Kei Emmanuel Duku
Nesitu Primary Health Unit (PHU) in Rajaf Payam, Juba County, Central Equatoria State, is facing pressure to meet the growing healthcare needs of the community.
Local leaders, health experts, and residents are now urging the National Ministry of Health to upgrade the facility to a Primary Healthcare Centre (PHC).
Primary Health Care Units (PHUs) are typically the first point of contact for individuals seeking basic healthcare services. They primarily focus on diagnosing and treating acute and chronic illnesses, providing preventive care, and referring patients to specialized care when necessary.
However, as the demand for healthcare services in Nesitu area surges, the capacity of a PHU has become limited. The facility is now struggling to cope with the large number of patients, particularly during peak days.
In contrast, a Primary Healthcare Centre offers a wider range of services than a PHCU. They offer preventive care, health education, and addressing social determinants of health. They are intended to meet the comprehensive health needs of entire communities.
Modi Mure Tombe Lado, the Area Chief in Rajaf Payam, estimates that over 100 patients visit Nesitu PHU daily, surpassing the capacity of the facility.
He stated that many residents, including those from Nyerjebe and Kubi, travel a very long distance to access healthcare at the facility.
Mr. Mure said upgrading Nesitu PHU to a PHC would improve healthcare access and quality for the local population, especially pregnant women and young children.
“We feel completely neglected,” said Mure. “A woman died in front of me, and when I questioned the health workers, they said the case was beyond their mandate and that they had done everything possible at a PHU level.
The population here has grown so much that PHUs are no longer sufficient. Women are giving birth on beds, and others are receiving injections or wound dressings in crowded conditions.”
Mure added that one of the major challenges facing patients at Nesitu PHU is the lack of an ambulance for transferring sick patients and pregnant women at night who might need specialized medical attention.
“I own a car, and I have decided to donate its use to the Nesitu PHU,” he said. “Any patient who needs to transfer a relative to Juba for advanced medical care can simply fuel the car, and we’ll transport them to Juba Teaching Hospital or a private clinic in the city.”
Currently, the health center is staffed by one Clinical Officer, one Midwife, three Nurses, a Community Midwife, and an Expanded Program on Immunization (EPI) staff member.
Mario Wani, the In-Charge of the facility, who has been working there since 2020, revealed that most of the staff are government employees.
He said that currently, the Centre has a total of 12 staff including security guards and casual labourers.
Despite their efforts to provide healthcare services, Mr. Wani said the dedicated staff at Nesitu PHC have gone without salaries and incentives for the past three years. This has affected their morale and ability to deliver quality care.
The Health facility also receives support from organizations like World Vision, Health Link, and UNICEF, but consistent supply of essential medical equipment remains a major challenge, he said.
He described that most of the drugs delivered to the unit as essential drugs, such as oral medications, yet most patients receiving medical services at the health unit present with complicated signs and symptoms.
Mr. Wani revealed that Malaria continues to be a prevalent health issue in the area, as most of the patients seeking care suffer from malaria-related symptoms.
“We last received drugs in September, and we’re supposed to get them every three months. But we’re currently out of stock. Artesunate, for example, finished a week ago. When we run low, we reach out to neighbouring health facilities. The last time, they provided us with an additional 50 doses. Health experts at Nesitu PHU are supposed to administer oral drugs only, as injectable drugs are typically used in primary healthcare centres, not at the PHU level,” said Wani.
He further identified several challenges facing health workers and patients at Nesitu Primary Healthcare Unit, including limited space for admissions, maternity wards, nutrition centers, and testing machines.
He noted that due to the lack of space, there is no privacy for sick patients receiving health services at the Health Facility.
The Outpatient Department (OPD), human chorionic gonadotropin (HCG) testing (for pregnancy), and laboratory services are all conducted in one room because of space constraints.
Mr. Wani also pointed out that the Expanded Program on Immunization services, antenatal care services, and the maternity ward have all been merged into a single area.
“All these tables you are seeing in each room are for different departments, like yesterday we received a case of serious malaria, the patient was in convulsion, we had to admit and later a pregnant woman was brought to deliver, we had to shift the malaria patient from the bed to give way for the pregnant mother to deliver from the bed,” he added.
The health unit also addresses cases of domestic violence, road accidents, and childbirth.
Wani urged the government and other health partners to support the ongoing renovation of the health facilities and the construction of a nutrition site by World Vision.
He called for the government to upgrade Nesitu PHU to a Primary Health Care Center to better manage the diverse medical needs of the local population.
“Although people say, PHU is not supposed to conduct delivery cases because the health experts are not qualified that is not the case with us here-Nesitu PHU. Last month 9 mothers gave birth here with the help of our health experts, what do you think if we have a maternity ward? And it is upgraded to a Primary Health Centre,” asked Wani.
Meanwhile, one of the residents Susan Zachariah stated that in absence of a maternity ward, the facility lacks accommodations for healthcare workers, including obstetricians and gynaecologists.
Furthermore, it does not have essential equipment such as ultrasound machines and devices for testing haemoglobin levels (blood levels).
“Last year, a woman died during childbirth due to excessive bleeding. This tragedy highlights the inadequacies of Nesitu’s facilities. Despite its small size, the health unit serves a large catchment area, including Jebel Amianen, Nyerjebe, and Jebel Moria. Upgrading Nesitu PHU to a health center is crucial to address the needs of this community,” she added.
Margaret Keji, Community leader and Women’s Representative in Nesitu added that the Unit offers limited services, primarily testing for malaria, sexually transmitted diseases, typhoid, and HIV/AIDS.
The absence of blood testing machines hinders the management of conditions like diabetes, which are common among pregnant women.
Many pregnant women avoid seeking maternity services in Juba due to high transportation costs and the poor quality of services at Nesitu PHU.
Additionally, husbands often refuse to support their wives’ healthcare needs outside Nesitu due to financial constraints.
The facility’s limited resources, including only two delivery beds, force some women to give birth on the floor, increasing the risk of complications and infections.
Without an ambulance, the health unit relies on borrowed private cars from residents and traditional leaders, further limiting its capacity to respond to emergencies.
Meanwhile, Fatima, a Midwife stated that the biggest challenge is the limited number of staff at Nesitu PHCU.
She urges that upgrading the Nestiu Healthcare Unit to PHC comes with improved delivery of health services such as registered Midwives, Clinical officers, and modern medical equipment for specialized patients.
She added that the Nesitu Primary Health Unit is situated at a centre where patients come from Torit and Nimule in case of an accidents along the way, it is the first point of contact for patients in need of emergency services.
“We only appeal for maternity ward because sometimes men are circumcised in the same room where women are giving birth and what we do, we usually advise women to close their eyes if they fear seeing being dressed after being circumcised, in the same room we carry minor stitching of women after delivering but if we have failed to manage a case now refer to Juba or other private clinics in Juba, all we want is Nesitu upgraded to a Health Center so the community of Nesitu and others beyond enjoys similar healthcare services like others,” noted Fatima.
However, Victoria Dokia Noah, a Midwife serving at Nesitu PHU stated that she had worked at Juba Teaching Hospital, Malakia PHC, and Giada Military Hospital before she was transferred to Nestiu PHU.
Dokia said that health workers at the unit are taking risks in handling some of the complicated cases like maternity services and administering injections that should have been transferred to bigger healthcare centers and equally appeals for upgrading Nesitu PHU to a primary healthcare Centre.
The challenges faced by Nesitu PHC, reflect the wider reality healthcare facilities face across the country. As the community calls for its upgrade to a health centre, the government and health partners should act immediately to prevent loss of lives.