Deborah Tolu-Kolawole, Isah Ojo, Tukur Muntari, Maiharaji Altine, Umar Sani, Ikenna Obianeri, Patrick Odey, Emem Julius and John Charles

In spite of years of federal and state government investments running into billions of naira to revitalise Nigeria’s primary healthcare system, at least 6,516 Primary Healthcare Centres across the country remain non-functional, exposing millions of Nigerians — particularly those in rural communities — to limited access to basic medical services.

An analysis of data obtained from the National Primary Health Care Development Agency by The PUNCH shows that Katsina and Osun states account for the highest number of inactive facilities, while findings indicate that the crisis is even deeper in conflict-ravaged Borno, where hundreds of PHCs destroyed by insurgency are yet to be rebuilt.

The report also reveals that beyond dilapidated infrastructure, chronic shortages of health workers, insecurity, poor funding and weak maintenance continue to undermine years of revitalisation efforts.

According to the NPHCDA data from the agency’s Primary Health Care Dashboard Katsina State tops the list with 442 non-functional facilities, followed by Osun with 406, Benue (343), Enugu (335), Adamawa (286), Jigawa (282), Delta (278), Yobe (248), Lagos (246), Ogun (246), Bauchi (229), Edo (221), Rivers (218) and Borno (159).

Others are: Bayelsa (120), Kwara (87), the Federal Capital Territory (68), Nasarawa (58), Sokoto (45), Oyo (40), Niger (35), Imo (34), Kebbi (32), Cross River (30), Kano (26), Zamfara (23), Plateau (18), Kogi (14) and Akwa Ibom (10), among others.

However, separate findings by The PUNCH revealed that the situation in Borno may be significantly worse than reflected on the national dashboard.

While the NPHCDA dashboard lists 159 non-functional PHCs in the state, the Director of Community and Family Health at the Borno State Primary Health Care Development Board, Dr Mala Wahab, disclosed that 358 primary healthcare facilities remain destroyed after more than a decade of Boko Haram insurgency.

According to Wahab, Borno had 735 PHCs before the insurgency but now has only 377 functioning facilities following years of destruction.

“Before insurgency, we had 735. Insurgency destroyed a lot of primary healthcare facilities,” he said.

He added that the administration of Governor Babagana Zulum had increased the number of operational PHCs from fewer than 100 to 377.

“Before Zulum assumed office, we had less than 100 primary healthcare centres, but now we have 377,” he said.

Wahab disclosed that three additional PHCs are about 70 per cent completed and would increase the number of functional facilities to 380 upon completion.

“When they are finished, we will have a total of 380. They are spread across all the local government areas. All of them are accessible and serving residents where they are located,” he added.

He noted that despite significant investments in infrastructure and equipment, manpower shortages driven by brain drain continue to affect service delivery.

“The state government was able to provide human resources for all of them as well as equipment and modern infrastructure, while development partners are complementing our efforts.

“Recently, the state employed more than 1,400 health workers deployed across the locations. Although we are affected by brain drain and people leaving in search of greener pastures, we have lost many workers, especially in hard-to-reach areas where people are afraid to work,” he said.

The NPHCDA dashboard further showed that Nigeria currently has 3,128 functional Level 2 PHCs, 3,275 revitalised PHCs and 5,141 facilities supported through the Basic Health Care Provision Fund.

The figures highlight the widening gap between infrastructure investments and actual service delivery at the grassroots, where millions of Nigerians depend on primary healthcare centres for essential medical services.

Primary healthcare centres are regarded as the foundation of every functional health system because they provide preventive, promotive, curative and rehabilitative healthcare close to where people live.

They offer routine immunisation, antenatal and postnatal care, skilled birth attendance, family planning services, treatment of malaria and common childhood illnesses, nutrition services, tuberculosis and HIV screening, disease surveillance, health education and referral services.

For many rural communities, PHCs represent the first—and sometimes only—point of contact with the healthcare system.

Health experts have consistently warned that when PHCs become non-functional, residents are often forced to travel several kilometres to secondary or tertiary hospitals, delay seeking treatment, patronise unqualified healthcare providers or resort to self-medication.

