle ambulance was provided for them, they would be able to transport emergency to a nearby hospital.
“It is just unfortunate that we don’t have the tricycle here, at least it will be useful during an emergency because it is better than putting someone on the bike for several hours.
“We don’t have PHC here, but if they give us something like that, possibly, we will use it to transport the sick and vulnerable when they need urgent medical care,” he noted.
Despite being remote locations without access to transportation, PHCs in rural communities including Olorunda in Abeokuta North LG, Itesi in Odeda LG, and Asaa in Yewa-North LG do not have the tricycle ambulances.
Drivers, fuel not provided
Findings by our correspondent also revealed that at all the PHCs with the tricycle ambulances, the government did not make provision for drivers or fuel. This, our correspondent gathered, was one of the reasons why the tricycle ambulances were not used in some of the PHCs visited during the investigation.
Even at PHCs where the tricycles were scarcely working, the nurses told PUNCH Healthwise that the ambulances are either operated by the gateman, security, or community health extension workers.
A public analyst in the state, Emmanuel Adegoke, said the non-availability of drivers and fuel contributed to the reason why the tricycle ambulances were abandoned at some of the PHCs.
Adegoke urged the government to provide resources needed for the tricycle to be put to public use. He stated, “It is a good initiative that the government is providing tricycles in some rural places, and they needed to be commended for coming up with such an initiative.
“But giving them tricycles and not providing drivers or making arrangements for fuel as you claimed will not make them function in many of these PHCs. They noted that the tricycle ambulances have helped to save lives and improve the health of the community. In contrast to the tricycles
A nurse at the Iperu PHC said they mostly used the tricycle to carry vaccines used in the hospital. She added, “We used to use it to carry vaccines. We don’t have a driver for it. So, it is the driver of the ambulance bus that used to drive it once in a while.”
Ambulances need professional drivers- Experts
Experts say a delay in rushing a patient requiring an emergency care to the hospital is associated with heightened death risk. According to an international humanitarian medical non-governmental organisation, Médecins Sans Frontières also known as Doctors Without Borders, the purpose of an effective emergency medical system is to provide timely medical care to prevent death or disability.
The NGO noted that delays in arrival to the emergency department and in receiving treatment could lead to severe negative outcomes and poor prognosis. “When it comes to maternal mortality, there are some delays. At times, there are either at least three or four delays. Delay in reaching the hospital is one of the delays. When they looked at the causes of maternal death, the death of pregnant women and even children, they would identify some delays. And one of those delays is a delay in getting to the hospital.
“And that delay in getting to the hospital, perhaps this will be addressed by the provision of the ambulance. That is not all. The other delay is the delay in receiving care, the delay in receiving treatment in the hospital. That particular delay has also been found to be an important cause of death in Nigeria.
“And that delay is mostly because even when the patient gets to the hospital, the receiving hospital or the hospital the patient has been referred to is not ready to provide that emergency care. We say emergency care means that the care has to be provided immediately in a matter of minutes or even seconds to save the life of the patient.
“If they address that delay not only to provide the ambulance but of course, they should make sure that the drivers and the assistants are trained so that there will be a trained crew manning the tricycle. And of course the other delay of ensuring that as the patient is coming the receiving hospital is being notified to get ready to receive their patient. So those are the two ways of dealing with it.”
A Public Health Physician, Dr. Austin Aipoh told PUNCH Healthwise that when there is an emergency, time is of the essence.
Aipoh said even one or five minutes could make a difference between life and death, urging the state government to do the needful.
Govt refutes abandonment
Reacting, the Ogun State Government said a two-prong approach was deployed in monitoring the operation of the tricycle ambulances in rural communities across the state.
The State Commissioner for Health, Dr. Tomi Coker told PUNCH Healthwise that there was a routine monitoring of the activity by the ward development committee on a monthly and quarterly basis.
She added that there was also periodic commissioning of audits or surveys on the utilisation and functionality of the tricycle by her office, adding that two unscheduled audits have been conducted across the twenty LGAs of the state.
On the allegations that the government did not provide drivers and fuel, the Health commissioner said the ministry empowered each health facility to function through monthly imprest operated by the Ward Development Committee and the Officer in Charge of the facility to ensure the smooth running of the health facility, including the day-to-day functionality of the tricycle ambulance.
She insisted that many of the health facilities were using their imprest (a fund used by a business for small items of expenditure) to fund the operation of tricycle ambulances, including fuelling and payment of stipends to drivers hired by the facilities.
When our correspondent told her that the tricycles had never been put to use in some places, the commissioner argued, “There is no record of the above claim as the state government hired the services of technicians who drove the tricycle ambulances to the various facilities for the initial delivery.
“Also, it was mandated that designated technicians at the Primary Healthcare Board service the tricycle ambulances and conduct training for the LGA representative during the handing over.
“The Ministry of Health always deploys a bottom-up approach in her implementation and therefore has empowered each health facility to function through monthly imprest operated by the Ward Development Committee and the Officer in Charge of the facility to ensure smooth running of the health facility including the day to day functionality of the tricycle ambulance. We have health facilities using their imprest to fund the operation of tricycle ambulance viz fuelling and payment of stipend to drivers hired by the facilities.”
On why the tricycles were not available in some needy communities, Coker said some rural terrains were not conducive to the use of such ambulances.
She noted, “The tricycle ambulance system was majorly designed for the rural areas as indicated in the distribution pattern of the ambulance, for instance, only one tricycle ambulance is in Abeokuta South LGA while Yewa North has seven tricycle ambulances. Also, some rural terrains are not conducive to the use of a tricycle ambulance.
“There has been no redistribution of tricycle ambulances within the LGAs as there is pictorial evidence from our recent end-of-year audit in December that the tricycle ambulances were distributed to the right facilities and are still at the same locations. There is also no report by any facility to the same effect.
“As I earlier stated the state ministry of health/the primary healthcare board conducts both routine and periodic audits of the tricycle ambulance and ensures that issues identified during the audit process are disseminated as feedback to the leadership and the health team of the concerned LGAs while immediate action is taken by all stakeholders to ensure the continuous functioning of the tricycle ambulance.