How corruption, irregularities mar BHCPF scheme in Kano
By Kola Omoniyi
By day, a yellow, rickety pickup truck is meant for moving heavy load – mostly firewood – from one village to another around Jeli community in Tudunwada Local Government Area of Kano State.
But at night, the only vehicle in the community 120 kilometres away from Kano city is always on standby to rescue any prospective patient due to lack of a standard healthcare facility and poor road network in the village.
Though the truck appears unkempt and unconducive to patients’ good, its owner, Haruna Sani, 45, says he has been using it to recue over 80 patients – mostly pregnant women – from the community in the last 15 years.
For them, this ramshackle truck is the closest thing to an ambulance during night emergency — and the difference between living through an emergency and dying in one.
Pregnant Woman Dies Inside Truck After Protracted Labour
Sani’s gesture is humanitarian, but Hassana Ibrahim was not lucky enough to enjoy it. She had already been laid at the back of the truck, but the vehicle’s kick starter went bad, the driver explains.
A group of hefty men were mobilized to push the truck for nearly 30 minutes. Then the trip of over 20km to the nearest hospital began. Unfortunately, Hassana died on the way shortly.
“Perhaps Hassana wouldn’t have died if my truck was in a good condition that day,” Sani says.
“She was already inside the truck in labour pains when we started pushing the vehicle for 30 minutes so she was already tired. She later died when we were close to the hospital.”
Jeli Primary Healthcare Centre is about 100 metres from the late Hassana’s house, but the centre lacks the required facilities for child delivery. Which was why Hassana was being transported a further 20km before she died.
Ownership Tussle Mars BHCPF Project at Jeli, Yaryasa Facilities
The deplorable condition of the Jeli Primary Health Care Centre exists despite its enlistment as a recipient of the Federal Government’s Basic Healthcare Provision Funds (BHCPF) scheme. Two years after Kano as a state began its implementation; there is no visible impact of the project at the centre.
Here is why: among the stakeholders of Jeli and Yaryasa PHCs in the Yaryasa ward of Tudunwada local government area, a controversy has been lingering over the rightful owner of the BHCPF project.
Akarami Nuhu Aliyu, an official of Kano State Contributory Healthcare Management Agency (KSCHMA) at Yaryasa PHC, claimed that he was among trainees for the project at Yaryasa before it was allegedly hijacked.
According to him, the scheme was diverted due to an alleged unresolved personal dispute between Magaji Ubale, the former In-Charge of the Yarsaya PHC and his former head of department (HOD), Medical, Suraju Sabayuki.
“All enrolees on this list are people of Yaryasa, but due to the diversion, only officials of Jeli facility can access the BHCPF Bank account.”
“Jeli is over 20 kilometres away from Yaryasa, the enrolees cannot afford transport fare of about N800 to the village and the issue stalled BHCPF implementation at both facilities.” Aliyu explained.
Shehu Garba, a physically challenged 65-year-old man and Elia Saleh, 80-year-old chief imam of Yaryasa Ward are among the enrolees. They lamented that all hope of accessing free healthcare at the Yaryasa facility was dashed after the scheme was diverted.
When contacted on telephone, both Ubale and Sabayuki denied having any personal issues. They both have their difference: Ubala linked the failure of the project to an alleged diversion by his ex-boss; Sabayuki insisted the move was a unanimous decision by all stakeholders.
The curiosity of our correspondent to clarify this allegation prompted the unscheduled visit to the hard-to-reach Jeli community where the pathetic death of late Hassana occurred.
The road to Jeli is bad, driving on it is a painstaking hurdle. Ongoing construction of a bridge has worsened the situation of the road. When our correspondent arrived at a portion with the most resistance, he had to abandon his travel vehicle on the roadside and proceeded with the journey on a commercial motorcycle.
Deplorable Road in Jeli Community
He eventually met with Sale Haruna, the In-charge of the Jali PHC. Sale is the only permanent staff at the facility.
Since March 2020 when he was contacted to take over the project, Haruna could not provide any dedicated list of enrolees for Jeli PHC when our correspondent visited him on July 7, 2022.
“The KPHCMB said it is only this facility (Jeli) they accredited and they know. So, I just received a call from our then HOD (Sabayuki) around March 2020 that the BHCPF will now be implemented at Jeli PHC’.
“A Director from KASHMA (Dr. Abdullahi) called me last month (June 2022) that their team will come and sort the challenges of our list very soon, ‘’ he explained.
Jeli PHC Official Withdraws Cash Despite Zero BHCPF Implementation
Despite the unresolved controversy, our correspondent learnt that Haruna had withdrawn N50-000 from the BHCPF account. He claimed to have spent the money on transportation.