Such delays contribute significantly to maternal deaths, infant mortality, vaccine-preventable diseases and poor health outcomes, particularly among children under five years and pregnant women.

The development comes despite sustained investments by the Federal Government and development partners to revive Nigeria’s primary healthcare system over the last decade.

One of the flagship interventions is the Primary Health Care Revitalisation Programme, coordinated by the NPHCDA in collaboration with state governments.

The initiative was introduced to rehabilitate thousands of dilapidated PHCs by renovating buildings, providing potable water, electricity, staff accommodation, delivery rooms, laboratories, cold chain equipment for vaccines, solar power installations and essential medical equipment.

The programme also seeks to ensure that every ward in Nigeria has at least one fully functional primary healthcare centre capable of delivering a minimum package of health services.

A major financing mechanism supporting the initiative is the Basic Health Care Provision Fund, established under the National Health Act.

The BHCPF receives at least one per cent of the Federal Government’s Consolidated Revenue Fund and is designed to strengthen service delivery at PHCs by financing essential drugs, vaccines, consumables, equipment maintenance, emergency transportation, healthcare worker incentives and facility upgrades.

The fund is implemented through agencies including the NPHCDA, the National Health Insurance Authority and the Nigeria Centre for Disease Control and Prevention, while states are required to meet accountability and counterpart funding requirements before accessing the intervention.

Since the commencement of BHCPF implementation, thousands of PHCs have benefited from rehabilitation works and operational funding aimed at improving service delivery across the country.

Successive administrations have also launched several programmes to strengthen primary healthcare, including the “PHC Under One Roof” policy, which seeks to integrate fragmented PHC management under a single state authority to improve governance, financing and accountability.

The Tinubu administration has continued to prioritise primary healthcare as part of its broader health sector reforms.

The Federal Government recently announced plans to upgrade thousands of PHCs nationwide, recruit and retain more frontline health workers, expand digital health systems, improve medicine availability and increase funding for grassroots healthcare as part of efforts to achieve Universal Health Coverage.

The government has also intensified the revitalisation of facilities through partnerships with state governments, development partners and international donors.

Despite these interventions, public health experts say infrastructure alone is insufficient to transform healthcare delivery.

They argue that many renovated facilities remain underutilised because they lack skilled health workers, essential medicines, laboratory services, electricity, water supply, functional ambulances and adequate security.

Kano equips PHCs

While the NPHCDA dashboard paints a grim national picture, some state governments insist ongoing investments are improving access to primary healthcare despite infrastructure and staffing challenges.

In Kano, the Commissioner for Health, Dr Abubakar Yusuf, said the state had rehabilitated and equipped 320 Primary Healthcare Centres in the last three years.

Speaking at a news conference to mark the third anniversary of Governor Abba Kabir Yusuf’s administration, Yusuf said the government inherited 1,236 dilapidated health facilities in 2023.

“When we came in 2023, we found 1,236 health centres in dilapidated condition. I am happy to inform you that within the last three years, the government has renovated and equipped 320 PHCs,” he said.

He added that additional healthcare personnel had been recruited through collaboration with the Federal Government and disclosed that the state planned to employ about 7,000 more health workers, including nurses and midwives, to strengthen service delivery.

According to him, the administration has also revived training and retraining programmes for healthcare workers, secured accreditation for several health-related courses and created opportunities for medical doctors to attain consultant status.

Corroborating the commissioner’s position, the Public Relations Officer of the Kano State Ministry of Health, Abubakar Nabulisi, told The PUNCH that the rehabilitated facilities were adequately staffed.

“All the facilities have qualified doctors, nurses and midwives and they are being paid by the state government,” he said.

States fault report

In Zamfara State, the Executive Secretary of the State Primary Health Care Board, Dr Hussaini Anka, dismissed suggestions that Primary Health Care Centres in the state had been abandoned, insisting that facilities across all 14 local government areas remained operational despite insecurity.

He acknowledged, however, that the centres were grappling with inadequate manpower.

“Our Primary Health Care Centres are still functioning in all the 14 local government areas of the state, and none has been closed despite the security challenges,” Anka said.

