DESPITE the guidelines set by the National Primary Healthcare Development Agency (NPHCDA) to ensure quality and accessible healthcare in Nigeria, primary healthcare (PHC) facilities across Kiyawa, Dutse, and Kafin Hausa Local Government Areas (LGAs) in Jigawa State fall short on critical requirements.

This report spotlights troubling lapses in PHCs in the LGAs. It reveals how these deficiencies impact the health and well-being of the communities relying on them. 

By Khadija Ishaq BAWAS

The low community awareness about the services rendered at the Madobi Primary Health Centre (PHC) in Dutse local government area is one which has made some community members shun the facility.  

During an interaction with some residents, it was evident that they were apprehensive of the facility. Some of them revealed that the selection process for beneficiaries in the Basic Health Care Provision Fund (BHCPF) lacks transparency. 

The BHCPF is an initiative by the federal government aimed at achieving Universal Health Coverage (UHC) by providing accessible and affordable healthcare to all citizens, especially the poor and vulnerable. Established under the National Health Act of 2014, the BHCPF allocates at least 1 per cent of the federal government’s consolidated revenue fund (CRF) annually to strengthen primary healthcare (PHC) services across the country.  

The BHCPF is designed to address the critical gaps in Nigeria’s healthcare system, such as poor funding, inadequate infrastructure, a lack of essential medicines and skilled personnel at the PHC level. The fund prioritises free healthcare for pregnant women, children under five, the elderly, and persons with disabilities.  It also empowers state and local governments to co-finance healthcare delivery, ensuring a shared responsibility in sustaining the system.  

Fatima Jibril, a 45-year-old mother of nine, explained that her daughter was able to benefit from the BHCPF only because she was privileged with a connection at the PHC.  

“If it weren’t for that, I don’t think we would have been enrolled by now,” she said. While the programme helped address her daughter’s healthcare needs, Fatima pointed out a major issue – many people in her community still do not know about the BHCPF. 

 Furthermore, even those who are aware of the programme often face challenges enrolling, revealing a significant gap in both awareness and access. 

Despite these advantages her family enjoys, Fatima notes occasional gaps in medication availability.  

“Sometimes, they tell us to come back the next day when there is lack of drugs and when you come back, they still don’t have the drugs,” she said. 

 “Asides that, we also worry about the safety of the centre, especially as it has no fence. At night, anyone can enter. It’s not safe, especially with young girls visiting the PHC,” she added. 

Unlike Fatima, Suleiman Saidu and his family are not enrolled in the BHCPF. During his visit with his pregnant wife, he expressed frustration about the additional costs he incurs for her treatment. He expressed sadness regarding the poor knowledge about the BHCPF, despite being a community member, questioning the selection process of beneficiaries. 

“I have been buying drugs at clinics and pharmacies which are expensive. I’ve only recently learned that there’s a programme here through our conversation. But even now, I’m not sure how to enrol or who to talk to because I don’t even know where to start from. 

 “If the selection process is much, more transparent and the community is fully aware of this programme and the services this PHC renders, it will encourage more people to visit this facility.  Aside our poor knowledge of the BHCPF, we don’t feel safe here, especially at night. There’s no fence or security personnel. This is why I came here with my wife so she can feel protected. 

“It’s worrying to see the staff leaving because they can’t stay here overnight. If the staff are leaving because of the lack of security, how about we the community members; what if there’s an emergency? We could be left without help when we need it most,” Saidu lamented.  

Ummi Shehu, a midwife at the PHC, is the only one available for night shifts due to the proximity of her home to the facility. She described several challenges, particularly the low patient turnout, which reflects limited awareness about the facility in the community. She also noted a shortage of equipment, which allows them to handle only one delivery at a time, forcing them to improvise with regular beds when two patients go into labour simultaneously. 

“At the moment, we have one delivery bed with limited disinfectant supplies and when two patients go into labour at the same time, we have to use a normal bed for one of them and use a make-shift bed for the other,” she said. 

