For some Nigerians, the Primary Healthcare (PHC) system is the first point of contact with health. At the PHC level, short-term, uncomplicated health issues ought to be resolved.
It is also the level at which health promotion and education efforts are undertaken, and where patients in need of more specialized services are connected with secondary care.
In this Investigation, Stephen Enoch visited Mazan Gudu PHC in Gabassawa, Doka PHC in Tofa and Achika PHC in Wudil Local Government Areas (LGAs) and reports.
On 20th July 2022, a community member in Mazan Gudu, Gabassawa LGA, Auwal Adam called on Stallion Times to expose the deteriorating state of the Mazan Gudu Health Post which according to him, caused outrage over the death of Dahiru Sule, a community member in the locality.
According to Auwal, Dahiru Sule died because Mazan Gudu PHC couldn’t offer first aid or any form of treatment to him after he had a ghastly accident.
After one year and six months, Stallion Times paid a visit to the community.
Mazan Gudu is a locality in Gabassawa where residents thrive on farming cash crops and carrying out menial jobs like block moulding, hawking street food, and others.
On reaching Mazan Gudu PHC, Usman Yusif, a local block maker who was passing by shouted from afar: “Everyone in this town is angry because this facility is dead and has caused a lot of difficulties and sad memories for us.
“The incident that still remains fresh in our memories is the death of Dahiru who used to live in the premises of this PHC.
“If you give me N60,000 I will mould blocks that will be enough to renovate this facility and even build an extra room.”
Usman Yusif a local block molder in Mazan Gudu. Photo: Stephen Enoch
Stallion Times learnt that Dahiru Sule volunteered to keep watch of the PHC as the facility had been burgled in 2021 and mosquito nets meant for distribution in the community were carted away because the facility lacks fencing and security to keep watch over it.
21-year-old Fatima Dahiru is the first child of the deceased Dahiru Sule and she is still agonized by the lack of quality healthcare delivery in the community.
To date, she blames the death of her Father on Mazan Gudu Health Post.
She believes that the heartbreaking loss of her Father could have been prevented if the facility was functional.
Fatima Dahiru, the daughter of Late Dahiru Sule. Photo: Stephen Enoch
On September 2021, Dahiru set out to the market to buy fertilizer but on his way back home, he had an accident along Gabassawa road and was rushed to Mazan Gudu health post since it was closeby for first-aid treatment as he was losing blood.
On arrival at the PHC, no health worker was around to attend to him or refer him to a higher health facility so, he was rushed to Gabassawa General Hospital where they spent more than 2 hours without response as the center was crowded with so many patients.
“Since the general hospital was crowded, we had no option but to take him to a traditional medicine doctor. His situation could not be handled there so we took him to a clinic where he was later stabilized.
“It was late in the night at 1 am that my father’s loud shout for help woke us up. He was crying of pain and we discovered that parts of his bed sheet was soiled with blood.
“At that point, we knew that all hope was lost because there was no means of transporting him to the general hospital and no clinic in Gabassawa would be open at that time.
“My father slowly died that night in pain and blood.
“At about 3 am, some relatives came to the house and witnessed the tragedy and at 7 am, his corpse was taken for burial.
“May Allah forgive the people in charge of managing the PHC because I am still sad that my father died because they abandoned the facility and when we needed it the most, they were unavailable.
“Remembering the moment my father died right in my presence always frightens me and I pray that none of my family or friends will pass through such pain,” Amina narrated.
While speaking, this reporter realized that Amina became angered as she raised her voice in anger over the bad state of the PHC which she said cost her father’s life.
Her voice had risen to a level where passersby wondered what could have triggered her to speak in such a harsh tone. It got to a stage where the interview was stopped abruptly and she walked into the house in anger.
Amina left the interview and walked into the house in anger. Photo: Stephen Enoch
According to the Red Cross, certain accident related deaths are attributed to the non-availability of first aid. This however suggests that Dahiru’s death could be prevented if he was administered first-aid when he was taken to Mazan Gudu health post.
Meanwhile, two years had passed after Dahiru’s death but the staff of the PHC were still nowhere to be found. When Stallion Times visited the PHC, it was in a deplorable state.
