By Stephen ENOCH

PERSONS with Disabilities (PWDs) face severe challenges in accessing healthcare in Kano State, Nigeria. Systemic neglect, bureaucratic obstacles, and inadequate medical facilities compound their difficulties. Their struggles at health centres such as Mazan Gudu Health Post and Gabassawa Primary Health Care (PHC) persist. Despite the introduction of the Basic Health Care Provision Fund (BHCPF), which is aimed at improving access to Medicare by the most vulnerable in the country, mismanagement and restrictive policies have left many PWDs without essential services. 

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A Community bonded by joy and pain  

Mazan Gudu, a village in Gabassawa Local Government Area (LGA) of Kano visibly thrives on communal support. The residents of the community marked by brown earth engage in farming and petty trading by day and gather in informal settings by night.

However, Bilkisu Sai’du, a 23-year-old resident of Mazan Gudu, faces a grim reality that shadows the beauty of her community. In 2023, her life was forever altered when her father suffered critical injuries in an accident.

Desperate for immediate medical assistance, they rushed him to the Mazan Gudu Health Post, only to find it locked. With no other option, they raced to another facility, but it was too late. Bilkisu’s father died en-route, leaving her and her mother to fend for their family of twelve.

Physically disabled, Bilkisu now carries the weight of supporting her family.

She sells kosai and koko (beancake and pap) in the mornings and awara at night, striving daily to make ends meet. Following her husband’s death, her mother has also turned to petty trade.

While other family members can access healthcare with relative ease, Bilkisu’s journey for medical help is fraught with challenges. She describes her quests for healthcare as “a hopeless adventure.”

The community has largely abandoned the Mazan Gudu Health Post, deeming it unusable. The facility, run by only one Officer in Charge (OiC), struggles to meet the health needs of hundreds of residents.

To verify these claims, Stallion Times visited the health post on multiple occasions and found it locked up each time.

The building’s exterior is marred by peeling paint and broken windows, while inside crumbling ceilings, rusted beams, and unusable toilets create an unsanitary environment. Basic amenities like electricity and running water are conspicuously absent.

Bilkisu recounted her daily struggle to access healthcare, sharing her frustrations with the reporter.

“Living with a physical disability is a burden no one should have to bear, but the fight for healthcare is even harder. It was to the failed healthcare system that I lost my father, and now that same system is making my life miserable,” she lamented.

“Visit the Mazan Gudu Health post and you’ll see it’s notorious for being locked and shabby. Whenever I try to get care at Gabassawa PHC, I’m overwhelmed by neglect and deprivation before I’m finally attended to,” Bilkisu added, her voice filled with distress.

Her story is not much different from Barira Alhasan’s, a 34-year-old hearing impaired mother of four, who despises the treatment of PWDs at Gabassawa PHC.

Alhassan faces significant challenges due to the lack of interpreters at the facility.

Conveying her pains to the reporter through a community interpreter, she said, “I know that the PHC isn’t accessible for the hearing impaired, so there is no point going there for my healthcare needs unless I go with someone who can explain to the doctor.”

A community hosting over 400 PWDs  

The village head of Mazan Gudu, Yusuf Abdullahi, voiced his deep frustration over the persistent exclusion of Mazan Gudu Primary Healthcare Centre (PHC) from the Basic Healthcare Provision Fund (BHCPF).

Despite the community’s population of over 5,000, with over 400 residents living with various disabilities, he lamented that the facility has been left without the vital resources needed for adequate healthcare delivery.

Yusuf highlighted the dire situation, emphasizing that these individuals, who are among the most vulnerable, have been denied access to essential health services.

The village head said he has tirelessly advocated for the inclusion of Mazan Gudu in the BHCPF, making repeated appeals to the Kano Primary Healthcare Management Board (KPHMB).

He added that he has provided compelling arguments, illustrating the urgent need for funding to improve healthcare services in a community where many rely on the PHC for their medical needs.

Yet, despite these efforts, he reported that no significant action has been taken to address the deficiencies at the facility.

“The neglect of our health needs is disheartening. We deserve better than this,” Yusuf told the reporter.

Yusuf’s concerns are also echoed by many others in the community who feel abandoned by the healthcare system. They noted that with insufficient medical resources, the facility struggles to meet the needs of its patients, forcing many of them to seek care in distant locations.

This has led to increased health risks and further marginalisation of already vulnerable PWDs.

Yusuf made an urgent need for change saying that the community waits for a response that could transform their healthcare landscape.