“We are only lacking enough staff to adequately attend to patients, but Governor Dauda Lawal has approved the recruitment of additional personnel. That process is ongoing, and by the grace of God, we will recruit enough staff for all our PHCs within a short period.”

Similarly, the Benue State Commissioner for Health and Human Services, Dr Paul Ogwuche, said it was misleading to assess the functionality of PHCs based solely on the presence or absence of medical doctors.

“Primary Health Care Centres are not designed to be routinely staffed by medical doctors,” he said, explaining that they are primarily run by community health officers, community health extension workers, nurses, midwives, environmental health officers, laboratory personnel and pharmacy technicians.

He noted that doctors are generally deployed to secondary and tertiary health facilities where specialised clinical services are provided.

Ogwuche maintained that the Benue State Government had continued to strengthen PHCs through renovations, equipment upgrades and the provision of essential medicines with support from the Federal Government and development partners.

“The vast majority of Primary Health Care Centres across the state remain functional and continue to provide essential healthcare services,” he said, adding that health workers employed by the state continued to receive their salaries and other approved entitlements.

Lamentation in Bauchi

However, findings by The PUNCH showed that many Primary Health Care Centres in Bauchi State are increasingly dependent on volunteer health workers, including nurses and midwives, due to a shortage of government-employed personnel.

Visits by our correspondent revealed that inadequate staffing has forced volunteers to shoulder much of the workload in several facilities.

A health worker, who spoke on condition of anonymity because he was not authorised to speak on the matter, said the shortage had placed enormous pressure on the few permanent staff members.

“We are overstretched. We are only assisted by volunteers who graduated from health-related colleges but have not secured government employment,” the source said.

Asked how the volunteers were remunerated, the health worker explained that only government employees received salaries.

“The few of us who are government staff are paid by the state. The volunteers receive no salary; their only reward is the experience they gain,” the source added.

The situation has raised concerns about the sustainability of primary healthcare delivery in the state, with volunteers providing critical services without remuneration.

Efforts to obtain the reaction of the Bauchi State Primary Health Care Development Board were unsuccessful, as the board’s Public Relations Officer, Ibrahim Sani, had yet to respond to enquiries as of the time of filing this report.

States defend investments

Meanwhile, the Akwa Ibom State Government said it has over 400 Primary Health Care Centres spread across the state’s 31 local government areas, managed by the Akwa Ibom State Primary Health Care Development Agency.

Although the state Commissioner for Health, Dr Ekem Emmanuel, could not be reached for comments, a source in the Ministry of Health, who spoke on condition of anonymity because he was not authorised to speak on the matter, said the existing number of PHCs was still inadequate to meet the healthcare needs of residents.

According to the source, several communities and wards are yet to have functional primary healthcare facilities.

“Akwa Ibom has over 400 Primary Health Care Centres and, as we speak, the state is building new ones. But the number is still not enough because some communities, including Unyenge in Mbo Local Government Area and others, are yet to have functional primary healthcare centres,” the source said.

Asked about the number of functional facilities, the source said, “I don’t have the statistics, but I know many communities have functional Primary Health Care Centres across the state.”

In Anambra State, the government said it has no fewer than 441 Primary Health Care Centres spread across its 21 local government areas and 179 communities, supported by about 3,000 healthcare workers, including doctors, nurses and other medical personnel delivering community-based services.

The Commissioner for Health, Dr Afam Obidike, disclosed this in a telephone interview with The PUNCH on Thursday, saying the recruitment formed part of Governor Chukwuma Soludo’s efforts to address manpower shortages and improve healthcare delivery.

Obidike maintained that PHCs across the state are fully functional, offering free antenatal care, childbirth services and surgeries.

“The PHCs have been upgraded across the 21 local government areas and are functioning effectively with state-of-the-art facilities. These centres provide free antenatal care, child delivery services and surgeries.

“These are part of the state government’s efforts to strengthen access to affordable healthcare, particularly in rural communities. At least 10 health workers have been assigned to each of the state’s 326 wards to address staffing shortages in Primary Health Care Centres,” he said.