Two months after the KASHMA’s promise to Haruna to update the Jeli PHC list, our correspondent contacted the In-Charge via telephone on August 9, 2022. He said he has not heard any update from the agency.
Again, Breastfeeding Mother Dies on Motorcycle in Jeli
Haruna also confirmed the death of another breastfeeding mother, Amina Salihu. The In-Charge says he referred Amina – an anaemic patient – to a standard hospital in Tudunwada, but she died on a motorcycle while on her way to the hospital.
When contacted, KASCHIMA’s Director of Programme, Dr. Abdullahi Sahad Ahmed, later clarified that the project was relocated to Jeli because Yaryasa PHC already has similar programs for public-sector employees and another one for vulnerable populations, while the Jeli facility had none.
Kano Scored Low Three Years after Receiving BHCPF Lion Share
The BHCPF full implementation began in 2019 with the first disbursement of N6.5bn by the federal government to 15 states, where Kano State got the highest allocation – N948million.
Despite this huge allocation and subsequent release of second tranche of funds in 2022, the project is yielding little or no result at many visited facilities among the benefiting 381 PHCs in Kano.
Stakeholders linked the development to the technical hitches of take-off of the project, mismanagement, corruption, nonchalant attitude and negligence among others.
Deaths, Mix-Ups On Enrollees’ Lists Stall BHCPF Implementation In Many Facilities
For instance, at Tsohon-Gari Health Clinic in Tudunwada LGA, the 298 enrollees in the Tsohon-Gari ward are denied access to the BHCPF benefits in the last two years following the death of the second In-Charge, popularly called 2-IC of the facility, Sani Salisu.
Umar Abdu, the In-Charge of the PHC, said Salisu, who was one of the signatories to the BHCPF account, died on 14th October 2020. He claimed to have written a letter to the KPHCMB since September 2021 with Salisu’s death certificate enclosed to secure approval to have Salisu’s name replaced, but to no avail.
Tsohon-Gari’s case is similar to that of Middle Road PHC in Fagge LGA, where the death six months ago of the ward development committee chairman, Alhaji Yau Muhammed, halted the project at the facility.
Hauwa Umar Fagge, the In-Charge of the facility, said she eventually succeeded in replacing Muhammed’s name with the new WDC Chairman, Anthony Monday – two months ago. Yet, the BHCPF has not fully kicked-off due to “lack of mandate” from the KPHCMB and the irregularities on the enrollees’ list.
“There was no phone number in the first list they gave us. It makes tracking of the enrollees very difficult. They just changed the list for us around first week of July 2022 when we discovered that only 27 out of 68 persons on the list are from this ward, the remaining 41 are from Sabongari East,” She says.
Also, Abasawa PHC in Tsamiya Babba ward in Gezawa LGA has only two enrollees on its list. Kabiru Yahaya, the In-charge of the facility, said the two enrollees have never been reachable when contacted.
“We have enough drugs; they only gave us two invisible enrollees,” he says
Similarly, most of the enrollees at Jaba PHC were from Minjibir LGA, some 60km away from Kano, just as some beneficiaries from Gandu Albasa within Kano metropolis surfaced on the Yaryasa PHC’s list in Tudunwada LGA.
Kano State got a target of 79,000 enrollees in the first tranche of the BHCPF scheme. However, our correspondent observed conspicuous lop-sidedness in the enrolment process.
For example, six among the 381 benefiting facilities got only one person each on their respective lists and 29 facilities have less than 10 persons each on their list according to KSCHMA’s data.
KASCHMA Blames Ward Heads, WDC for Compromise
Reacting, KASCHMA, the agency responsible for the implementation of the NHIS gateway of the BHCPF scheme, attributed the development to multiple registrations as a result of over reliance on the community leaders, who allegedly compromised the process.
Speaking on behalf of the Executive Secretary of the agency, Halima Muhammad Mijinyawa, KASCHIMA’s Director of Program, Dr. Abdullahi Sahad Ahmed said many enrollee forms were reprinted and diverted.
“We assumed that the Ward Head and WDC know their people very well, so we allowed them do the screenings but many of them inserted names of anybody they know regardless of their locations. For example, we discovered that one of the beneficiaries is a staff of Nigerian Security and Civil Defence Corps (NSCDC) who did not qualify,” he added.
Dr. Ahmed said the agency is now conducting spot verifications to ensure that each beneficiary submits his or her National Identification Number (NIN) before they can continue to benefit from the programme.