The BHCPF, established under the National Health Act of 2014, aims to enhance access to essential healthcare services for all Nigerians, particularly the vulnerable and underserved.

The BHCPF also aims to provide a Basic Minimum Package of Health Services (BMPHS) through Primary Healthcare Centers nationwide.

The key objectives of the BHCPF include ensuring the availability of essential drugs and medical supplies, improving the infrastructure and operational capacity of PHCs, and reducing out-of-pocket expenses for healthcare services.

The sick health facilities

Visits to Mazan Gudu Health Post, Gabassawa PHC, Yan Shana PHC and Hungu PHC, showed facilities in poor conditions. Findings at the centres revealed facilities with broken windows, peeling paint, and unsanitary conditions.

The Mazan Gudu facility, in particular, lacks basic amenities like electricity and running water, forcing those who can afford it to seek help from private hospitals or nearby patent medicine stores.

The financially disadvantaged have no choice but to rely on the inadequate Gabassawa PHC, approximately two kilometres away. For persons living with disability, particularly those with mobility constraints, this is an additional hassle in life’s daily grind and accessing healthcare.

‘Watching women suffer is heartbreaking’

The Woman leader in the community, Binta Sule, speaks with profound sadness about the desperate conditions at the PHC and the unique struggles faced by women with disabilities, especially during childbirth.

“It’s heartbreaking to watch these women suffer, particularly when they’re giving birth,” she says, her voice heavy with sorrow.

The absence of proper transportation forces women to be transported on a cart, usually reserved for moving goods and farm produce – a stark symbol of the neglect this community endures.

“We know this facility isn’t functioning as it should, but if we even had just an ambulance, we would have done everything to keep it running. In times of need, it would make all the difference in getting women to the hospital safely,” Binta explains.

She recounts a tragic incident during 2024 Ramadan when a woman lost her life due to the lack of timely transport.

Hajara Bashari’s final moments unfolded like a nightmare, as described by Sule, the Woman Leader in her community.

“The joy of her new baby was palpable when she gave birth at home in the afternoon, assisted by a local birth attendant. We all celebrated when we heard the baby’s first cry,” reflecting on the happiness that quickly turned to despair.”

By nightfall, that joy transformed into a harrowing tragedy.

“Around 9.00pm, Hajara began to bleed uncontrollably. We rushed her to Mazan Gudu PHC, hoping to find help, but the facility was locked, with not a single staff member in sight. We felt utterly helpless,” Sule recounted.

In their desperation, Sule said their group searched for transportation to the nearest healthcare facility, but the only option available was a cow-drawn cart. As they made their way through the darkness, Hajara grew weaker, gasping for breath.

“Time was against us. Before we reached halfway, she succumbed, leaving behind her husband and their newborn baby. It was a devastating day for our entire community,” the leader lamented, her voice heavy with sorrow.

“It’s even beyond sad that both able-bodied women and those with disabilities are sometimes pulled on a cart by a cow to reach the nearest hospital. This isn’t how any woman should be treated by the healthcare system in Kano,” Sule said in anger.

Reflecting on the broader neglect, Sule added, “When it’s time for elections, all our leaders come begging for votes, but after we fulfill our obligations, they forget about us. This has been the cycle, year after year.”

Also, in Gabassawa PHC where residents now seek healthcare, inadequate staff and equipment remain the order of the day. The facility lacks essential infrastructure such as ramps and elevators, making it difficult for wheelchair users.

The absence of sign language interpreters and visual aids further alienates PWDs from essential services.

A health worker, Gazali Ibrahim, a Community Health Extension Worker (CHEW), denied allegations of discriminatory treatment, stating that the facility treats all individuals equally.

The Part II of Accessibility of Physical Structure of the 2018 discrimination against persons with disabilities (prohibition) Act’ a healthcare center should have accessible ramps, wide doorways, and accessible restrooms for PWDs to ensure that they can navigate facilities independently and with ease.

For a PWD with hearing disabilities, the same Act dictates that a centre should have visual alert systems, sign language interpreters, and written communication tools to facilitate effective communication during their visit.

 Dashed hope

At Yan Shana PHC in Kumbotso LGA, 82-year-old Zainabu Umar, who lost her sight due to an illness, initially felt hopeful as a beneficiary of the BHCPF. However, the facility’s poor conditions and lack of essential services quickly dashed her hopes.

“What are they doing with funds from the BHCPF?” Zainabu questioned after being referred to a distant hospital for a simple test.   

