SPECIAL REPORT: Bauchi communities struggle to access healthcare as govt fiddles with funding priorities

Hannatu Sabiu held her three-year-old grandson, Muhammad Sani, close to her chest, his limp body resting against her. The boy’s half-open eyes darted weakly around the dimly lit consultation room of a health post in Ringim, a village in Ganjuwa Local Government Area (LGA) of Bauchi State.

At intervals, Muhammad would let out a shriek, and his grandmother would rock him gently to stop him from crying, while she explained his condition to a health worker attending to them.

The child had been sick for a while, withdrawing from the playground and clutching his belly while he cried on his grandmother’s lap. He was administered paracetamol at home for days, but his condition only worsened.

“The fever was on and off,” Mrs Sabiu told PREMIUM TIMES at the health centre one Saturday in October.
That morning, he vomited all that he had eaten, even though he had barely eaten anything in days. “That’s why I brought him to the hospital,” she said.

She was offered some drugs, including an Oral Rehydration Solution (ORS) prescription, and asked to take the boy to the Primary Healthcare Centre (PHC), Kafin Madaki, also in Ganjuwa LGA.

PHC Kafin Madaki is several kilometres from Ringim, and can only be accessed via bumpy roads that worsen during the rainy season.

Lamaran Haladu, who heads the Ringim Health Post, said he suspected blood shortage in the boy’s body, prompting the referral.

However, Mr Haladu, a Community Health Extension Worker (CHEW), said the health centre doesn’t have the capacity to diagnose the boy’s ailment.

The health centre only treats minor conditions, such as fever and malaria. Other severe conditions that may require blood transfusions are usually referred to either the PHC Kafin Madaki or the General Hospital.

This is the case for many residents who visit this health centre, which serves several communities, including Kanaka, Wushi, Dati, Unguwan Madaki, Unguwan Sarki, Jauro Sani, Hardo Kundi, and Digawan Kanaki.

“Overall, our target population is almost 10,000,” said Mr Haladu. “People in Jeren Gabar, a village after Kanaka, usually can’t come here during the rainy season because they have to cross a river.”

However, the PHC Kafin Madaki, where Mrs Sabiu was referred to, was under lock that morning when PREMIUM TIMES visited on the same day. Residents said it was operational, but the officials were not around that day.

It meant Mrs Sabiu could not present her grandson for medical checks when she eventually got there.

Common diseases killing Bauchi kids

Although no Cholera diagnosis had been made yet on Muhammad, the symptoms he presented were similar to those of Cholera, a recurring disease whose outbreak the state is currently battling. Across Bauchi, children face identical risks as preventable diseases spread through communities lacking functioning health facilities.

A few weeks prior, the state government announced 58 Cholera fatalities amid an outbreak in 14 of the state’s 20 LGAs. The government reported a total of 258 new cases, indicating a fatality rate of 22 per cent.

Cholera is a severe diarrheal disease that spreads through contaminated food and water. According to the World Health Organisation (WHO), it can kill within hours if not treated.

In the last five years, the disease killed more than 4,700 people in Nigeria, according to aggregated data from the Nigeria Centre for Disease Control and Prevention (NCDC).

Four states – Bauchi, Jigawa, Kano, and Zamfara – accounted for 53 per cent of all cases in the last five years.

Aside from Cholera, Bauchi also battles other endemic diseases like Measles, Lassa Fever, and Malaria, all of whose fatalities worsen as a result of weak primary health care services, according to health experts.

Earlier this year, the state government reported a rise in measles cases among children, with more than 200 cases recorded in the first three months of the year. By September, the number of cases reported in the state had risen to 1,303, making it the state with the third-highest number of cases after Zamfara (4,679) and Yobe (1,765), according to the NCDC.

In its epidemiological report for the last week of August, the NCDC reported that it had recorded 871 confirmed cases of Lassa fever. “Ondo, Bauchi, Edo, Taraba, and Ebonyi states remain the primary hotspots, accounting for 91 per cent of all confirmed cases,” the agency said.

Children of Muhammad’s age are disproportionately affected by these diseases, according to Save the Children, a non-profit organisation working to protect children’s rights.

Also, Bauchi’s under-five mortality rate is one of the highest in the country at 125 deaths per 1,000 live births, according to the 2023/2024 National Demographic Health Survey (NDHS). This is higher than the national average of 110 deaths per 1,000 live births.

Meanwhile, a 2023 study on the knowledge and skills of Community Health Workers (CHWs) regarding epidemic-prone diseases in Ganjuwa LGA found that most of them had a limited understanding of prevalent diseases, such as Measles, Lassa Fever, and Pertussis.

The study noted that only 23.94 per cent of the CHWs recognise that Ganjuwa LGA, where they work, is affected by all four epidemic-prone diseases – Diphtheria, Measles, Lassa Fever, and Pertussis.