Official Issues N100, 000 Cheque for a Dustbin, Gets N65, 000 Kickback
A pocket of sharp practices was also discovered at Jaba PHC where Samira Ibrahim Ayuba, the In-charge of the facility, issued seven cheques for withdrawals of cash from the BHCPF account in just a single day. The withdrawals have come to be regarded as shady.
She said the cheques – issued on the last day of the year 2021 – were meant for the procurement of some running materials, drugs and payment of casual workers.
Samira said she was hinted about the mandatory retirement of all unspent funds after the December 2021, hence the 11th hour rush for the massive withdrawals. But after sensing imminent troubles, she directed all the beneficiaries to refund some monies.
In one of those suspicious withdrawals, she issued a check for N100, 000 for the procurement of a single outdoor plastic dustbin. She later went to the market, bought the dustbin for N35,000 and requested for a kick-back of N65, 000 from the seller, Kabiru Ibrahim.
“I went to Sabongari market to buy the dustbin and I told the seller (Ibrahim) to take his exact money (N35, 000) and give me the remaining balance (N65, 000) by hand (cash),” she says.
“Later I was told it was wrong. I now went back to him, gave him the BHCPF account to help me refund N70, 000. After that, I paid his N5, 000 balance from my own monthly N50, 000 that I withdrew for running cost”.
Even the N50,000 monthly running cost that Samira referred to, it was gathered that she earlier withdrew N50,000 twice on the 31st of December, 2021 before she later refunded N50, 000.
Bank’s Cheque books Delay BHCPF Implementation in Kano Six LGAs
All 51 PHC facilities captured under the BHCPF in six LGAs of Kano, including Tsanyawa, Bichi, Kunchi, Garko, Makoda and Dambata are yet to commence the implementation after two years.
Some of the affected officials at Tsanyawa LGA told our correspondent that even though, they have been receiving alerts of disbursements from the KPHCMB and KASHMA for over a year, they cannot withdraw the money due to lack of cheque book from their bank.
The Tsanyawa Comprehensive Health Centre already has 583 enrollees on its list, but it cannot boast of taking care of a single one.
“We have over N4-609-520 (Four million , six hundred and nine thousands , five hundred and twenty naira) in our account, they are just busy crediting the account every quarter but we cannot withdraw due to the cheque book problem,” says the in-charge of the centre, Sharhabil Habeeb.
“The enrollees usually come for medical care but we can’t do anything, we always beg them to be patient,” he laments.
When contacted, Dr. Tijjani Hussain, KPHCMB’s Executive Secretary, admitted that the project has not commenced in the six LGAs due to the delay in issuance of cheque books. He refused to mention the name of the bank.
Dr Hussain said after several follow up for two years, the board had asked the banks to refund all BHCPF money in its custody, while expediting process of opening another account at some other bank for the project.
KPHCMB’s Embargo Halts NPHCDA Gateway at Many Kano Facilities
Despite the uninterrupted disbursement of funds to all 381 benefitting facilities, the NPHCDA gateway of the BHCPF project which caters for running costs, renovation of facilities as well as midwives payment and new recruitment has been suspended in many facilities for over a year in Kano.
The ongoing construction and renovation of facilities at Gungara Health Post, Kademi PHC and Garmarya Health Clinic in Gaya LGA were all suspended after the alleged embargo.
Stalled BHCPF Project at Gungaya Health Post
Halted Renovation at Garmarya Health Clinic
KPHCMB Defends Embargo, Blames Lack of Transparency in Implementation Process
State officials involved in the implementation have denied a blanket embargo on the project.
In response to our correspondent’s query, Dr. Tijjani Hussain, KPHCMB’s Executive Secretary, said the order only affected many officials and their facilities for not being transparent.
“In some facilities, an In-Charge will withdraw about N2 million while the guideline says they can’t withdraw more than N50, 000; some will claim they have painted some rooms and painting was never done.
“So, we had to stop them and punish them, but not a blanket order. Some of them are even apprehensive of withdrawing the money because of the consequences if they default on the guidelines,” he explains.
He added that the embargo also affected payment of midwives and other casual workers as well new recruitments due to the conspicuous infractions in the recruitment and payment process. He assured that all the identified challenges would be resolved soon.
Nevertheless, Sani – the humanitarian driver in Jeli community – believes that his 15-year-old truck cannot be there forever.
He however hopes that Hassana’s death would be the last avoidable case of an expectant mother dying in the community only if the state government provides a standard healthcare facility and adequate personnel for the villagers.
This report is published with support from the International Budget Partnership IBP and the International Centre of investigative Reporting, ICIR.