How Jigawa’s underfunded rural health system fuels infant, maternal mortality

It was 1 a.m. on 9 October, when 25-year-old Sadiya Sirajo felt the sharp waves of labour. Her estimated due date (EDD) had arrived. But there was one problem.

At Kwadabe, where she lived in Kiyawa Local Government Area (LGA) of Jigawa State, a health centre is situated a few metres from her home, but it wasn’t an option. Not only was it shut, but it also lacked facilities to cater to childbirth.

Mrs Sirajo stopped visiting the facility for antenatal care, opting instead for the Primary Health Care Centre (PHC) in Katanga, a few kilometres from her home, and occasionally another hospital in Dutse, the state capital.

It was her first pregnancy, and she wanted adequate healthcare for herself and her unborn child, she said.

But none of her plans prepared her for late-night labour in a community with no working clinic, no open pharmacy, and no available health worker to call.

An infant’s true home

A day before Mrs Sirajo went into labour, she had a mild fever and went to the hospital for a scan. She was given some drugs and asked to go back home, and she felt better.

She did not anticipate the late-night labour.

“We called Katanga (PHC), but they said there are no health workers, so we stayed home,” she narrated to PREMIUM TIMES later that Thursday.

Just before the Muslim morning prayer, she gave birth to the child. “He didn’t cry when I gave birth to him,” she said. “They sprinkled water on him, and it looked like he was alive, but he stopped breathing.”

“They bathed him and took him to his true home (buried),” she stated almost without emotion.

Jigawa’s infant deaths

“We struggle with the death of children a lot,” said Binta Lawal, a resident of Kwadabe.

Nigeria has a maternal, neonatal, and child health problem, and it is pronounced in Jigawa, particularly in rural communities like Kwadabe, where access to basic healthcare services is not readily available.

The state has the highest under-five mortality rate in Nigeria, at 161 deaths per 1,000 live births, according to the Nigeria Demographic and Health Survey (NDHS) 2024.

Worryingly, the chances of an infant dying within the first month of birth in the state have increased, according to the NDHS. The neonatal mortality rate in the state increased from 46.8 deaths per 1,000 live births in 2018 to 52 deaths per 1,000 live births in 2024.

The African Institute for Development Policy (AFIDEP) also noted in a 2024 study that Nigeria’s neonatal and under-five mortality rates have worsened over the years.

“For both neonatal mortality rate and under-five mortality rate, the reference or business-as-usual projections indicate that Nigeria is off track and far from reaching the Sustainable Development Goals (SDGs) targets by 2030,” the study found.

Dilapidated health centre

The only health centre in Kwadabe, Mrs Sirajo’s community, is a health post.

According to Nigeria’s Minimum Standards for Primary Healthcare, developed by the National Primary Health Care Development Agency (NPHCDA), a health post’s estimated coverage population is 500 people. It is supposed to have male and female toilets in the premises, a water supply, a fenced area with a gate, and a waste disposal site.

However, Kwadabe has more than 10,000 residents, according to an official who declined to be named for fear of retribution. The health post also caters to residents from adjoining communities, including Kawara Gabas, Kawara Yamma, Shadaka, and a riverine Dadi community.

The centre also lacks toilets and a water supply. The old, deteriorating structure is also not fenced, remaining as it had been since the first construction in the 1990s.

The official stated that the officer in charge of the health post, a Community Health Extension Worker (CHEW), is the only permanent staff member. The two others, one CHEW and a secondary school certificate holder, are volunteer staff.

The health post operates from a small two-room building and a veranda.

“We thank the workers because even though the health centre is dilapidated, they still show up,” said Mrs Lawal.

As a result of the leaky hospital roofs, officials store the centre’s drugs and other products in a house in the community to avoid destruction when rain falls.

According to Ibrahim Garba, an elder in the community, the community has engaged the local government chairman to help expand the health post into a PHC.

