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Nigeria’s nurses shine light on poor hospital conditions

Pushing to Improve Conditions in Rural Areas.

01

A Calling to Help Women & Organize

Roseline Solarin remembers the exact moment she decided to become a nurse. She was just 10 years old.

“My younger sister had malaria and her temperature was so high that we went to the clinic,” she says. “The first person I saw was a family friend who was a nurse.” As Roseline watched in awe, the nurse, dressed in immaculate white, calmly asked some questions, took her sister’s temperature, and then began soaking sponges in cold water and giving her a sponge bath. “Before the doctor even arrived, she had brought my sister’s temperature down and made her comfortable. I knew right then that I wanted to be somebody like that,” Roseline remembers.

As an adult, Roseline’s passion for taking care of others has gone far beyond her simple desire to become a nurse. She is also a certified midwife and nurse practitioner and when she started working at a government run hospital, she joined the local chapter of the National Association of Nigerian Nurses and Midwives.

A local health care worker sorts through medical records at an underfunded health clinic.
A local health care worker sorts through medical records at an underfunded health clinic. Photo by Rajan Zaveri for International Budget Partnership © 2022.

The local government could not pay the midwives’ salaries, so they just stayed home. There was a big exodus.

Roseline saw that her union representatives deeply cared about the welfare of its nurses and the community at large and dove into union work. “Whenever you had a problem, you went to the union,” she said. She saw that participating in the union was a way to play an important role in making positive change. “These leaders were mentors to me,” she says.

She was elected assistant secretary of her chapter in 1991, then financial secretary for four years and then eventually unit chairman. Today, she chairs and oversees the national organization.

When Rosaline was a young midwife and nurse, the government took good care of its healthcare community and the rural primary care centers, she says. That all changed as new elections and coups brought in new leaders with little commitment to rural healthcare.

Many primary health centers in rural areas of the country are understaffed and have grossly inadequate supplies, including a lack of electricity or running water.
Many primary health centers in rural areas of the country are understaffed and have grossly inadequate supplies, including a lack of electricity or running water.

02

Tracking the Breakdown of Rural Healthcare

Nigeria has a three-tiered system of healthcare – tertiary, secondary and primary. Local governments are responsible for primary healthcare in rural areas, which includes labor and delivery.

Starting in 2015, she says, the entire rural healthcare infrastructure began to fray. “The local government could not pay the midwives’ salaries, so they just stayed home. There was a big exodus.”

No nurses were hired to replace the ones who were retiring or going abroad for work. Infant mortality shot up. And primary care centers were left to molder and decay, along with the roads leading to these centers, making it perilous for anyone to even make the journey.

“If a pregnant woman is in labor and because of bad roads cannot use a car, bicycle or motorcycle to transport her to the hospital, terrible things can happen. We have had some patients who have bled to death, or ended up having a stillbirth because they could not get good access to a hospital,” Rosaline said. “And if there are not enough qualified midwives at the health center or access to electricity and potable water, they will get substandard care even if they do manage to make it there.”

Local fisherwoman Nilawati runs a training on diversifying income for other women in her community due to budget credibility issues facing fisherfolk in Indonesia.

Over the past 7 Years

Roseline Solarin, chair of the National Association of Nigerian Nurses and Midwives, is a tireless advocate for better healthcare for rural communities.
Roseline Solarin, chair of the National Association of Nigerian Nurses and Midwives, is a tireless advocate for better healthcare for rural communities. Photo by Rajan Zaveri for International Budget Partnership © 2022.

03

Raising Awareness & Finding Solutions

Together with IBP, JDPC collected evidence to raise attention to Ogun’s consistent deprioritization of primary healthcare centers in its budget. Between 2013 and 2019, Ogun state officials made no budgetary allocations to primary healthcare centers. They had also failed to enroll state clinics into a federal program that recruits midwives for rural communities. Ogun’s state government was also not drawing down on the Basic Healthcare Provision Fund (BHCPF), a federal and state funded initiative that provides matching federal funding to states for theirprimary healthcare centers.

Ogun government officials admit that they struggle to recruit qualified healthcare personnel for primary healthcare centers, which subsequently slows down the disbursement of funds, procurement of equipment and other investments for these centers. Given tight resources, they have concentrated spending on a limited number of centers with the personnel and accounting systems to adequately absorb and manage funds. This leaves important gaps in who gets care.

Roseline’s group is a major stakeholder in this and what we hope is that we show the government that we have clusters of groups who are interested in primary health care services. When we engage together, it helps the government to hear from the people and the nurses directly that these are critical issues they are facing.

Roseline and JDPC are trying to raise awareness of these gaps and find solutions with the government. During a recent study of Ogun state, JDPC found that more than 70 percent of the primary health centers failed inspection. “These buildings are dilapidated and need restructuring and the roads are bad,” Olaitan Olumide, JDPC Governance Project Manager noted. “They do not meet the standards for a primary health care facility,” he said.

The same study found that out of more than 400 primary care centers in Ogun state, only 212 have qualified nurses and midwives.

Olaitan said IBP’s model of working with impacted communities directly to collect data and drive reforms, however, is already yielding results. And he is excited about partnering with Roseline and the nurse/midwives union to press for meaningful improvements in women’s healthcare.

“Roseline’s group is a major stakeholder in this and what we hope is that we show the government that we have clusters of groups who are interested in primary health care services. When we engage together, it helps the government to hear from the people and the nurses directly that these are critical issues they are facing,” he said.

Nurse Practitioner and Midwife Roseline Solarin shares the critical issues facing women and nurses at dilapidated healthcare centres.
Open Budget Dialogue with 6 communites in Gambia on the importance of budget participation. / Gambia Participates
Women listen in rapt attention as activist Roseline Solarin addresses a local Town Hall meeting on local healthcare issues.
Local fisherwoman Nilawati runs a training on diversifying income for other women in her community due to budget credibility issues facing fisherfolk in Indonesia.

Together, they recently petitioned the government at a local Town Hall to hire more nurses and improve the working conditions at the centers. At the meeting, “the government made commitments that they’ll employ more midwives,” Olaitan said. “That commitment is important to action,” he said, adding that the media was there to record this commitment and hold the government accountable.

Roseline confirmed that the pressure on the government is working. Just six weeks ago, 44 more qualified midwives were hired to work in the rural primary care centers. “But even with those 44, it’s not enough,” she said. “If you have a comprehensive health care center where you can do surgeries and immunizations, you require nothing less than 12 midwives in each facility.”

Roseline said she looks forward to future Town Halls and to working with IBP and JDPC to keep pressing for change for the nurses, midwives and local women at the primary care centers. “Everyone will see what is going on, [they] will see how the community people are really deprived and we will find a solution,” she said.

Pressure on the government is starting to yield results, but there is work left to do, says healthcare advocate Roselin Solarin.
Pressure on the government is starting to yield results, but there is work left to do, says healthcare advocate Roselin Solarin. Photo by Rajan Zaveri for International Budget Partnership © 2022.
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