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SPECIAL REPORT: Despite multi-billion naira investment, understaffing, lack of drugs hamper healthcare in Borno communities
Abstract: Despite the injection of funds in Borno State’s Primary Healthcare (PHC) system, access to essential drugs and services remains a significant concern in some communities. Imran Ridwan reports
The sunrise over Zabarmari village in Jere Local Government Area of Borno State was beautiful, but it offered no comfort to Fatima Sani, a 22-year-old woman in labour.
Her baby was coming, but the nearest health centre – her only hope – was closed.
Aisha and her family members securing Fatima’s dead baby,taking a trycycle home
Fatima had done everything right. She attended prenatal care and knew when her baby was due. Sadly, she never expected to travel 20 kilometres for delivery, passing three closed health centres along the way.
Tragically, after a long struggle, Fatima lost her firstborn child at Maryam Abacha Women and Children’s Hospital in Muna, a community along Dikwa Road, Maiduguri.
Aisha at home in Zabarmari, recovering from an unsuccessful childbirth.
While relatives mourned and cried, Fatima’s sister-in-law, Aisha Mustapha, a 28-year-old resident of Zabarmari, through tears, shared the heartbreaking news of their “journey for a safe delivery ending in a devastating stillbirth”.
Before the death of Fatima’s child at the Maryam Abacha Women and Children Hospital, Fatima had earlier attended the Dalaram Old Maiduguri Primary Healthcare Centre.
Lawan Goni an elderly man at Auno Primary Healthcare.
The Dalaram PHC is 15 kilometres away from Fatima’s community. The community health workers couldn’t handle the childbirth, and shockingly, there were no doctors or midwives on duty – even though it was only 2 p.m.
Desperate, Fatima and her family had to travel another six kilometres despite already providing all the necessary supplies.
“They started basic care and gave her an IV drip we had to buy,” Aisha explained. “But then, their shift ended—they don’t work nights. We had to go somewhere else. They recommended Maryam Abacha Hospital,” Aisha added.
This reporter’s visit to Zabarmari PHC confirmed what residents feared: it’s not there when people need it. The PHC, meant to serve over 15,000 people, was deserted by 1 p.m., with only security officials at the gate. Signs outside the health facility advertise childbirth services, HIV care, and more – but it’s all useless as all the doors are closed.
Similarly, the Shuwari community boasts a well-built primary healthcare (PHC) centre, but operation hours remain a critical concern. Operating under the Jere LGA PHCs and managed by the Alliance for International Medical Action (ALIMA), the facility serves residents for less than 10 hours daily.
Babagana Mustapha, a 28-year-old community health worker at the PHC, said, “Nighttime emergencies are impossible to handle, and we urge the government to address this limitation.”
Muna IDP camp Primary Health Care Center, Jere LGA Maiduguri Borno State.
Also, in Muna IDP Camp PHC, limited operating hours (8 a.m.-3 p.m.) further complicate matters. According to 28-year-old Falmata Usman, even for childbirth, you might need to buy items, and sometimes they refer you to the Lake Chad hospital. “People go where they can find solutions,” said Falmata.
Hundreds of internally displaced people (IDPs) call the Muna camp home, with over 2,000 relying on its sole health facility. While this reporter found the clinic clean and well-ventilated, two non-functional motorcycle ambulances outside painted a contrasting picture.
Laudable Infrastructure, limited services
Nigeria has clear guidelines for its Primary Healthcare (PHC) centres. These guidelines outline staffing, equipment, medicine, and even operating hours needed to bring essential care to communities. PHCs offer more access to qualified professionals, making healthcare available to more people.
According to the approved budgets of the Borno State Government, the state had invested over N7 billion in its Primary Healthcare (PHC) programme from 2020 to 2023, with significant allocation towards infrastructure and additional midwife recruitment in 2021.
In May 2023, reports emerged that Borno State won a $1.2 million award for ‘PHC leadership’. The award, funded by the Bill & Melinda Gates Foundation and Aliko Dangote Foundation, aims to strengthen the state’s healthcare sector.
Despite the injection of funds in Borno State’s Primary Healthcare (PHC) system, access to essential drugs and services remains a significant concern in some communities.
This reporter visited ten PHCs in Maiduguri Metropolitan Council and Jere Local Government Area, including Auno, Dalaram, Zabarmari, 707, Wulari, Nana Kashim Premier, Mairi, Shuwari, Muna, 202, and Yerwa.
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Sadly, some still fall short of Nigeria’s Minimum Standard for Primary Healthcare despite investments in infrastructure.
The Zabarmari PHC tragically illustrates this failure.
It wasn’t just Fatima who suffered from delays, unprofessionalism, a lack of essential drugs, and a critical shortage of doctors. Such preventable tragedies remain far too familiar. The World Health Organization (WHO) directly links these problems to needless maternal and newborn deaths.
Shuwari Primary Health Care Center, Jere LGA Maiduguri Borno State. Managed by ALIMA.
“This clinic is one of the oldest around,” says 30-year-old Zabarmari resident Babagana Mustapha. “It should have been upgraded with better staff by now. I only take my kids there for headaches, and only in the morning. For anything serious, I go all the way into town,” Babagana explained.
The Zabarmari PHC needs a basic ambulance tricycle for faster transport to better hospitals. Without doctors, a quicker transfer could still make a difference. This raises serious concerns about access to emergency care.
Auno, a small community outside Maiduguri, in Jere LGA, also shares a heartbreaking reality: its Primary Healthcare centre is under-equipped.
“We lack doctors and necessities like water,” admits Zanna Sheriff, head of the Auno PHC. “I often spend my money on water for deliveries and other essential needs,” Zanna added.
Similarly, in Auno, Lawan Goni, a 60-year-old resident, was forced to take his sick son to a distant hospital in another town for basic malaria treatment. “I don’t regret the trip,” says Goni. He knew his son wouldn’t receive the care he needed at the local PHC.
Maryam Idris, a 30-year-old resident near the Auno Health Centre, feels frustrated. Despite the centre’s convenient location, she’s stopped visiting due to what she sees as inadequate drug supplies.
“They hardly ever give out medication,” she explains. “They might give you a prescription for a week’s worth of drugs but then tell you to buy them yourself.” This has been a major problem, especially when her two-year-old daughter was sick. The centre could only offer paracetamol, leaving her questioning if they didn’t have more resources.
Lack of essential drugs
It’s important to understand that primary health centres do have limitations. However, they are meant to give special attention to those most in need – pregnant women, children, the elderly, people with disabilities, and those in poverty.
Nana Kashim PHC manager, Yakawu Mustapha, acknowledges the centre tries to do this, even with limited re