By day, this yellow, rickety pickup truck is meant for moving heavy loads – mostly firewood – from one village to another around Jali community in Tudunwada Local Government Area of Kano State.
At night, the only vehicle in the community which is 120 kilometres from Kano city is always on standby to move any prospective patient due to the lack of a standard healthcare facility and poor road network in the village.
Even though the truck appears unkempt and inconducive to patients’ good, its owner, Haruna Sani, 45, says he has used it to rescue 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 in a 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 in the back of the truck when the vehicle’s kick starter went bust, the driver explains.
A group of hefty men was 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.
“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.”
“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.”
“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.”
Humanitarian Driver, Haruna Sani
Jali Primary Healthcare Centre is about 100 metres from the late Hassana’s house, but the centre lacks the required facilities for child delivery. This was why Hassana was being transported a further 20km before her death.
Jali Healthcare Centre
Ownership Tussle Mars BHCPF Project at Jali, Yaryasa Facilities
The Jali Primary Healthcare Centre (PHC) is in deplorable condition 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 Jali 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 the Kano State Contributory Healthcare Management Agency (KSCHMA) at Yaryasa PHC, claimed that he was among the 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 officer 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 Jali facility can access the BHCPF Bank account.
“Jali 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, the 80-year-old chief imam of Yaryasa Ward are among the enrolees.
They lamented that all hopes of accessing free healthcare at the Yaryasa facility were dashed after the scheme was diverted.
Shehu Garba and Elia Saleh
When contacted on the telephone, both Ubale and Sabayuki denied having personal issues.
Both have their different explanations: 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 Jali community where the pathetic death of late Hassana occurred.
The road to Jali is bad, driving on it is a painstaking hurdle. The ongoing construction of a bridge has worsened the situation of the road.
When our correspondent arrived at the portion with the most resistance, he had to abandon his travel vehicle on the roadside and proceeded on the journey on a commercial motorcycle.
Deplorable Road in Jali Community
He eventually met with Sale Haruna, the person 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 Jali PHC when our correspondent visited him on July 7, 2022.
“The KPHCMB said it is only this facility (Jali) 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 Jali 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.
Jali PHC Official Withdraws Cash Despite Zero BHCF Implementation
Despite the unresolved controversy, our correspondent learnt that Haruna had withdrawn N50,000 from the BHCPF’s account. He claimed to have spent the money on transportation.
Jali PHC BHCPF Statement of Account
Two months after the KASHMA’s promise to Haruna to update the Jali PHC list, our correspondent contacted the person in charge via telephone on August 9, 2022. He said he had not heard any update from the agency.
Again, Breastfeeding Mother Dies on Motorcycle in Jali
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 clarified that the project was relocated to Jali because Yaryasa PHC already had similar programmes for public-sector employees and another one for vulnerable populations, while the Jali facility had none.
Kano Scores Low, Three Years after Receiving BHCPF Lion Share
The BHCPF's full implementation began in 2019 with the first disbursement of N6.5 billion by the federal government to 15 states, where Kano State got the highest allocation of N948 million.
Despite this huge allocation and the subsequent release of the second tranche of funds in 2022, the project is yielding little or no result at many visited facilities among the benefiting 381 PHCs in the state.
Stakeholders linked this to the technical hitches encountered in the take-off of the project, mismanagement, corruption, nonchalant attitude, and negligence among others.
Deaths, Mix-ups on Enrolees List Stall BHCPF Implementation in Many Facilities
At Tsohon-Gari Health Clinic in Tudunwada LGA, the 298 enrolees in the Tsohon-Gari ward have been 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 in 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, Alh. 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 a “lack of mandate” from the KPHCMB and the irregularities on the enrolees’ list.
“There was no phone number in the first list they gave us. It makes tracking of the enrolees very difficult.
“They just changed the list for us around the 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 Sabon Gari East,” She said.
Also, Abasawa PHC in Tsamiya Babba ward in Gezawa LGA has only two enrolees on its list.
Kabiru Yahaya, the In-charge of the facility, said the two enrolees have never been reachable when contacted.
“We have enough drugs; they only gave us two invisible enrolees,” he said.
List of Enrolees at Abasawa PHC
Similarly, most of the enrolees at Jaba PHC were from Minjibir LGA, some 60km from Kano city, 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 enrolees in the first tranche of the BHCPF scheme. However, our correspondent observed conspicuous lop-sidedness in the enrolment process.
For example, six of 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 enrolee forms were reprinted and diverted.
“We assumed that the Ward Head and WDC know their people very well, so we allowed them to 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 Civil Defence 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 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 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 kickback of N65,000 from the seller, Kabiru Ibrahim.
Outdoor Plastic Dustbin Procured by Samira
“I went to Sabon Gari market to buy the dustbin and I told the seller (Ibrahim) to take his money (N35,000) and give me the remaining balance (N65,000) by hand (cash),” she said.
“Later I was told it was wrong. I now went back to him and 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 Chequebooks Delay BHCPF Implementation in 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 they have been receiving alerts of disbursements from the KPHCMB and KASHMA for over a year, but cannot withdraw the money due to a lack of chequebooks from their bank.
The Tsanyawa Comprehensive Health Centre already has 583 enrolees on its list, but cannot boast of taking care of a single one.
“We have over N4,609,520 in our account, they are just busy crediting the account every quarter but we cannot withdraw due to the chequebook problem,” said the in-charge of the centre, Sharhabil Habeeb.
“The enrolees usually come for medical care but we can’t do anything, we always beg them to be patient,” he lamented.
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 the issuance of chequebooks.
He refused to mention the name of the bank.
Dr. Hussain said after several follow up for two years, the board had asked the bank to refund all BHCPF money in its custody while expediting the 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 to 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 explained.
He added that the embargo also affected the payment of midwives and other casual workers as well as 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 Jali community – believes that his 15-year-old truck would not be there forever.
He is hopeful 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.