A staff member at the Madobi PHC in Dutse LGA, who pleaded anonymity, voiced his frustration about the current state of the centre, pointed out a persistent gap in community awareness of the BHCPF.  

“A lot of people who come here still don’t know about the free services available to children under five and pregnant women. They assume they need to pay for everything, so they avoid coming here until it’s serious.  

While the centre claims to carry out awareness campaigns about the PHC and the services it renders, this reporter’s interaction with community members proved it is either ineffective or untrue.

On security, Suleiman said: “We are in the open without fencing. We’ve faced security issues for over two years now. Drugs have gone missing, and we’re always at risk of break-ins. Without an accommodation for midwives to stay, we only rely on the one midwife who lives nearby for night duty,” he said, highlighting the shortage of on-site staff after hours.  

“If we don’t improve security, we’re risking the safety of our patients and the equipment. And without more awareness, we’ll keep seeing people who struggle to afford care when there is a fund that can help them out. 

Abdullahi Ibrahim, the Ward Development Committee (WDC) chairman for the PHC, did not speak on the selection process of beneficiaries but rather emphasised that the WDC plays a vital role as the bridge between the community and the facility. He avoided the questions but spoke on other issues asides the selection process, saying: “We hold meetings every Monday, where we table whatever issues or matters arising.”  

Addressing challenges, Abdullahi noted, “There’s an issue with the distribution of mosquito nets during antenatal care. Also, the lack of accommodation for midwives is a major concern.” He explained that, while the facility is meant to be operational 24 hours a day, the lack of housing for midwives means that only one midwife is available at night. 

The other midwives must return to town each evening, leaving the facility with limited staff to handle emergencies.  

“Sometimes at midnight, a women go into labour, but there’s only one midwife to attend to her since the others have all gone back to town,” he added. 

According to the NPHCDA minimum standards for PHCs Madobi PHC is supposed to have at least two security personnel.  

On awareness, the minimum standards states that such centre should engage in community mobilisation for health as well as routine home visits and community outreach. These services ought to be conducted in the health centre and in the communities, as stipulated.  

Sanitation challenges, a persistent Issue 

The Katanga Primary Health Center (PHC) in Kiyawa LGA, unlike other smaller facilities, is a vital resource for the community due to its relatively larger size and capacity. However, while bustling with patients and families seeking care, a visit to the facility reveals serious issues ranging from poor sanitation to inadequate staffing, which mar the healthcare experience for the community. 

The condition of the sanitation infrastructure has become a critical concern for community members. Hadiza Adamu, a mother attending to her sick child, expressed frustration about the non-functional restroom at the PHC.  

“There is no proper toilet here,” she lamented, adding: “Everyone just does their business around the back. The odour can get terrible sometimes.” 

 The situation forced many to seek privacy in the bushes nearby, raising not only concerns of discomfort but also health risks. Another community member, Hauwa Adamu, voiced also her disappointment: “It’s been a while that we’ve had to manage without a working toilet. We shouldn’t have to go into the bush when there’s supposed to be a toilet for us here.”  

The officer in charge of the facility, Muhammad Lawal Abdulkarim, provided insights into the sanitation issue, explaining that the facility “uses a WC toilet, but due to a broken pump and water scarcity, we had to lock the toilets in the female wards.” 

“Without water, people would use it without flushing, and the smell becomes unbearable,” he explained.  He spoke about recent repairs to the water pipe funded by the BHCPF but added that a permanent solution remains uncertain. 

Financial strain on patients 

In addition to inadequate sanitation, the high cost of care at the PHC adds to the burden on local families. Muhammed Tukur, a resident who brought his young child for treatment, shared his struggle with expenses.  

“I had to spend N4,000 for three days just to get blood taken for my child. For some of us, N4,000 is not easy to come by, especially when we have to travel long distances to get here. 

  “Despite the availability of some free medications for eligible patients through BHCPF, costs still weigh heavily on families, particularly those who are economically disadvantaged,” he said.  