“Additionally, their understanding of the mode of transmission of these diseases was poor,” the researchers concluded. “This could be an indication of the weakness of the capacity of community members to carry out surveillance activities within their communities.”

Manpower shortage leaves women, children vulnerable

Elsewhere in Misau LGA, Hadiza Muhammad, 28, who never birthed any of her five children at home, was reconsidering having another child after a terrible labour experience at the PHC Misau (Township Maternity), Misau LGA.

About a month before, when she went into labour to give birth to her son, it took hours, but she was only attended to by some health workers-in-training, who, she said, based their decisions on guesswork as she laboured.

“In my previous experiences, I got injections when I was struggling. But on this day, I was struggling, but they couldn’t do anything,” she narrated.

“Even when I finally gave birth to the baby, the students were not too sure what to do; they were talking to themselves, and if one said this, the other would say something else.”

Mrs Muhammad recalled pleading with them to get a more experienced official to help out, but none came. After the traumatic birth experience, she said the students couldn’t stop her bleeding and referred her to the Federal Medical Centre (FMC), Misau.

Unlike Mrs Muhammad, Laraba Ishaku’s sister was not lucky. Almost two years ago, Mrs Ishaku led her younger sister, who was in labour, to the health centre, but the volunteer workers told her there was still time, and that they should go back home and return later.

“They asked us to come back later at night or the next morning, but we had to go back before the time because of how intense it was getting for her,” she recalled.

According to her, there were only two workers at the hospital that evening.

They asked her to get a mosquito net for the woman in labour. She had taken only a few steps outside the hospital when someone ran up to her to check on the patient, who was having convulsions.

“I went back and quickly went to look for the health workers. Before they tried to do anything, my sister died. I couldn’t do anything. I just cried,” she said.

Across many PHCs and a general hospital surveyed by this newspaper in Bauchi, manpower shortage is a common problem.

Many health centres are only coping by engaging volunteers, most of whom lack experience. In many cases, there are more volunteer workers than government-employed professionals at the health centres.

The 2024 State of States report by the civic tech organisation, Budgit, revealed that only 10.9 per cent of hospitals in Bauchi State had at least one medical doctor attending to patients.

According to the report, only 137 of 1,255 surveyed health facilities fall into this category.

Another report by SBM Intelligence noted that Bauchi has the worst Doctor-to-Patient Ratio among Nigeria’s 36 states and the Federal Capital Territory (FCT), with 54,249 people per 139 doctors.

Last year, the then Commissioner for Health, Adamu Sambo, admitted that Bauchi State’s primary health centres are understaffed.

Mr Sambo said the state has over 1,300 primary health centres with only 3,234 healthcare professionals.

“Only 80 per cent of them are actively rendering services at health facilities. Additionally, over 1,000 volunteers support the agency, which the agency has no control over,” he said.

In September, the government said it had recruited 3,000 health workers. However, this has not changed the situation on the ground.

For instance, at Sirko PHC in Misau LGA, a renovated structure stands erect, but three of the six officials who work there are volunteer staff – all CHEWs.

At Ringim health post in Ganjuwa LGA, there are two permanent staff – one CHEW and one environmental officer. The three others are volunteer staff, the official in charge told this newspaper.

At the Alangawari community, the health centre is manned only by three volunteers, one of them, Aliyu Bello, said. They only treat mild fevers, such as malaria, as they’re not equipped to do more than that.

“There’s a labour room, but there’s no midwife. So pregnant women have to go to Misau to give birth,” Mr Bello said.

“Because this hospital is not yet fully functional, ANC doesn’t hold, except they’re going to go to Misau.”
At the General Hospital Kafin Madaki, Ganjuwa LGA, the situation is similar. For months, the hospital has not had a permanent medical doctor. There has only been one locum (temporary) doctor at a time, one of the health officials told PREMIUM TIMES during a visit in October. The official didn’t want to be named for fear of retribution.

According to the official, there are only four nurses at the General Outpatient Department, including the Chief of Nursing. He explained there were just two nurses at the maternity unit, helped by some volunteers whom he described as ‘untrained staff’. He said most of them are secondary school certificate holders who should only be cleaners or run errands at the hospital.

Operating amid scarce resources

The official explained that the General Hospital doesn’t have oxygen for patients, and any patient in need of oxygen would be referred to the capital in Bauchi, a 44-kilometre journey.

“Weekends are the worst days for us. We run 24-hour shifts. One person is monitoring the whole facility. When the maternity ward has a case beyond them, they’ll call your attention, and you’d have to go there to attend to the patients because they are untrained staff.”

Despite the lack of complete resources to operate, Mr Haladu said the Ringim health centre admits patients for mild fever and other conditions.

On the day PREMIUM TIMES visited, a young boy lay on a metal bed frame with a mat placed on it in place of a mattress, with an IV line inserted in his arm.

