Investigations
INVESTIGATION: In Zamfara, forgotten Health Center throws community into health crisis
In the late evening of Friday, September 14, 2024, shortly after the Maghrib prayer, Bashir Muhammad, a 34-year-old father of seven who has been suffering from typhoid fever for a decade, sat down innocently, contemplating where to seek medication the next day. He had previously relied on the Primary Health Care (PHC) center for treatment. However, for the past five years, he has been unable to visit due to the facility’s poor condition.
Muhammad was initially hopeful when the PHC was converted into an infectious disease facility in 2020, believing it would improve his access to treatment. However, his optimism faded as both the new facility and the original PHC continued to be neglected by the authorities.
For nearly a decade, Muhammad visited the center regularly for medical services. But now, he has spent five years without using the PHC due to its deteriorated state. His faith in the facility has been eroded as its condition worsened with an empty pharmacy.
Currently, Muhammad relies on a local chemist in the Damɓa Community for medical care, although he’s getting better despite the rising costs of living. He described his situation: “The illness began after I got married. Whenever it flares up, I experience fever, abdominal pain, and yellow vomiting. I used to visit the center for injections and other medications, but now I avoid it because of the facility’s condition. Instead, I turn to a local chemist in Damɓa, as there is no functional health facility nearby and traveling to Gusau is too costly given the current cost of living”.
A report showed that typhoid remains a global public health problem with a higher burden in low-and middle-income countries due to poverty, estimated to cause between 9.9 and 24.2 million cases and 75,000-208,000 deaths per year globally. Another report also indicated that in Nigeria and other developing countries, incidence of typhoid fever is estimated at 540 per 100,000 annually with an annual mortality rate of 2.5 per 100,000 persons. The disease is believed to be caused by drinking contaminated water and poor personal and environmental hygiene.
Damɓa Community, located in Gusau Local Government Area of Zamfara, Nigeria, is about 4-5 kilometers from Gusau metropolis and has a population of around 14,000. It borders the ancient town of Kwatarkwashi, surrounded by mountains and rivers within the Bungudu Local Government Area.
Despite its sizable population, the community continues to struggle with inadequate infrastructure, including poor road access and a severely under-equipped Health Centre. This facility lacks essential medical equipment, latrines, and reliable electricity, though it is staffed appropriately. Consequently, residents face significant health challenges and frequent crises due to limited access to quality healthcare services.
Deteriorated condition of Damɓan abandoned PHC Photo credit: Shehu Muhammad Shehu
This could hamper the Federal Government’s efforts in actualizing one of its strategic policy Universal Health Coverage (UHC) to provide quality healthcare delivery at the grassroots level in Nigeria.
Residents in Frustration
This situation has caused serious frustration and anxiety among many residents, who face significant health risks due to inadequate healthcare services. Balkisu Shu’aibu, a mother of two, shared her distressing experience after spending five years using the neglected PHC. “I was brought here for labor with my first child but had to run away because they lacked a proper delivery room and toilets,” she recounted. She noted that while in the labor room, the leaking roof made the situation even worse by drenching her.
She added that for her second child, she was compelled to stay and deliver at the PHC despite the poor conditions. “I had to deliver on the bare floor with no bed and no toilets. When I needed to relieve myself, I had to go to neighboring houses because I had no other option,” Balkisu said, clearly upset.
Balkisu Shu’aibu standing in front of the PHC after collecting malnutrition milk for her one-year-old baby Photo credit: Shehu Muhammad Shehu
Balkisu, lamenting that they have no other viable options and find the hospital only manageable due to its proximity, urged the government to provide assistance. “Life is becoming more costly, and we have nowhere else to go,” she said
Another 25-year-old, nursing mother, Shamsiya Tukur, who brought her child for immunization, reported that, aside from immunization and prescriptions, getting medicine in the PHC has become an unachievable dream for her. “I have come here more than 20 times without receiving any medicine. The doctors simply prescribe the medication and ask us to buy it ourselves,” she said annoyingly.