Also speaking, the Executive Secretary of the Anambra State Primary Health Care Development Agency, Chisom Uchem, said the ongoing reforms were designed to improve grassroots healthcare delivery through the deployment of qualified personnel.

However, the TB Network Advocacy Team expressed concern over what it described as the chronic underfunding of Primary Health Care Centres in the state despite multiple government interventions and support from development partners.

The organisation said the funding gaps continued to undermine service delivery and health outcomes across Anambra.

In Cross River State, the government said it had recruited more than 2,000 health professionals to strengthen primary healthcare delivery.

The Commissioner for Health, Dr Henry Ayuk, told The PUNCH that the recruitment was aimed at addressing manpower shortages across the state’s health facilities.

“The state has already employed over 2,000 health professionals under this administration. They include nurses, doctors, laboratory scientists, pharmacists and other healthcare professionals,” he said.

Ayuk added that, with support from the National Primary Health Care Development Agency and counterpart funding from the state government, each of Cross River’s 196 political wards now has at least one functional Primary Health Care Centre.

“Across the 196 wards, each health centre has at least one bed attendant and access to a medical doctor. Deliveries, surgeries and other essential health services are carried out there,” he said.

He, however, explained that due to a shortage of medical doctors, physicians currently supervise three to four PHCs within a jurisdiction rather than being permanently stationed at a single facility.

“But with the approval to recruit 40 additional doctors, I am confident service delivery will improve further,” he added.

The Director-General of the Cross River State Primary Health Care Development Agency, Dr Vivien Mesembe, also said the state’s PHC system had recorded significant improvements under Governor Bassey Otu’s administration.

She recalled that many facilities were in deplorable condition when she assumed office.

“Some of the facilities were so dilapidated that they were unfit for human use. Patients had resorted to traditional birth attendants and patent medicine vendors because our facilities were neither functional nor adequately staffed,” she said, adding that the state was digitising PHCs across its 196 wards while strengthening routine immunisation services.

Experts demand reforms

Health advocates have said revitalising Nigeria’s primary healthcare system will require far more than renovating dilapidated facilities, calling instead for increased funding, stronger governance, improved accountability and better welfare packages for frontline health workers.

Speaking with The PUNCH, the Deputy National Coordinator of TiB and an ambassador of the National Primary Health Care Development Agency’s Primary Health Care Under One Roof initiative, Jonathan Ugbal, attributed the challenges facing Primary Health Care Centres to poor remuneration, weak political commitment and inadequate funding.

“The Alma Ata Declaration made it clear that Primary Health Care Centres are the foundation of every health system. The problem of non-functional PHCs is rooted in poor remuneration, lack of political will and other systemic bottlenecks,” he said.

Ugbal called for stricter implementation of the Basic Health Care Provision Fund, insisting that resources earmarked for primary healthcare should be released directly to PHC Boards or facilities rather than being diverted to higher levels of care.

“These funds must get to the PHC Boards or Agencies and should not be diverted to tertiary facilities. Where possible, they should be disbursed directly to the facilities, alongside the statutory five per cent allocation from local governments. States that fail to comply should face sanctions,” he said.

He also advocated autonomous Primary Health Care Boards in all states, separate salary structures for PHC workers, enhanced welfare packages and rural posting allowances to attract and retain skilled health personnel.

“While there is growing enthusiasm for ultra-modern hospitals, there is a need to refocus attention because PHCs remain the first point of contact for basic healthcare, immunisation, maternal and newborn care. Public office holders should also be assessed based on the number of functional PHCs, staffing levels and the availability of essential medicines to encourage healthy competition,” he added.

Similarly, the Advocacy Manager at Rural Healthcare for All, Ayodamola Oluwatoyin, urged state governments to take full advantage of the Basic Health Care Provision Fund to strengthen primary healthcare services.

“We are seeing considerable efforts at revitalisation, and states need to key into this initiative. The NPHCDA is doing a lot and deserves commendation,” she said.

“The Basic Health Care Provision Fund is available for every state to access. Health is a fundamental right of every citizen. We need functional PHCs because when people, especially those in rural communities, cannot access basic healthcare, the consequences are severe,” Oluwatoyin added. (PUNCH)

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