The facility lacks tactile signage, braille labels, and audio communication devices, as well as other essential equipment such as functional diagnostic tools, reliable electricity, clean water supply, and adequate medical supplies.

“So, I felt there was no need to keep going there since it offered me no hope,” she stated.

‘Bureaucracy hampering use of funds’

Further investigation revealed that bureaucratic restrictions imposed by the Kano State Primary Healthcare Management Board (KSPHCMB) prevent the use of funds for necessary renovations and maintenance.

Yan Shana Community members accused the Ward Development Committee (WDC) and the Officer-in-Charge (OIC) of mismanagement, but WDC Chairman, Abubakar Jibrin, blames bureaucratic constraints.

Jibrin disclosed that the Kano State Primary Healthcare Management Board (SPHCMB) restricted the PHC’s use of funds, preventing essential renovations and maintenance.

“The money which is supposed to be paid into our account is over N300,000 but the only money we have been receiving since the beginning of this year is N270,000 and we have been instructed use the funds to purchase drugs only.

“The ban on spending our funds for renovation and other running costs in the center has taken us backwards,” Abubakar lamented.

He also explained that this means Yan Shana PHC is shortchanged more than N30,000.

When asked why these funds are withheld from the PHC, Abubakar stated that he was also oblivious of the reason, stressing that despite several pleas for clarification from the PHCMB, no response was given.

“I have been embarrassed more than two times by community members when they alleged that I siphoned their funds but I try to explain myself and keep assuring them that the facility will be fixed, hoping that the ban on spending funds for renovation will be lifted but all my assurances has failed and they now take my word with a pinch of salt.

“Just last year, we used the BHCPF to purchase a petrol generator to power the PHC when we need energy but it was stolen because we could no longer pay the security man because of the ban on spending our funds asides on drugs.

“If we had liberty to spend our funds the way we want, we would have started making plans on making this PHC accessible to PWDs because they are actually complaining to us about this problem.”

This kind of systemic issues have a negative effect on vulnerable people seeking healthcare, particularly PWDs like 82-year-old Zainabu Umar, who lost her sight in her sixties due to an illness. The shift from a life of ease to one of dependence marked a distressing chapter in her life, where every aspect of her daily routine required assistance.

Enrolled as a beneficiary of the BHCPF in 2021 at Yan Shana PHC in Kumbotso LGA, she initially felt a glimmer of hope. This support seemed a small compensation for her blindness, reducing her financial burden for healthcare.

However, this hope was short-lived. Yan Shana PHC, despite its accreditation under the BHCPF, was woefully ill-equipped to meet basic healthcare needs.

On a visit, it was evident that the facility lacked adequate seats, forcing women, including those with disabilities, to sit on the floor or thorny mats swarming with insects.

Umar’s frustration grew as she recounted being referred to the Murtala Mohammed Specialist Hospital (MMSH) (a general hospital in Kano city) which is about 11 kilometers away, for a simple blood glucose test — a service the PHC is mandated to provide, according to the BMPHS in the BHCPF guideline of 2020.

Her anger was profound as she questioned, “What are they doing with funds from the BHCPF?” The struggle to receive this essential care only deepened her suspicion of mismanagement by the facility.

She added, “When my son in-law took me to MMSH, the hardship we passed through just because the hospital couldn’t find my referral code for referrals under the BHCPF scheme was horrible. It took a lot of struggle and force before my rest was done. Why do I have to pass through this stress before accessing healthcare?

“Please let the government do something about the poor state of Yan Shana PHC so that people like me would not have to waste so much money travelling long distances to access healthcare when we have a hospital in our locality.”

The reporter took a tour round the facility and reports that the center stands as a stark symbol of a healthcare system in neglect and decay. Lacking accommodation for persons with disabilities (PWDs), the facility stood as a harsh reminder of the healthcare system’s failures, particularly for those like Zainabu, who navigate life with additional challenges.

The toilets are unusable, mucky with broken fixtures, and no running water, emitting a foul stench that saturates the air. Windows are shattered or absent entirely, leaving gaping holes that let in dirt, insects, and the elements.

The Hungu story 

Hungu PHC in Albasu LGA faces similar issues, with poor funding and lack of resources exacerbating challenges for PWDs.

Essential services and accessible medical equipment remain scarce, affecting the quality of care and undermining trust.

Zuludeen Alhassan, a visually impaired patient, described feeling invisible at the facility due to inadequate support.

