This assessment throws up critical sanitation and hygiene issues which cuts across the majority of the PHCCs assessed.

For instance, about fifty percent (50%) of the PHCCs assessed had  rickety walls and leaky roofs, with torn nets on doors and windows, while a majority of the PHCCs (about eighty percent) had dirty, broken down/abandoned toilet equipments with no source of clean water connected to the toilets.

None of the facilities assessed had separate male and female toilet facilities, providing little or no safety and comfort for female users. A factor which can discourage pregnant women and nursing mothers from using these PHCCs.

Very few facilities had functional motorized boreholes, with the majority of the facilities relying on rain water collected in deep-wells and buckets. In some facilities (ten percent of facilities), the Officers in Charge (OIC) purchase water with their personal money for use in the PHC. 

Also only about thirty percent (30%) of assessed PHCCs have staff accommodation provided within the premises. Majority of the facilities are also poorly staffed, with facilities significantly short on the recommended numbers for CHEW, JCHEW, support staff, health attendant/assistant, and security personnels.

With the majority of the PHCCs assessed looking dirty and poorly maintained, there is a strong case for extra personnel across facilities to handle the daily cleaning needs of the facilities.

Budget Review

Imo State Public Expenditure Review

Budgetary allocation to the health sector when adjusted for inflation remains below the 2019 level. The revised 2020 budget of the state shows that allocation to the health sector was slashed sharply from a 2019 high of N35.83billion to N10.59billion.

Budgetary allocation to the health sector averaged 6.68percent of aggregate expenditure between 2015 and 2021, notably short of the “Abuja conference” target, where African Union countries pledged to set a target of allocating at least 15percent of their annual budget to improve health outcomes. The Imo state government had under-allocated funds to the health sector by approximately N107.64 billion between the fiscal year 2015 and 2021.

Per capita, public health allocation has fallen from the 2019 level of $15.09 per person per annum to $7.72 per person per annum in 2021. The Sharp fall in per capita public health allocation can be connected to the depreciation of the Naira against other major currencies. While the federal and local governments do invest in health, Imo state’s contribution is grossly inadequate.

Despite the Imo state government mobilising on average 61.15percent of its targeted revenue between 2018 and 2020, budget performance for the health sector was a paltry 16.96percent. That raises a serious prioritization question.