Challenges in maternity and staffing 

Staffing challenges in maternity care at Katanga PHC further underscore the limitations of the facility. Currently, the centre has two midwives. Both are on the verge of leaving – one due to retirement and the other because of an upcoming marriage.  

“Before January, we might be left with none,” Abdulkarim warned. While two new replacements have been recruited through the BHCPF, they have yet to begin work, creating potential gaps in maternal health services. 

Also, the need for a separate maternity hall has become pressing. Abdulkarim notes that the current maternity area within the main building lacks the privacy required for childbirth, which impacts the dignity and comfort of women in labour.  

“The lack of a maternity room has made some men prevent their wives from birthing their babies here because there is no adequate privacy.”  

Reliance on inadequate power sources 

The lack of a reliable power source also poses a significant hurdle to effective healthcare delivery at Katanga PHC. Currently, the facility relies on a small generator that produces noise that is disruptive to both patients and staff. Abdulkarim lamented the absence of solar power, which would provide a quieter and more consistent power solution.

“We need steady electricity, especially for the laboratory and blood bank. If we had solar, we wouldn’t have to deal with the noise, which can be uncomfortable for patients, especially the children,” he explained. 

The generator presents its own set of challenges. Years ago, its cable was stolen, leaving the facility to manage with a smaller, inefficient unit.  

Facility infrastructure and resources 

Beyond these operational issues, the PHC’s infrastructure is also showing signs of severe neglect. The roof over the main building is caving in, posing a potential safety hazard to both patients and staffers. Abdulkarim highlighted the need for renovations, explaining: “We need more beds and mattresses, and the roof over the facility is caving in. Renovation is badly needed here.” 

The limited resources extend to the overall maintenance of the facility. An unused ambulance parked at the front, along with an out-of-service generator, serves as a stark reminder of the facility’s limitations in providing the necessary care for a growing population. 

NPHCDA’s standard stipulates that, “Walls and roof must be in good condition with functional doors and netted windows. Functional separate male and female toilet facilities with water supply within the premises. There must be clean water source from a motorized borehole, be connected to the national grid and other regular alternative power source as well as a sanitary waste collection point.” 

On staff accommodation, the centre is expected to have 2 units of 1-bedroom flats. Despite having accommodation for the midwife, it remains locked and unused. Again, this health centre falls short of this requirement. 

Speaking on improving healthcare in Jigawa’s rural communities, Musa Bello, a health expert with the African Health Budget Network (AHBN) emphasised the need for better allocation and use of the BHCPF to enhance Primary Healthcare Centres (PHCs).  

“Direct funding enables PHCs to improve service quality and maintain infrastructure,” he said, adding that recent allocation reforms now favour centres with higher utilisation. However, he noted that delayed disbursements hinder effective operations and suggested better fund management for smoother service delivery. 

Neglected and inconsistent healthcare at Kafin Gana health post 

If PHCs are faring badly, health posts, which usually service smaller population of people in remote and far to reach places, have an even worse deal. For example, the Kafin Gana health post in Birnin Kudu LGA is meant to serve as a critical lifeline for healthcare delivery in the community where it is located. But its state of neglect and unreliable staffing hinder its effectiveness, frustrating residents and compromising their access to timely medical care.  

Located conveniently by the roadside, the centre facility consists of two blocks connected by a veranda. Despite its central location, the facility appears unwelcoming and unstaffed during supposed working hours. Bird droppings and a general sense of neglect characterise its atmosphere, creating a sense of abandonment and posing health risks to visitors.  

When this reporter visited at 10 am on Thursday, October 24, the facility was empty with no staff in sight. For residents who depend on this facility, the lack of proper care and resources left them with no choice but to look elsewhere. 

Abba Hudu, a resident and father of two, expressed frustrations with the non-availability of the facility’s staffers, a recurring issue where they often arrive late in the afternoon.  

