Billions Budgeted, Clinics in Ruins: Inside the Crisis Endangering Mothers and Children in Kano’s PHC System
By Hauwau Sani
In a small village in Kano State, a pregnant woman once went into labour under conditions no mother should ever endure. The primary health centre nearest to her home had no electricity. As her contractions intensified, the only health worker on duty held a torchlight in one hand while attempting to deliver her baby with the other.
Economic Confidential reports that this was not an isolated incident. It is the daily reality for thousands of women across rural Kano.
Across dozens of Primary Healthcare Centres (PHCs) visited during this investigation, the picture is the same: collapsing buildings, empty drug shelves, no water, no electricity, and in many cases, only one exhausted health worker struggling to serve entire communities.
These facilities—meant to be the backbone of Nigeria’s healthcare system—have become symbols of abandonment.
A System on the Brink
PHCs are supposed to provide the most basic and essential services: maternal care, immunization, early diagnosis, and disease prevention. But in Kano State, many barely function.
Investigations by Economic Confidential across Sumaila, Shanono, Gwarzo and other LGAs reveal a system in deep crisis.
At Jisai Health Post in Sumaila, resident Usman Yelwa described the facility bluntly: “The ceiling has fallen off and the roof leaks whenever it rains. There are no beds, no medicines. Patients sit on benches or the floor.”
In Yan Shadu Health Post in Shanono, Officer-in-Charge Jamilu Atiku said the clinic becomes unusable during heavy rains: “Rainwater enters the building and patients have nowhere to stay.”
Some PHCs resemble abandoned structures more than medical facilities. Ceilings have collapsed. Windows are missing. Walls are cracked. Roofs leak. Many buildings are unsafe for both workers and patients.
No Water, No Power, No Sanitation
Clean water—one of the most basic requirements for any health facility—is absent in many PHCs.
At Goron Dutse PHC, workers pay ₦100 per gallon for water fetched from a dam. This water is used for everything: washing equipment, cleaning delivery rooms, and maintaining the facility.
Some clinics have no toilets at all. During immunization campaigns, patients use toilets in nearby homes.
Electricity is equally scarce. Many PHCs operate in total darkness. Health workers rely on torchlights or phone flashlights during night deliveries.
One health worker described the experience as “working blind.”
“When a woman comes at night, we sometimes use torchlight. You pray nothing goes wrong.”
In communities where referral hospitals are hours away, such conditions can be fatal.
Empty Shelves, No Equipment, Guesswork Medicine
Most PHCs visited had only three common drugs:
– Paracetamol
– Anti-malaria medication
– Flagyl
Diagnostic tools are almost non-existent. Without equipment to run tests, health workers rely on guesswork or refer patients to distant hospitals.
For many rural families, transportation alone costs around ₦5,000—an impossible sum for many. As a result, people delay treatment or resort to self-medication.
One Health Worker for an Entire Community
Staff shortages are severe. Several PHCs have only one worker responsible for all services.
At Tumfafi Health Post in Gwarzo, the officer in charge said:
“We don’t have equipment to assist pregnant women.”
To repair parts of the building, staff used wooden planks taken from an abandoned mosque.
At Burnabus Health Post, the only staff member travels from another town and appears mainly during vaccination campaigns.
The result is predictable: burnout, exhaustion, and a sense of abandonment among health workers.
Communities Forced to Do Government’s Job
In many villages, residents maintain PHCs themselves.
Near Burnabus Health Post, Malam Hudu Ali said the clinic was built over 30 years ago by community members:
“Both men and women contributed to build it.”
Since then, no government authority has renovated it. When parts collapse, villagers repair them with whatever materials they can afford.
In one community, a PHC destroyed by fire five years ago now operates from a section of the village head’s house. No reconstruction has taken place.
Blocked Access, Blocked Accountability
During this investigation, attempts to visit PHCs in Rimin Gado LGA were blocked by local officials, who insisted on permission from the Ministry of Health—permission journalists say is rarely granted.
This restriction prevented further documentation of conditions in that area.
A Deadly Disconnect: Billions Budgeted, Clinics in Ruins
On paper, Kano appears committed to healthcare:
– ₦72 billion allocated to health in 2024
– ₦90.6 billion allocated in 2025—exceeding the Abuja Declaration benchmark
Yet many PHCs have no water, no electricity, no staff, no medicines, and no equipment.
Experts say the problem lies in weak oversight, poor accountability, and inefficient use of funds. Local governments—responsible for PHCs—often lack capacity. Donor-funded programs rarely strengthen infrastructure. Procurement processes lack transparency.
The result is a deadly gap between budget figures and reality.
Maternal Mortality: The Human Cost
Nigeria remains one of the most dangerous places in the world to give birth.
– About 75,000 women died from pregnancy-related causes in 2023
– Nigeria accounts for nearly one-third of global maternal deaths
– National maternal mortality rate: 512 deaths per 100,000 births
– Some estimates place it above 900 deaths per 100,000 births
Kano is one of the epicentres:
– Estimates range from 576 to 1,025 deaths per 100,000 births
– Only 30% of pregnant women deliver in health facilities
Without functional PHCs, women experiencing complications often arrive too late—or never arrive at all.
Government Response
Kano State Commissioner for Health, Abubakar Labaran Yusuf, was contacted for clarification. After multiple calls and messages, he issued a brief response outlining the administrative structure of the state’s healthcare system but offering no direct explanation for the severe conditions observed in rural PHCs.
The Commissioner stated that the Ministry oversees healthcare policy and supervises the Kano State Primary Health Care Management Board (KSPHCMB), which manages PHC services across all 44 LGAs. He noted that funding comes from state allocations, federal programmes such as the BHCPF, and development partners including the Global Fund, Gavi, the World Bank, and FCDO.
He added that staffing is based on human‑resource gaps identified by the KSPHCMB, with recruitment carried out in collaboration with Local Government Authorities. Equipment and essential supplies, he said, are procured through state budgets, intervention funds like KHETFUND, and donor support, following facility assessments and audits.
The Commissioner also highlighted quarterly Integrated Supportive Supervision (ISS) and routine monitoring visits as mechanisms for ensuring compliance and quality improvement across PHCs.
However, the response did not address the specific issues uncovered by the investigation—such as PHCs without electricity or water, collapsed buildings, severe staff shortages, or communities forced to maintain clinics themselves. The Ministry’s statement focused on structure and processes, leaving the on‑ground failures unaccounted for.
A System in Urgent Need of Rescue
Primary healthcare is the most cost-effective way to reduce maternal and child mortality. But in Kano, the system meant to save lives is itself dying.
Unless urgent action is taken, thousands of rural families will remain trapped in a cycle where access to healthcare depends on distance, luck, or the goodwill of overstretched workers.
For many mothers in Kano’s villages, childbirth still happens in darkness—not because medicine lacks the knowledge to save them, but because the system meant to deliver that care has been allowed to collapse.
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