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.

The government had reportedly failed to provide a driver, and the nurses did not have the time or resources to operate the tricycle themselves.

Some of the nurses who spoke with PUNCH Healthwise lamented that the tricycle ambulances have remained abandoned for over a year since it was brought to the PHC.

A nurse, Tolu Adekunle (not her real name because of victimisation) revealed that the tricycle had never been put to use not even for a day since it was brought to Adehun Primary Health Centre.

“We were happy when the government brought it, but as you are seeing it over there, it is just for decoration. We have never used it for a day.

“There is no provision for fueling or a driver that would be driving it. So, for over a year that it has been brought here, it has remained abandoned and unused.

“We have thought that this tricycle would make our job easier and would also help in transporting some of our patients who need urgent medical care in a bigger hospital. But here we are, we continued to struggle to provide basic care with limited resources,” she lamented.

Not only was the tricycle abandoned in Adehun PHC, findings by PUNCH Healthwise investigation showed that it was a similar situation in almost all the PHCs visited in different parts of the state.

For weeks, our correspondent traced the location of some of the tricycle ambulances now gathering dust in many of the PHCs. and discovered they were abandoned by the government which obviously defeated the purpose of providing them as they remained unused till date.

PUNCH Healthwise investigation observed that the tricycle ambulances have become a grim reminder of what they could have been.

The once-bright colours have faded, and they are now covered in dust and cobwebs. The nurses pass by them every day, knowing that they represent a lost opportunity to improve healthcare and waste of taxpayers’ money.

Towed to the community

The nurses at the Elere PHC in the Ewekoro Local Government Area of the state claimed that one of the tricycle ambulances given to them was towed to the community.

According to them, the tricycle ambulance was not working when it was brought and had remained unused.

One of the nurses simply identified as Grace told our correspondent that the community needed the ambulance to attend emergency cases and save lives.

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.

Rot away

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.

It was observed that the paint had faded and chipped away, revealing the metal frame beneath. Cobwebs hang from the handlebars and dust covers the seats.

In many of the PHCs visited, PUNCH Health wise investigation discovered that the tyres were flat, and the wheels were covered in dirt. The once-gleaming ambulance now looks forlorn and forgotten.

Even the once-proud logos and decorations have faded, leaving only a ghostly trace of what was once there.

In Italopo Primary Health Centre in the Ijebu-Ode area of the state, our correspondent observed that the tricycle was parked and abandoned at the entrance of the hospital.

Some residents, including one of the nurses at the centre confirmed to our correspondent that the tricycle was working before, but had been abandoned for more than five months due to mechanical issues.

The nurse, who pleaded anonymity to protect her job, revealed that the tricycle had some mechanical faults and that the hospital is currently waiting for the ‘person in charge’ to fix it.

She explained that before the present condition of the tricycle, it was used to transport emergency patients and vaccines.

“It has not been working for more than six months and we are still waiting for the government to repair it. It is useful, but since the present condition, nothing has been done for now.

“We don’t have a driver for it; it is someone here that knows how to drive that always helps us with it. And when the person is not available, we become stranded,” she added.

At Abigi PHC in the Ogun Waterside LG, the tricycle looks like it has not been used for a very long time. It was observed that the tyres were flat, and one of the mirrors was broken.

But when our correspondent met with one of the nurses at the centre who did not mention her name, she insisted that the tricycle was working.

She said it was serviced about two months ago and it had helped transport emergency cases to the Ibiade General Hospital.

She stated that since the government failed to hire a driver, one of them had to volunteer  to drive it to save some of the emergency patients in critical condition .

Some residents, however, told PUNCH Healthwise that the tricycle had been abandoned for a very long time.

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. Okorie stated further that 68 out of 1000 children between the ages of 0 and less than one year died after their birth in Ogun State.

He noted that the state has also ranked the highest in deaths of children under five years with a record of 85 deaths out of 1000 children.

He further said that Ogun also recorded the lowest newborn care with an estimation of 77 per cent.

Not in the most needy communities

During the investigation, our correspondent discovered that there were some rural communities where tricycle ambulances were needed, but they did not have them.

The Alapako PHC reportedly provides healthcare for 66 villages in the Obafemi-Owode LG but does not have a tricycle ambulance to help transport patients during an emergency.

The nurses told PUNCH Healthwise that many of their patients, including those who are pregnant, arrive at the hospital on motorcycles.

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.

“We all know how expensive it is to buy fuel now, it will not be wise for any government to give such facilities to those PHCs and not provide someone that his job will be to drive it.

“The government is trying to use the tricycle to solve the high mortality recorded in the state due to emergency, you can now imagine if there is any reason to use the tricycle late at night, but there is no designated person available to drive it, what do you think will happen?

“As much as it is  a good thing that the government provides the tricycle to some of the PHCs, it is important that other resources are provided or else the tricycle will not be put to use in some of those places.”

Partially working

An investigation by PUNCH Healthwise showed that the tricycle ambulances were working in Efire PHC in Ogun Waterside LG, Iperu PHC, and Ogere PHC in Ikenne LG.

During the visits, it was discovered that the tricycles had been put to good use, providing much-needed medical care to rural communities.

Some of the nurses who spoke with our correspondent revealed that the tricycles were equipped with basic medical supplies and also used to transport vaccines.

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.

A Professor of Community Medicine and Public Health at the University of Port Harcourt, Rivers State, Best Ordinioha, said the government should provide trained drivers to operate the tricycle ambulances.

While stressing that having ambulances in rural communities will help in combating high maternal and child mortality, the public health physician noted that such tricycles should have basic equipment and allow medical procedures to take place while in transit.

He noted, “It is not enough to provide an ambulance and hand it over to an untrained driver. Usually, they have these paramedics, and those paramedics are trained to give first aid and to keep the patient alive until the patient arrives at the hospital.

“The other thing is that there should be a facility for oxygen and the rest. And of course, there should also be a room for medical procedures to be performed while in transit. So that is the ideal ambulance.

“The tricycle, for example, should have the basic equipment or should allow the functioning of medical procedures to take place while in transit.

“So, if it has a carriage, the patient should be able to lie down and if possible,  there should be a room for the health worker so that the health worker can continue to provide, and deliver health emergency care while in transit. So that is the minimum.”

The professor of public health, however, identified delays in reaching the hospital at the time of emergency as major factors contributing to the high maternal and child mortality rate in the state.

“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.

“However, the primary responsibility for the smooth running of the tricycles lies with the Ward Development Committee of each facility in line with the global and national decentralized model of the Primary Healthcare System.

“His Excellency continues to be committed to the provision of quality, innovative, affordable, and accessible healthcare for Ogun State citizens with equity and fairness across the three Senatorial districts.”