The systemic issues at the Hungu PHC in Albasu LGA, exacerbate challenges for PWDs. Essential services such as accessible medical equipment and trained support staff remain scarce.

This neglect not only affects the quality of care but also undermines the trust and confidence of visually impaired patients like 51-year-old Alhassan who lives in a world devoid of sight, as he depends heavily on the support of others to accomplish even the simplest tasks.

In many instances, staff members are not adequately trained to assist PWDs, leading to unintended neglect or insensitivity. often feels invisible at Hungu PHC, as health workers fail to provide the necessary support for him.

“I sit for hours waiting for someone to notice me,” he said.

“Even when I am attended to, I am not usually satisfied with the quality of health service I am provided with. Active listening is an important skill that health workers need, to have productive interactions with visually impaired patients like me but all the time, they are always in a haste and sometimes I end up taking my prescription wrongly,” he stated.

Alhassan highlighted another significant issue PWDs face – the frequent non – availability of essential drugs.

He opined that the management of the PHC should set aside specific medications for PWDs to ensure they are readily available when needed, but unfortunately, this is not the case.

According to him, purchasing drugs out at pharmacies is really expensive and often lead people to visiting traditional medicine doctors which is cheaper but not as effective as modern drugs.

Alhassan recalls a time when he had to turn to a street beggar to fund his treatment.

“On that day, I waited for long hours as usual but when it was time to collect the my drugs, I was given a prescription and told to buy the drugs from a pharmacy. I was filled with anger as to why the PHC can’t set aside drugs for PWDs.

“I didn’t have the complete money so I turned to a street beggar, to fund my healthcare. If Hungu PHC really cared for PWDs I wouldn’t have to pass through such horrible experience,” Alhassan narrated.

Close observation showed that Hungu PHC lacks essential tactile guiding paths and Braille signage, making it difficult for visually impaired individuals to navigate the premises independently.

The WDC Chairman of Hungu PHC, Umaru Shehu, explained that due to a ban on using their funds, the centre cannot afford critical services and maintenance, including electricity, water, security, fence repairs, basic painting, and necessary equipment.

Despite repeatedly appealing to the PHCMB to lift this ban, their requests have been unanswered, forcing PWDs and other community members to endure the consequences of these unmet needs.

Shehu told Stallion Times that the facility has not received its complete funds (N320,000) for the past 4 months, although he refused to disclose the amount that is paid to the centre’s BHCPF account which is to be strictly spent on drugs, as instructed by the PHCMB.

Part 6 (39 ) of the 2021 Kano State Persons With Disabilities Law mandate accessible communication services and subsidised medical services for PWDs. However, implementation remains a problem.

The director of Planning, Monitoring, and Evaluation at the Kano State Primary Healthcare Management Board (KSPHCMB) Bashir Sunusi, assured that ongoing reforms would soon improve healthcare facilities.

“You will see changes by December this year,” he promised.

Sunusi also confessed that PWDs in Kano State live in misery. “The need for equal access to medical services is not just a policy matter but a fundamental human right. It is time to turn promises into action and deliver a healthcare system that truly serves all citizens, irrespective of their abilities,” he strongly argued.

According to the recommended mechanisms to strengthen accountability in implementing the BHCPF, health facilities are to produce a plan for how the BHCPF will be spent. Health Facility Committees are to monitor how revenue from the Fund is spent. However, the ban on spending their funds for renovations and other running costs by the PHCMB,  shows that Yan Shana PHC and others like has been stifled.

Significant challenges faced by PWDs 

The Kano State-led Accountability Mechanism (KanSLAM) is coalition of Civil Society, Government representatives and the media which is dedicated to improving the transparency and effectiveness of healthcare services. The  co-chair of KanSLAM, a pharmacist, Maimuna Yakubu, highlighted that facility spot-checks help point to highlight challenges faced by PWDs in accessing inclusive healthcare.

“The stories of these PWDs reflect the broader struggles of the disabled community in Kano,” she pointed out.

Yakubu emphasised that continuous advocacy to the PHCMB and other relevant stakeholders is crucial to overcoming these issues.

“There is a need for PWDs to be included in crucial decision-making processes at the PHCMB to influence policies that suit their healthcare needs,” she advised.

While the PHCMB may have its reasons for restricting funds for renovation and other running costs, it is imperative to allocate specific funding to meet the unique needs of PWDs.

Yakubu said each PHC has its distinct challenges, and lifting the ban on restricted funds is the first step towards improving access to healthcare. Additionally, ensuring targeted funding for PWDs is essential for creating a more inclusive and effective healthcare system.