“When I brought my sick child in the morning, there was no one to attend to us. I felt very bitter after waiting for hours. 

“I had to visit a chemist, which is more expensive. A local farmer like me who is struggling to survive. Many families face hardship due to their inconsistency. Pregnant women too find themselves having to travel to Kantoga, about 3 kilometres away, incurring extra transportation costs which adds financial strain on them. 

Another resident, Mariam Aminu, acknowledged that staff generally arrive punctually on days designated for immunizations or antenatal care, but said on other days, patients were left waiting indefinitely.  

“It is only on immunisation days that they arrive on time but on otter days, you will just be frustrated if you come here in the morning or past 3.00 pm in the afternoon.  

“It is so sad because they come late, yet they close very early. Just like some of my friends, I also seek medical attention from local chemists. 

The facility’s guard and caretaker, who gave his name simply as Abdulhamidu, lamented the negative impact of staff absenteeism.  

“When the staff are not here, there’s no one to administer drugs or treat patients,” he explained, noting that families often leave out of frustration, to nearby Kantoga or local chemists for treatment. “ 

The lack of consistent and timely care has overtime diminished the community’s trust in the facility, with many opting not to rely on it at all,” he said. 

In terms of infrastructure, the facility is also inadequate for the community’s needs. Yakubu Usman, a father of four, pointed out the need for maintenance and expansion, lamenting that the building was too small for the population it serves.  

“Many people have come here and left because the staff are not around. They are supposed to come on time,” he added, calling for increased staff and stricter attendance policies. 

Administrative and financial shortfalls 

On the administrative front, Naziru Umar, who is in charge at the facility, spoke about the financial challenges that limit the PHC’s capabilities. While the facility does not receive support from the BHCPF, it relies on a drug revolving fund (DRF) from the local government.  

“This arrangement forces many patients to pay out of pocket for medications, which can be financially burdensome for families. Although a nonprofit, Global Fund, provides malaria testing kits and treatment drugs, other essential resources remain scarce,” he said. 

  According to Umar, the staff roster includes four main staff and two casual workers. But these numbers are misleading; as some staff members travel long distances, resulting in unpredictable attendance and contributing to the absenteeism that frustrates the community. This inconsistency leaves the facility often understaffed, if not entirely empty, during critical hours. 

 Despite this, at the time of the interview, he was the only staff member present. 

Leadership gap between health post and community leadership 

The ward head, Musa Dansinke, revealed a significant communication gap between the health post and local leadership. Dansinke denied knowledge of the persistent staffing issues, because, according to him, community members had not reported their grievances directly to him.  

“If there are concerns, people should report them to me, but so far, I haven’t received any complaints,” he said. 

 This disconnect reflected a lack of leadership engagement with the community’s healthcare concerns but also highlights a missed opportunity for advocacy and possible interventions. 

The NPHCDA guidelines (for health posts?) state that the hours of operation is between  9.00 a.m. – 4.00 p.m.  

 According to the NPHCDA, “It is expected that 40% of health workers time will be spent in the health post and 60 in the community (According to the Ward Minimum Health Care Package).  

“Health facilities can open at the convenience of the community with the provision that the health post will be open for at least 8 hours every day,” the guidelines provide. 

But with the complains of the community members, it shows that the Kafin Gana health post falls short of this.  

Counting the cost 

Between 2021 and 2024, Jigawa State received substantial funding through the BHCPF. In 2021, Jigawa received  ₦554 million  under the National Health Insurance Scheme (NHIS) component of the BHCPF. This funding covered health services across 287 political wards in the state. 

In 2022 the state was among the ones with the highest allocations, receiving ₦1.64 billion for its primary healthcare facilities. Through the National Health Insurance Scheme (NHIS), it received ₦730.1 million, the highest amount allocated to any state that year.  

In 2024, N12.911 billion through the BHCPF for the third quarter of 2024 was distributed, of which Jigawa is a beneficiary, although the figure for Jigawa isn’t prominently detailed as this reporter could not get such information during the second visit to  PHCs Jigawa.  

