SPECIAL REPORT: Broken Promises: Neglected Kwara PHCs costing lives

By Abdulganiyu Abdulrahman Akanbi

The road leading to Tswako, a rural community in Lafiaji, the headquarters of Edu Local Government Area of Kwara State, is hellish. When residents pray not to fall sick or need medical attention, they simply want to evade the excruciating pains of travelling on the bumpy, earthen road to the community’s dilapidated Primary Healthcare Center (PHC).

It was in late February. Birds, goats and reptiles had taken over the abandoned hospital. The health facility was in ruins, with some medical equipment already rotting away. Established in 2001, Twasko PHC was once a bustling facility that catered to the locals. It is now a shadow of itself, no thanks to age-long neglect by successive governments in Kwara State, Bala Muhammad, the community’s traditional head, lamented.

“We had once enjoyed quality health service in this community. We used to visit this health centre for all health issues until things got worse. When we noticed that this building was not safe again, I had to give an apparently to the health workers. That was over five years ago,” Muhammad told this reporter.

Only two health workers currently run the PHC at Muhammad’s property, and getting quality healthcare service has become a tall order at a facility that is supposed to serve five hamlets with a population of about 300. Many residents are now forced to seek treatments elsewhere, Muhammad further decried.

Short of minimum requirements

According to the National Primary Healthcare Development Agency (NPHCDA), PHCs are expected to offer 24-hour services, be fenced, and have staff quarters or accommodation for the workers within the community. They should also have essential drug supplies, a waste disposal system, equipped laboratories, and connections to the national grid. The PHC must also have a minimum of four nurses/midwives, nine community health extension workers (CHEW), a laboratory technician, a pharmacy technician and a medical officer (if available). However, neither Tswako PHC nor other PHCs in different rural communities of Kwara State visited by this reporter meet these minimum requirements.

The Officer-in-Charge of Tswako PHC, Abubakar Adamu, recalled how the hospital gradually degenerated into its present status after he was posted there in 2010.

“A series of appeals were made to the government, but unfortunately there was no progress to the PHC until it got rotten. It is the community that gave me a room where I manage to attend to patients,” Adamu said, noting that the PHC couldn’t serve the community as a result of the infrastructural decay, absence of basic medical equipment and essential drug supplies.

“We often manage to treat basic malaria, and when it gets tough, we only give first-aid treatment and refer the patients to other clinics. We have simple instruments like thermometers to test body temperature, and if we discover that it’s malaria, we will give them some anti-malaria drugs which are often bought because the PHC does not have drugs in stock. We don’t even have beds for patients who need rest.

“The PHC does not have a personal source of water, but there is one tap behind the building that we manage. There is no electricity supply either. I can’t sleep here. I normally go home (Lafiaji) every day. It’s 35 minutes away, and I usually rush down when there are emergency cases,” he said.

Residents bear the brunt

With tears rolling down his cheeks, Abdullah Yisa, 50, narrated how he lost his pregnant wife to an unsafe delivery.

“When my wife was labouring, she was rushed to the community’s PHC, but she was referred to another hospital in town because equipment was not available. We tried our best to reach the hospital while we carried her on bikes, but unfortunately, she gave up the ghost along the way,” he recalled.

Hajiya Fatimoh Ibrahim, 42, bemoaned the plight of women, especially during pregnancies and labours.

“Over the years, many residents of Tswako had lost their lives because this PHC was not working, and we were often referred to the town for healthcare,” she said.

She explained that in 2024 when his son’s wife wanted to give birth in the evening, no health worker was available at the PHC.

“We had to rush her to the town. We were in the rainy season then and the only available means of transportation was canoe. Instead of using about an hour to reach the town, we used more than two hours which made her situation worse,” she added, noting that she narrowly escaped death, but the baby didn’t.

Another resident, Nasir Abubakar, recounted how he lost his ailing father, Mallam Ishaku, in 2021 due to lack of a functional PHC in the community.

“He had not been feeling well. In the middle of the night, his situation deteriorated, but the PHC could not admit him. We had to wait till the next morning, but before dawn he had died,” he said.

More PHCs in Shambles

The poor state of roads leading to Amu and Abayawo Primary Health Centers in Moro and ASA Local Government Areas Kwara State has significantly increased patients’ risks of miscarriages, delayed treatment, and other critical health challenges. Both healthcare workers and patients have expressed deep concerns over the situation.

When this reporter visited the PHC on March 5, 2025, the facility was closed and appeared deserted. But upon speaking with residents, it was discovered that the health centre only opens twice a week owing to lack of medical equipment and supplies.

The Amu health facility is in a shambles; it is bushy, the roof is dilapidated, the restrooms are deplorable, and no source of power connected to the clinic. The mattresses and injection boxes in the hospital wards had become dusty.

“We are not happy with the situation of this clinic. As you can also see, everything is in ruins. In fact, we don’t have any medications as small as paracetamol in this facility to treat patients. We don’t even have equipment to receive pregnant women whenever they want to deliver,” Mariam Alabi, a community health worker at Amu PHC, told this reporter, adding that the community contributes funds to procure some basic medications.