She expressed her frustration at having to seek out a chemist for medications rather than receiving everything at the center when she comes for antenatal and other medical services.
For Umar Bello of 40, a resident of Damɓa, the situation in the health center is unbelievable despite being a public healthcare facility. “Look at the uprooted roofing, look at the ceiling, doors and windows and this is where we are being treated. This is very very unfortunate”, he said with a frustrated look on his face.
He added that “there are only six beds in the center and that is where both men, women and young children are being admitted. We want the government to help us to make this PHC look beautifully like that covid-19 center which remains inactive for four years”, Bello implored.
Health Workers’ Struggles
Rabi’u Ibrahim, the Officer In charge of Damba Primary Healthcare, dedicated and spent more than a decade working in the PHC with his team of health professionals; despite the overwhelming challenges of infrastructure and medications, they remained committed to providing quality healthcare to the community.
Women and children waiting for health personnels to attend to them in a rotted hall at Damɓa PHC. Photo credit: Shehu Muhammad Shehu
Dr Ibrahim said despite all their tireless efforts and sacrifice, lack of infrastructure, medical equipment and the deplorable condition of the facility is discouraging residents from coming to the center for medical services.
“Our main concern is that whoever came to this hospital with his family and saw the condition we are in, he would never come back again despite the fact that we have the technical staff to treat the patients”, said Dr Ibrahim in a pitiful tone.
The facility, with 25 staff members, operates out of a dilapidated hall and four small rooms with rotted, leaking roofs. These rooms are used for consultations, a ward with just six beds for both male and female patients, and a pharmacy with nearly empty stock. Due to the poor conditions of the center, its workers are forced to admit patients for only a day. “We only admit patients for a day because we don’t run shift duty and the condition of the PHC is totally bad, however, we only have 6 beds in our ward”, he added pathetically.
The general ward with only 6 beds where male and females are admitted. Photo credit: Shehu Muhammad Shehu
Zaharadden Muhammad, a health worker at the PHC, stated that the center is in desperate need of emergency aid and has not received any government attention for a long time. “One of the major challenges we face is the lack of government support. The PHC should be on the list of facilities receiving government support, given the data we collect monthly. We do not have RDT machines to diagnose malaria, which is prevalent in the rainy season,” Muhammad explained.
He further noted, “I can’t even remember the last time we received medical equipment from the government. We can only prescribe and ask patients to buy the medicine themselves, which some cannot afford. Our pharmacy is nearly empty, despite having a technician to manage it. Currently, we can only offer prescriptions and immunizations due to the lack of equipment, medicines, and adequate facilities.”
The empty pharmacy of Damɓa Primary Healthcare Center. Photo credit: Shehu Muhammad Shehu
Residents lamented that they are now left struggling with various ailments, including hypertension, diarrhea, malnutrition, typhoid and malaria. While malaria is the most prevalent disease affecting the community, especially during this rainy season.
A Relocation Nightmare with Failed COVID-19 Center
Covid-19 pandemic brought a new challenge for Damba residents as their beacon health center was converted to covid-19 center, they were equally left without a functional health facility after it was relocated to a new site.
According to a document obtained by UDEME, in 2020, the the Bello Matawalle-led administration allocated the sum of N48.96 million Naira for the conversion of Damba Primary Healthcare Center to COVID 19 Centre. The contract which was assigned under the state ministry of Health was awarded to AKA Dino Multi Biz Ltd company with a duration of three months to be completed.
The signboard of the failed COVID-19 center. Photo credit: Shehu Muhammad Shehu
As one approaches the newly converted COVID-19 center, located along Gusua-Zaria Road, in Damɓa, Gusau local govt, the impressive building will welcome you. The center is well-constructed, fenced, interlocked and painted, but surprisingly, it has remained inactive.
When touring the Centre, this reporter observed that although the PHC had been completely converted to covid-19 center with an amazing look, there was not a single staff in the center apart from a watchman, while the