There was no sign of any staff or patients inside as the centre was under lock and key. The floor had become cracked and parts of the roofing were badly damaged.
Mazan Gudu PHC. Photo: Stephen Enoch
When this reporter took a peep through the window of the PHC to see the interior, close observation showed that termites had eaten up most of the wooden furniture as the interior was covered with cobwebs.
Sections of Mazan Gudu PHC. Photo: Stephen Enoch
A tour around the PHC revealed that the PHC wasn’t connected to the national grid with no alternative source of power supply. Consequently, the toilets were also in a decrepit state as the septic tank was filled, causing a stink around the area.
Sections of Mazan Gudu PHC. Photo: Stephen Enoch
According to the National Primary Healthcare Development Agency (NPHCDA) Minimum Infrastructure standard for a Health Post, the centre should amongst others, have two rooms with cross ventilation and the roof must be in good condition with functional doors and netted windows.
The PHC should have functional separate male and female toilet facilities with water supply within the premises, and be connected to the national grid or other regular alternative power source.
It also stipulates that the centre should be clearly signposted and should have staff accommodation provided within the facility.
Hours for operation are from 9am – 4 pm, or 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.
Building plan for a Health Post. Photo: NPHCDA
Mazan Gudu Community Association Calls for Help
The death of Dahiru was so painful that Mazan Gudu Community Development Association decided to come up with a plan to fix the PHC and employ a temporary staff to run its activities since the centre opens occasionally.
Wasulu Abdullahi, the secretary of the association disclosed that the group started making little contributions towards renovating the PHC and stocking it with a first-aid, to prevent what happened to Dahiru from recurring.
“Renovating this health post and buying some essential commodities will cost us nothing less than N200,000 and we have been making contributions since last year but we can only boast of N50,000.
“On behalf of the association and the community members, we are pleading to charitable organizations or Non-Governmental Organizations to help us renovate this PHC and keep it running so that preventable deaths can be avoided,” Abdullahi pleaded.
PHCs Poor State Relegates Women to Giving Birth at Home
In Doka community, Tofa LGA, women have developed a preference for giving birth to children at home rather than visiting Doka PHC.
32-year-old, Sa’adatu Lawan, nearly lost her 7th child when she attempted to give birth to the baby at Doka PHC.
According to Sa’adatu, she had been persuaded by health workers who came for a sensitization exercise at Doka to give birth to the baby at the hospital rather than opting for the services of Traditional Birth Attendants (TBAs) when she was pregnant for the child.
“Because I was convinced that giving birth to my child in a health centre is safer than elsewhere, I agreed and on the day I was in labour, I went to Doka PHC.
“Surprisingly, the health worker there told me they did not have some kits that will be used to conduct the delivery so I went home to get some of the items I had at my disposal.
“Trekking back home to get the equipment felt so frustrating as I was in pain and on the road, although, the PHC is just about 200 meters away from my house.
“While walking home, my water broke and I began to feel the intensity of the labour pain.
“Immediately I entered the house, the baby started coming out so I just had to lay on the floor of my room and cried for help.
“Thank God for my neighbours who quickly called an Unguwarzoma (Hausa word of TBA) who came and aided in the delivery of my child.
“From that day, I swore not to give birth to any of my children there,” Sa’adatu disclosed.
“If you go to the PHC, the female ward is unkempt and their toilets will entirely discourage you from going to the facility because it is too dirty.
“They lack manpower and there is no stable midwife to conduct deliveries. When people need their services, it is either they do not have it or maybe they have closed for the day.
Sa’adatu’s neighbor Lami, is part of the population with a preference for delivery at home, not minding possible risks.
According to her, the lack of manpower and the worsening condition of the centre discourages most women from birthing their children there.
When this reporter visited Doka PHC officials maintained that the PHC is not understaffed but this reporter saw only a few workers on-site at the time of filing this report.
Doka PHC. Photo: Stephen Enoch
According to the pharmacist in charge of the pharmaceutical department, Abdulmuni Saminu, the facility does not admit patients from 4 pm as the duration of service to the community is from 7 am to 4 pm daily.
