Primary Health Centres (PHC) across Nigeria have overtime being characterized by infrastructural decay; loss of health inventory; unavailable medical equipments; poor staffing and working conditions; vaccines are either unavailable or cannot be stored in most PHCs; most PHCs lack access to clean water as medical staffs have to buy from water vendors (without knowing the source or quality of water); where boreholes exist, many of them are either broken or are not powered. Several PHCs are forced to shut down services at 5pm because they lack illumination at night. Medical personnel either rely on rechargeable lamps, kerosene lantern, or fuel powered generators for night emergencies. PHCs are mostly in rural and poor settlements unseen by the government and elected representatives. Ironically billions and millions are budgeted annually for the construction and rehabilitation of new and existing PHCs, with cost ranging from N12million to N30million (depending on the PHC model; Type 1 or 2), yet the PHCs remain in deplorable conditions, with inconsistence power supply being at the heart of the problem.
The study explores the energy situation in Primary Health Centres (PHCs) in Nigeria, using 60 PHCs in the Federal Capital Territory, Abuja as a case study. 57% of surveyed PHCs are on-grid, while 43% are off-grid. Evidence from this study shows that an average primary health care centre spends between N3,500 and N19,000 servicing electricity bills from the grid, which provides power for an average of 4 hours a day or less. To augment the poor grid supply, the PHCs turn to fossil generator sets, which they run for an average of 6 hours a day; this cost them between N20, 000 and N29, 000 a month on fuelling (excluding maintenance and repairs). This sum up to N23, 500 – N48, 000 a month; and between N282,000 and N576,000 a year; to access electricity for 10 hours using an unreliable grid electricity and polluting fossil generator sets. This still does not cover the expected standard 24-hours uninterrupted clean electricity supply deserving all health centres (regardless of size, location or ownership). These electricity expenses are usually transferred to low income patients though health charges and personal out-of-pocket payments by the staffs. Sometimes, the cost is also borne by donor organisations, NGOs and philanthropists.
The central finding of this study is that access to reliable electricity is critical for the efficient running of Primary Health Centres (PHCs), and this can speedily be delivered to PHCs through off-grid Solar PV (which the study have proven to be more economical and reliable). Therefore, there is a need to prioritize the energy needs of PHCs to encourage the provision of 24 hours services, especially when Nigeria’s electricity grid remains unreliable and limited. The study recommends the mainstreaming of standard off-grid renewable energy for lighting, heating and cooling in the design, construction and rehabilitation of all PHC in Nigeria.
Finally, while there is need to increase the budget allocation to the health sector, specifically to Primary Health Care Development Agencies/Boards, there is need for transparency, accountability and better planning.
Caution need to be taken as regards building new PHCs without proper provision to ensure their functionality; and central to their functionality should be adequate provision for clean reliable energy to power the facility and equipment in the PHCs.