“For PWDs to surmount these challenges they have to be empowered to advocate for their needs so that policy makers will interface with them and understand their need for better because outcomes because while KanSLAM and other organisations advocate on behalf od the PWDs, their capacity of the PWDs needs to be built to advocate for their healthcare needs themselves.

“There is a need for PWDs to be also included in the crucial decision-making table at the PHCMB so that they can influence policies to suit PWDs healthcare needs. I also want to use this medium to call on the Kano government to sponsor PWDs to read medicine, nursing and other health-related courses in the higher institution so that when they go back to their communities, they will implement the change they desire,” Yakubu advised.

Just like KanSLAM advocates for the access to healthcare for PWDs, the Resource Center for Human Rights and Civic Education (CHRICED) has also been at the frontline of advocacy for the health rights of PWDs to be upheld in the state.

The program officer the Centre, Zuwaira Omar, said CHRICED was at the forefront of the successful signing of the Free Maternal and Child health Law by the Kano House of Assembly.

“Right from time, we have been advocating for the inclusion of PWDs into the all health related programs in the state, asides the BHCPF in the state.  I suggest regular town hall meetings between the different leadership structures of PWDs in Kano and PHCMB so that gradually, they will tailor effective mechanisms to address their health care needs,’ Omar suggested.

Law on PWDs’ access to healthcare

Part 6 (39) of the Kano State Persons With Disabilities Law (2022) outlines some responsibilities of the government toward the healthcare needs of PWDs.

For effective implementation of the provisions of this law, it shall be the responsibility of the State Government to ensure that:

(a) Communication services are accessible to PWDs, which shall include sign language interpretation and information in Braille;

(d) PWDs are taken into consideration in the formulation and designs

of educational, health, sports, employment and rehabilitation policies and programmes;

(i) Medical services are subsidised or insurance are provided to PWDs.

In the Discrimination Against Persons with Disabilities (Prohibition) Act, 2018, government shall guarantee that PWDs have unfettered access to adequate health care without discrimination on the basis of disability.

(2) A person with mental disability shall be entitled to free medical and health service in all public institutions.

Improved healthcare delivery assurances to PWDs

KSPHCMB director, Sanusi explained that funding for the BHCPF has been temporarily suspended due to ongoing healthcare reforms, specifically the Sector-Wide Approach (SWAp).

He enlightened that SWAp is a coordinated agreement between governments and donors to streamline aid distribution for health sectors in developing.

According to him, these reforms have affected several health programmes, including the BHCPF.

He noted said that the NPHCDA had directed the pause in BHCPF funding to allow for the implementation of these reforms. The aim is to consolidate various funding streams into a single pool, which will improve the efficiency and effectiveness of fund distribution to health facilities, ultimately enhancing their operations.

Responding to concerns from Mazan Gudu residents about their exclusion from BHCPF benefits, Sanusi carified that the PHCMB does not determine which health posts receive funding. Selection of beneficiary facilities is handled by the NPHCDA, and Mazan Gudu’s case would need to be addressed at that level.

Beneficiaries’ selection process

“The selection process is managed by local government authorities who identify facilities in need,” he said, giving assurance that if Mazan Gudu health post is among the high-volume facilities requiring urgent funds, the PHCMB would advocate for its inclusion in the next funding round presented to the NPHCDA.

According to Sanusi, Recently, the Federal Ministry of Health, through the NPHCDA, conducted an assessment in Kano to determine the operational costs of running PHCs at various levels. In the coming months, facilities are expected to be adequately equipped to serve their communities.

State government’s commitment

“The Kano state governor has shown a strong commitment to healthcare by approving over 80 health-related proposals from the commissioner of health.

The healthcare needs of PWDs will be prioritised during the upcoming renovations to ensure their specific requirements are fully addressed.

“This robust plan for the PHCs which is coming soon and is a game-changer in the kano state health sector and the cost is running into billions, I assure you that on or before December, this year, you will see changes, because the DG of PHCMB, Commissioner of health have given their words and you will see that a lot of facilities in Kano will be greatly improved,” Sanusi assured.

As PWDs live in their misery, hoping for a time when they will have equal access to medical services in Kano, addressing their needs is not just a matter of policy but a fundamental human right.

It is time to turn promises into action and deliver a healthcare system that truly serves all citizens, irrespective of their abilities.

 *This report was done with support from the International Centre for Investigative Reporting, ICIR.