When asked about the poor patronage of the PHC by the community members, he said “We don’t have any patients currently, when the weather changes the people’s health changes and that is when they come to us.”
According to an official who spoke anonymously, one of the reasons for low patronage of the PHC by community members is as the result of few equipment.
He further revealed that the constant transfer of staff from the facility is another reason for the low patronage from community members.
“Community members lack cooperation with the new medical personnel attending to them due to familiarity with previous medical practitioners that have attended to them in the past.
“Some of them are usually uncomfortable with the new faces,” He disclosed.
Equipment covered in dust and an empty female ward in Doka PHC. Photo: Stephen Enoch
A discreet investigation by this reporter revealed that Doka PHC has 17 staff on the roaster, but this conflicted with what the reporter saw at the time of the visit to the centre.
The shelves for drugs could only boast of a few commodities, which coincided with the narrative of Sa’adatu and other community members.
Checks at the facility also indicate that there was no patient on admission as all the wards were empty with dusty beds which indicates that it has been out of use for a while.
This reporter also discovered that most of the medical equipment seen was covered in dust as some lay fallow.
Sections of the PHC in poor condition. Photo: Stephen Enoch
Although officials said the PHC had an adequate power supply, there was no power supply at the time of visiting this facility.
The poor hygienic conditions of the toilets were an eyesore the surroundings of the PHC were bushy as it had been overgrown with grasses.
Picture of a toilet in the male ward of Doka PHC. Photo: Stephen Enoch
There was no ambulance for emergencies on site and these conditions amongst others as observed by Stallion Times, corresponded to the reasons why women prefer to give birth at home and why community members barely visit the centre.
Like Doka, Like Achika
In Achika, community members disclosed to Stallion Times that they prefer accessing medical services from Yan Gargajiya (Traditional medicine doctors) and pregnant women have a preference for traditional birth attendants for delivery.
This reporter was denied access to the facility for unexplained reasons. The health worker who spoke said he was acting on “instructions” given to him by a higher authority.
The reporter made his way into the community where he met with Fatima Yusuf, a former temporary staff of Achika Health Post.
According to Fatima Yusuf, Achika Health Post barely serves the community as members prefer Yan Gargajiya to visit the facility.
She disclosed that the Facility is under-equipped, which makes officials refer patients to any close hospital be it private or government-owned when confronted with serious health issues.
A community member who visited Yan Gargajiya after an accident. Photo: Stephen Enoch
She revealed that the major activities that are carried out in the facility are antenatal and immunization.
Fatima recalled one of the worst moments she experienced in the PHC while she was working there.
She narrated her experience: “A patient came with his wife to deliver their baby in September 2021. It was their first child and they opted for the services of a midwife rather than TBAs.
“I was surprised because most women in this community prefer to give birth at home because the PHC has no stable midwife and is inconsistent in its services.
“At 7 am on that Thursday morning, Hassan rushed into Achika health post with his wife who was in labour. It is complicated and she could not give birth on her own.
“The sad thing was that the midwife who used to assist with deliveries sometimes was not around and her number was not reachable.
“Hassan’s wife was in labour from 7 am to 4 pm in the evening without delivering the baby. I could feel her pain because she was in so much discomfort.
“Hassan was left with no option than to call a mid-wife but just when he came to tell us that a mid-wife was coming, his wife delivered a dead baby,” She narrated.
These children were given birth to, at home, says Amina. Photo: Stephen Enoch
Findings from community members revealed that the PHC has insufficient health workers, and low community participation, just like Doka PHC and Mazan Gudu PHC.
According to a World Health Organization (WHO) report titled; Improving maternal and newborn health and survival and reducing stillbirth: Progress Report 2023’,
Kano State Primary Healthcare Management Board Keeps Mum
Despite multiple attempts to obtain a response, the Kano State Primary Healthcare Management Board remained unresponsive, failing to return calls or messages from Stallion Times at the time of filing this report.
This publication was supported by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) through Stallion Times under the Collaborative Media Engagement for Development Inclusivity and Accountability Project (CMEDIA) funded by the MacArthur Foundation.