Despite these huge investments, recent statistics from the National Demographic and Health Survey (NDHS) show that Jigawa State experiences a maternal mortality ratio of 714 deaths per 100,000 live births. This alarming figure underscores the significant challenges in maternal healthcare in the state, reflecting inadequate access to quality prenatal and delivery services, as well as limited emergency obstetric care. 

Flaws in Jigawa’s PHCs administration  

Bello, the health expert at AHBN, addressed persistent stock-outs, advocating efficient utilisation of the drug revolving fund (DRF) model, which he called, “the most efficient strategy”, to ensure steady drug supplies.  

“With DRF, facilities can use initial funds to buy drugs, sell them at subsidized rates, and reinvest the returns. This self-sustaining cycle reduces dependency on limited budgetary allocations,” he explained. 

Bello also urged for greater transparency in selecting BHCPF beneficiaries, citing local practices in Kano as a model. “In Kano, they involve community representatives, traditional leaders, and civil society groups in the selection process,” he noted. This approach, he added, ensures that vulnerable families who need free healthcare most are identified. 

To improve infrastructure, Bello suggested budget allocations for sanitation, fencing, and power.  

“In their annual budget, they can put some of the money in the capital project that can be used to renovate primary’s capacity. It’s either fencing or general renovation or electricity or water supply. These are all in process of that can be in the capital, budget of the annual budgetary allocation for the primary care facilities in the their agency, either primary care management board or primary care development agency.  

He also highlighted donor-funded projects, such as the World Bank’s IMPACT program, which focus on improving healthcare infrastructure. 

The Jigawa State Primary Healthcare Management Board and its director bear significant responsibility for the dire state of primary healthcare facilities in the state, as highlighted by this investigation.

The inability to uphold the National Primary Healthcare Development Agency’s (NPHCDA) minimum standards has left critical gaps in infrastructure, staffing, security and other areas. Furthermore, the board’s failure to address pressing issues, such as shortages in medical supplies and absence of midwives at night, compromises the accessibility and quality of care, particularly for vulnerable populations like pregnant women and children.

The negligence extends beyond infrastructure and awareness. Instances like the abandonment of the Kafin Gana health post during working hours and the poor sanitation at Katanga PHC in Kiyawa LGA underscore a systemic failure in oversight and accountability.  Despite the financial allocations facilities remain underfunded and ill-equipped to meet the healthcare needs of their communities.  

Contacted, Shehu Sambo, the director, Jigawa State Primary Healthcare Management Board (JSPHCMB), said he could not speak on the matter and directed this reporter to the commissioner of health in the state. 

“You have to go to the ministry with a letter of introduction first and then speak with the commissioner on this issue,” Sambo said.  

The commissioner of health, Jigawa State, was contacted via WhatsApp after having trouble connecting through his phone line. In his response, Abdullahi Muhammad acknowledged the importance of such insights in improving the state’s healthcare services.  

The commissioner assured that the ministry would carefully review the observations and take the necessary steps to address the challenges identified in Jigawa’s healthcare facilities. 

Kamed tv sighted a broadcast published on the Jigawa State government’s website in October 2024 by Hamisu Mohammed Gumel, the chief press secretary to the governor of Jigawa State, Mallam Umar Namadi, in which he highlighted the recent launch of the J-Basic Healthcare program, the state’s adaptation of the Basic Health Care Provision Fund (BHCPF). 

 Governor Namadi stated, “Our goal is to ensure that every Jigawa resident can receive the care they need without facing financial hardship.” 

He also noted other ongoing efforts, such as revitalising primary health centres, constructing new general hospitals, and offering free dialysis services for renal patients. 

However, despite these initiatives, there remains a need for improvements in certain PHCs, such as those in Katanga, Modobi, and Kiyawa, where issues with staffing, infrastructure, and BHCPF access persist. 

This investigation was supported by the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting (ICIR).