“There was a time the special adviser to the local government chairman came to check the hospital. I was not there, but I was told he came.

But we still haven’t heard anything from them,” he said.

Mr Garba said residents seek healthcare services in other communities because of the state of the hospital.

“For any serious health issues, we go to Katanga or even Dutse. That’s a problem for us,” he added.

“There is no equipment at the hospitals. That’s why people always have to travel with their patients. If the hospital were fully functional, we wouldn’t have to take those journeys.”

Residents of communities like Kwadabe, without immediate access to healthcare centres, continue to face the risk of complications before eventually presenting themselves at health facilities, said Tanimola Akande, a professor of public health at the University of Ilorin.

Mr Akande noted that the residents also tend to use herbs and patronise traditional healers or patent medicine stores with low or no competence in managing patients.

“They also have higher risks of long hospital stay because of complications (or) death as a result of delay in getting access to skilled health workers,” he said.

A fatal childbirth

In Giwa, a village on the outskirts of Birnin Kudu LGA of Jigawa, the story is similar.

Mustapha Hamza, now in his 40s, has lived in Giwa his entire life, near the community’s only health centre. Twice, Mr Hamza said, he saw firsthand how the inadequacies of the hospital affect women in labour.

In the first case, Mr Hamza and another neighbour sandwiched the pregnant woman on his motorcycle as they sped to the PHC in Wurno. But along the way, the pain got intense for the woman, and they had to stop beside a tree.

“Luckily, there was another woman who accompanied us on the bike that day,” he recalled.

“She was the one who helped. It was after she gave birth on the road that we climbed onto the motorcycle to continue our journey to Wurno.”

In the second instance, the woman, his brother’s wife Balkisu, wasn’t as lucky.

It happened five years ago, he said.

When Balkisu went into labour that fateful day, there were no motorcycles. She was wheeled in a cart from Giwa to the PHC Wurno, but she never made it to the hospital as she died alongside her unborn child.

However, many of the inadequacies that led to Balkisu’s death still live with the Giwa people –a dilapidated, barely functional health centre without facilities for midwifery or admission of patients.

The health centre, which falls short of all the standards mandated by the NPHCDA, had existed for over 30 years, he said.

“But because it has been long and the town has expanded, we need it upgraded,” he said.

He explained that residents visit the health centre only for routine immunisation of children and antenatal care for pregnant women.

“We have stopped bringing patients here, especially when it’s critical. We would rather take them down to Wurno,” he added.

On a Friday morning when PREMIUM TIMES visited in October, the facility was locked, and the officials were away.

Nigeria has one of the highest Maternal Mortality (MMR) rates in Sub-Saharan Africa, at 1,047 per 100,000 live births, according to AFIDEP.

Although Nigeria aims to reduce its MMR to less than 70 deaths per 100,000 live births, the projected rate for 2030 indicates that it will still be high, at 501, according to AFIDEP.

“To attain the SDG target of 70 MMR from 2020 to 2030, a required annualised reduction rate of 27 per cent is necessary. Yet between 2003 and 2020, the reduction rate for MMR was 0.2 per cent,” it stated.

According to Mr Akande, a consultant public health physician, lack of access to healthcare is a significant reason for increased deaths related to pregnancies and increased deaths in children below the age of 28 days.

He explained that the first two levels of delay in maternal health care are often related to poor access.

“The first level of delay is in patients not making decisions on time on going to the health facility, while the second delay is in getting access to the health facility due to transport challenges, long distances and affordability,” he said.

“Cultural factors also affect the high rate of maternal and neonatal mortality, as these factors also affect access to health care. This is particularly more in the rural settings in Nigeria.”

Interventions bolster PHC services

In the last few months, the Wurno PHC, which Giwa residents rely on, has seen some renovations and funding under the World Bank’s

Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services (IMPACTS) project and the Nigerian government’s Basic Health Care Provision Fund (BHCPF).