“We are just two in this hospital. We live in far places and spend close to N2,000 every day on transportation. And once it is evening, we can’t get a bike to return home,” she said, explaining why they only work during the day and three days a week.

Mr. Saheed Aremu, the youth leader of the community, said receiving medical aids such as drugs at the Amu health centre has been a nightmare for more than eight years, adding that if there are emergency cases, they travel for over an hour to the teaching hospital in Ilorin, the state capital.

Imam Sulyman, the religious leader of the community, recounted how the community lost seven elderly persons and two pregnant women in recent months due to lack of quality healthcare services in the community.

“We didn’t have money to take them to private hospitals or the teaching hospital in Ilorin, so we managed them at home, and they later died. One of my brothers’ wives also died while labouring. These are unfortunate incidents we do not want to remember,” he recalled.

Abayawo health post

The worrying cases at Abayawo health post were not far from sight when this reporter visited the facility in March 2025. The facility lacks any semblance of a clinic. Aside the bushes that manned the structure on both sides, the building is not in good shape.

“When we realised that we needed a healthcare facility and the government was not ready to renovate the collapsed PHC, it was the community that allocated a house for the health post,” Mrs Sherifat Alabi, a resident , explained.

As Mrs Sherifat led this reporter round the facility, it was observed that only an apartment was fairly renovated to serve as a clinic.

“No resident uses the PHC again because of the structure. They don’t even remember there is a PHC here again,” a health worker in Abayawo PHC, who sought anonymity, lamented.

“Oftentimes, we lose people while rushing them to the private hospital due to the distance. We believe that if the nearest PHC is functioning, issues like that will be minimal,” Mallam Jimoh, a youth in the community, said.

PHC is for All People Everywhere — WHO

According to the WHO, the fundamental premise of primary health care is that all people, everywhere, have the right to achieve the highest attainable level of health. Primary health care is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. But, the premise is not realistic in Kwara rural communities like Tswako, Amu, Abayawo, Bindofu among others, where PHCs failed to meet up with these health expectations.

At Kusomunu and Abayawo PHCs, the tale of neglect was written all over the buildings, in and out. The structures were dilapidated with open ceilings, leaking roofs, while the medical shelves were dusty and empty. The facilities have no safe water supply and proper sanitation system. This makes the health workers engage in waste burning which often causes air pollution in the communities.

Broken promises

“I reported the deteriorating status of this PHC to the HOD and LIO in the local government,” said Umar Muhammad, the health attendant at Tswako PHC.

“They always come to observe the clinic and promise to fix it, but I would not hear from them again. I’ve written letters to them more than 10 times. I even wrote a letter to them in 2024. When we presented a letter to the TIC chairman, he said the matter was beyond his capacity, but he would forward the letter to Governor Abdulrahman Abdulrasaq for intervention.

We gave him the letter, but we haven’t heard anything positive.”

The village chief of Tswako community, Muhammad Mayaki, said government officials only come to take pictures of the deteriorated PHC without taking action afterwards.

PHCs are Important for Improved Community Health

Dr. Abel Ojo, a health expert, said PHC is an important first contact healthcare facility in a given community where a trained, certified and licensed community health practitioner should be available to attend to minor ailments and make appropriate referrals.

Ojo bemoaned the poor state of PHCs investigated, noting that such development was dangerous.

“Lack of adequate edifice; basic amenities like potable water supply, electricity and qualified health personnel are great hindrances to quality health care services for children and pregnant women,” he said, advising the government to retain health workers in rural areas by creating an enabling environment such as job security, good pay, rural allowance and many emoluments.

“The long and short effects of poor and/or non-functional PHC in our community include, but are not limited to, premature death of a baby, death of pregnant women in related pregnancy issues, inadequate treatment of illnesses, miscarriages, abortion of all types, non-quality service and many more.

“My advice to the communities is that they should see the healthcare facility as their own and be ready to patronise it, and the government should be ready to finance the facilities and equip them with human and material resources,” Ojo added.

The Executive Director of the Kwara State Primary Healthcare Development Agency (KPHCDA), Prof. Nusirat Elelu, admitted that collapsing health facilities as well as critical shortages of staff and medical supplies are commonplace in many PHCs in the state but said that the government is working to address these critical challenges.

She also noted that the KPHCDA only coordinates the activities of primary health care affairs in the state, adding that not all PHCs are directly managed by the state government.

“We are simply following the policy direction of the government to make sure that there is one functional PHC in each ward across the state. We have over 500 PHCs in Kwara and we can’t do them all at once. When you mention all these PHCs, you might not expect direct answers to some questions especially when some of these ones are not intervened from the state,” she said.

When asked to comment specifically about the collapsed infrastructures and staff and resources deficit in Tswako, Abayawo and Amu PHCs, she said, “Although we would prioritise PHCs that need urgent interventions, we would have to be strategic. In order for equity distribution, we are currently doing one per ward.

Commenting on shortages of staff, Prof. Elelu said that the majority of health workers are staffed and paid by the local government, with only a small minority controlled by the state.

This story was produced for the Frontline Investigative Program and supported by the Africa Data Hub and Orodata Science.

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