As dusk settles over the Dansarai community in Malumfashi Local Government Area of Katsina State, activity at the primary health centre begins to reduce. Inside the female ward, two patients lie on metal-framed beds while relatives hover nearby, waiting for the evening routine to wind down. By nightfall, most non-critical cases are expected to return home.
The Dansarai primary healthcare centre, as well as a similar one in neighbouring Dayi, is officially designated to provide round-the-clock basic healthcare services to the surrounding rural communities. However, PREMIUM TIMES field visits revealed notable gaps between policy and after-hours realities.
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While Dayi PHC maintains limited overnight coverage supported by on-site security and skeletal staffing, services at Dansarai are largely concentrated within daytime hours, according to staff and patients. Health workers cite manpower shortages, as well as water and power constraints, as key factors hindering service delivery after dark, even as state authorities said corrective measures were underway.
According to facility staff, the two centres serve multiple surrounding rural communities, making consistent after-hours coverage critical for emergency maternal and child health cases.
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Under Nigeria’s primary healthcare service standards, primary healthcare centres designated for 24-hour care are expected to maintain continuous skilled attendance, particularly for maternal and emergency cases. Public health specialists warn that when night coverage becomes inconsistent, rural patients, especially pregnant women and children, face increased risks linked to delayed treatment and referrals.
Dansarai scene
When PREMIUM TIMES visited Dansarai PHC between 2:30 p.m. and 3:00 p.m. on 13 February, the wide, fenced compound appeared orderly, with freshly painted buildings and staff quarters. Inside the female ward, two patients were on admission attended by relatives, while the male ward had two patients. About five volunteer health workers, led by Hafiz Haruna, were on duty.
Staff and patients said the facility relies heavily on volunteers for routine service delivery.
Mr Haruna, who said he has volunteered at the facility since 2016, explained that the centre typically operates from morning until early evening, with services rarely extending late into the night.
“Our official closing time is between 4 p.m. and 5 p.m. If there are many patients, we may stay until about 8 p.m., but not deep into the night,” he said, citing manpower constraints.
One patient, Rabiatu Abdulrasheed, said she often returned home after receiving treatment and returned the next day when further care was required.
“We go back home,” she said.
The facility’s water supply remains basic. During the visit, PREMIUM TIMES observed that the centre relies largely on a manually accessed well within the premises. Staff and officials said the facility does not have a piped water system — a situation health workers said added pressure to routine operations.
Electricity supply at the facility is also limited. Officials said the Dansarai PHC is not connected to the national grid and lacks a capable solar inverter system. The centre relies on a small generator that primarily powers laboratory services, leaving much of the facility dependent on daylight operations.
Staffing data reviewed by PREMIUM TIMES indicates a thin permanent workforce. Facility officials said only three staff members are permanent employees, with casual workers and volunteers supporting them. Health workers and patients said the facility depends heavily on volunteers to sustain daily operations.
Dayi: A more complex picture
A visit to Dayi Primary Health Centre presented a more mixed picture. When PREMIUM TIMES arrived at about 5:30 p.m. on 13 February, a Friday, some health workers were still on duty, and security personnel were observed within the facility premises, occupying part of the staff quarters converted for their use.
The officer in charge, Mani Ahmad, said the facility is designed to operate “almost 24 hours,” although maternity services scale down at night if no patient is in active labour. He said admitted patients in other units are typically monitored overnight, while emergency cases beyond the centre’s capacity are referred to higher-level hospitals.
Health workers attributed the relative overnight coverage partly to the presence of local security personnel stationed at the facility. Umar Habibu, who oversees routine immunisation, said the deployment has improved staff confidence to remain on duty, although broader insecurity in surrounding rural areas continues to shape work patterns.
Despite the extended service claim, officials acknowledged persistent infrastructure gaps. Mr Ahmad said the facility has struggled with water shortages for over a decade and currently relies on daily purchases from water vendors. Solar lighting, he added, covers only parts of the hospital, leaving some sections poorly lit at night.
Official response
In phone and WhatsApp conversations with PREMIUM TIMES, the Katsina State Primary Health Care Board acknowledged infrastructure gaps affecting some rural facilities and outlined measures to address them.
The Executive Secretary, Shamsuddeen Yahaya, said Dayi PHC has faced “perennial water scarcity” despite the presence of a borehole and overhead tank, explaining that the pipes drawing water from the ground had collapsed. At Dansarai, he said the facility lacks an on-site water source after a previously connected borehole broke down.
On electricity, the board said Dayi is connected to the national grid and supported by a mini solar backup and generators, although these do not power the entire facility. Dansarai, however, is not connected to the national grid and relies mainly on a small generator serving the laboratory.
The board maintained that both facilities have the required number of posted staff, including four midwives in Dayi and two in Dansarai, and noted that additional health workers recruited by the state government would be deployed to facilities and others in Malumfashi Local Government Area.
It also confirmed that both PHCs are beneficiaries of the Basic Health Care Provision Fund (BHCPF), with the latest direct facility funding disbursed on 30 January.
The official added that the state has approved plans to upgrade at least one primary health facility in each ward to Level II status, including installing 5KVA solar inverters and new boreholes.
Policy context
Primary health centres are designed to serve as the first point of contact for basic medical care, particularly in rural communities where access to general hospitals is limited. Under Nigeria’s primary healthcare framework, such facilities are expected to provide essential maternal and child healthcare, as well as outpatient services, many of which are structured to support round-the-clock care.
In Malumfashi Local Government Area, patients requiring advanced treatment from Dayi and Dansarai are typically referred to the General Hospital in Malumfashi, about 21 kilometres away, or to facilities in Musawa and neighbouring Kano State.
Public health experts have long warned that staffing, power supply, and water infrastructure gaps at frontline facilities can weaken primary healthcare delivery, particularly in rural areas affected by insecurity.
Human impact
For many residents, the effect of these service gaps is measured in distance, time and cost. Patients and caregivers who spoke with PREMIUM TIMES said evening referrals or repeated daytime visits often entail additional transport costs, especially for families from surrounding settlements.
At Dansarai PHC, some patients said they routinely return home after treatment and return the next day when further care is required. Health workers acknowledged the strain but said the facility continues to operate within its available manpower and resources.
For residents in outlying settlements, the distance to referral centres means night-time medical decisions are often shaped as much by transport availability and security concerns as by clinical urgency.
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Conclusion
The Katsina State Government said its ongoing staff recruitment and facility revitalisation efforts would strengthen primary healthcare delivery. However, visits to Dayi and Dansarai suggest that while progress is being made, gaps in infrastructure, staffing distribution and night-time coverage remain uneven at the facilities.
As the state moves to upgrade at least one fully functional primary health centre per ward, health workers and residents say sustained investment in personnel, water systems and reliable power will be critical to translating policy targets into consistent round-the-clock care in rural communities.
Yet beyond the official assurances and upgrade plans, the conditions observed in Dayi and Dansarai reveal a familiar gap between policy design and frontline reality. In communities where primary healthcare centres remain the closest lifeline, the difference between a functional night shift and a closed ward is often measured not in policy documents but in whether staff, water, light and security are reliably in place when patients arrive after dark.
Until those gaps are closed, the promise of round-the-clock primary care in parts of rural Katsina may remain a mirage.