PREMIUM TIMES observed that the hospital has also received a solar installation to provide electricity during power outages, as well as the construction of a midwife’s quarters, courtesy of the IMPACTS project.

According to an official who didn’t want to be named, the hospital has one nurse, one midwife, one Community Health Officer, two CHEWs, two JCHEWs, three lab technicians, and three pharmacists.

However, the PHC doesn’t have a medical doctor, a phenomenon quite rampant across primary healthcare centres in the state.

Overstretched health centres

The PHC Wurno is also gradually nearing its capacity for the targeted population it is supposed to care for.

According to PHC standards, the estimated target population is from 10,000 to 20,000 people. The target population for PHC Wurno had risen to 18,864 as of 2024, one official confirmed to PREMIUM TIMES.

The official said the PHC serves 22 communities, including Giwa, Jangargare, Shungun and Samammiya.

Additionally, at Waza Health Centre in Birnin Kudu LGA, the targeted population has exceeded 19,000 as of 2024, Yusuf Usman, the official in charge of the hospital, told PREMIUM TIMES. This exceeds the maximum population of 5,000 prescribed by the NPHCDA standards.

Mr Usman said the hospital only renders services such as routine immunisation and antenatal care.

Serious ailments or complications during childbirth are referred to either the PHC Kangiri or the General Hospital, Birnin Kudu.

According to him, the PHC Kangiri is 15 kilometres away from the health centre, and the General Hospital is about 20 kilometres away.
He said there are four health officials in the hospital – himself, a holder of a Bachelor’s Degree in Public Health, two CHEWs, and one JCHEW.

Like the Wurno PHC, the Waza health centre also doesn’t have a medical doctor.

Nigeria has a shortage of medical doctors that is more prevalent in rural communities.

According to the Health Preparedness Index 2025, the country has 15,361 people per doctor. It is particularly severe in states like Jigawa, which has a doctor-to-patient ratio of 48,466.

According to the Health Preparedness Index, which was calculated by evaluating the doctor-to-population ratio, infant/child mortality rates, and health budgets, among other factors, Jigawa is one of the least prepared states.

A medical doctor and public health expert, Anne Umoren, explained that the working conditions also discourage doctors from taking placements in rural areas.

“If a doctor is posted to that (rural) area, the hospitals or let’s say, the government, they do not give accommodation to their healthcare professionals, especially for those that are posted out from states or, let’s say, outside their local governments,” she said.

Government House prioritised over PHCs

Meanwhile, the Jigawa State Government’s spending on prestige projects continues to deprive essential services, such as healthcare, of funds.

The state’s budget performance for 2024 revealed that the government prioritised spending on Government Houses, including renovation and the purchase of luxury vehicles, over the welfare of the people through the rehabilitation of hospitals.

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According to the state’s 2024 budget performance, only 37 per cent of the State’s Primary Health Care Development Agency (JPHCDA) budget allocation was released, as against 75 per cent for the Government House.

Out of the N7.6 billion allocated for the JPHCDA in the 2024 budget, only N2.8 billion was released, representing 37.4 per cent.

However, for the Government House, N8.9 billion (75 per cent) of the N11 billion allocated was released.

The government spent N3.2 billion on renovating government houses and purchasing luxury Sport Utility Vehicles (SUVs) last year.

The government spent N1.7 billion on the SUVs, N246 million on the Presidential Lodge in Dutse, the state capital; N291 million on the Governor’s Residence; N161 million on Government Guest Houses and Chalets and N4.8 million for the renovation of commissioner quarters.

Conversely, only N1 billion was spent on the “renovation and upgrading of Primary Health Centres (PHCs).

This sum was derived from two key projects: N646,415,347.53 expended on the major “rehabilitation and upgrading of Primary Health Centres across the State” and N446,644,020.00 spent on the “renovation of PHC facilities at Ward-level across the State for Basic Healthcare Provision”.