His brother, Mansur, who was staying with him, said he was having a fever and they had to journey from Kanaka on his motorcycle to this health centre for medical attention.

“The journey took about an hour from home,” said Mansur. “We’re supposed to have a health centre, even if it’s a small one like this. So, we don’t always have to travel to Ringim for medical services.”

But that’s not all. Mr Haladu often had to deliver babies in improvised conditions, without access to a safe or properly equipped labour room.

At other times, when he suspected there could be complications, he referred them either to PHC Kafin Madaki or directly to the General Hospital in Kafin Madaki.

But the situation at the General Hospital is also dire. One of the health workers told PREMIUM TIMES that the only personnel present at the General Hospital’s maternity ward after closing hours were untrained staff.

He said the ‘untrained staff’ help out because they have worked with the officials for a long time and have learned some of the basics over the years, but have not received formal training.

“Lack of trained staff –skilled manpower– has increased the fatality rate of neonates…and maternal mortality,” he said.

“Sometimes, even when the woman in labour gives birth and the child is stressed, the attendant, because they’re not skilled, does not know how to resuscitate the child.”

According to the NDHS, only 28.4 per cent of Bauchi’s births are conducted by skilled providers, including doctors, nurses and midwives. Nationwide, the figure stood at 45 per cent.

According to a public health expert and medical doctor, Anne Umoren, CHEWs are not trained to deliver childbirth or diagnose patients’ ailments.

“For maternal and neonatal care, their training for that is mostly on basic obstetric and emergency obstetric care. It’s a programme that encompasses giving antibiotics, recognising that, yes, that is an obstetric emergency,” she said.

“So, they are trained first to recognise that, yes, it’s an emergency. They are trained to know their limits and how to give first aid before they now contact the nearest and fastest healthcare facility.”

Ms Umoren said rural health centres struggle to retain doctors due to the lack of specific amenities, including accommodation for doctors posted outside state capitals.

“Most of the time, it’s a challenge. So, if a doctor is posted to a remote area, he or she would rather go there once a week because of the stress of getting there, the bad road, because to gain access there can be a little bit difficult,” she added.

In all the PHCs visited by PREMIUM TIMES, none had even a quarter of the 24 personnel recommended by the National Primary Health Care Development Agency (NPHCDA) as minimum standards for PHCs in Nigeria.

The NPHCDA recommends that a standard PHC should have at least four nurses/midwives, one medical officer, one CHO, one pharmacy technician, three CHEW, one laboratory technician, one medical records officer, one environmental officer, six JCHEW, two health attendants, two security personnel and one general maintenance staff.

Little progress, but misplaced priorities continue

Earlier this year, the Bauchi State Government, assisted by the World Bank, launched an ambitious initiative of about N7.5 billion to renovate over 100 PHCs across the state under the bank’s Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services (IMPACTS) project.

In February, Plan International Nigeria handed over seven renovated PHCs to the state government.

Last year, the United Nations Population Fund (UNFPA) also renovated and upgraded two PHCs for improved family and child health, and handed them to the state government.

While some PHCs have been renovated, specific issues, such as manpower shortages, persist. In some communities, there are no health centres at all, leaving residents in precarious situations. In others, the health centres are dilapidated, as residents await government intervention.

However, the government’s misplaced spending has continued to deplete the state’s funds.

In July, Governor Bala Mohammed approved N7.8 billion for the renovation and remodelling of the State House of Assembly complex.

In 2023, the government spent N16 billion for ‘upgrading’ the Government House, N10 billion more than the initial N6 billion budget, according to the state’s audit report. This is way above the N10.4 billion allocated for the state’s Primary Health Care Development Agency (BSPHCDA), which manages all the state’s PHCs, in the 2025 budget.

Communities in limbo

In Kafin Zaki community, Ningi LGA, the only health centre had been dilapidated and non-functional for over seven years, the village head, Haruna Garba, said.

Mr Garba said the community attempted to engage the government, including through letters, but got no response, forcing residents to go to the health centre at Gidan Baiwa, a neighbouring community, for their healthcare needs.

“When we have emergencies, we always suffer to get them to a hospital. In fact, most times, they’re placed on a cattle-pushed cart because of the way our road is,” he said.

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Before the health centre degenerated completely, he said it only had one official who wasn’t always available.

“I once raised these complaints with the district head of Ari, and he spoke to some officials to warn the health officer deployed to the hospital, but he has stopped coming completely,” he said.

“Nothing is happening here, except when there’s a vaccination exercise, and the vaccinators come, then they administer the vaccines here.”

Meanwhile, residents of Bakutumbe, another village in Ningi LGA, said they do not have a health centre.

According to Dauda Yakubu, the village head’s representative, the community had been piling up sand for years, hoping to donate it for the construction of a health centre whenever the government begins it.

“That’s part of our contribution to seeking the development,” Mr Yakubu said.

Mr Yakubu said the community also set up a committee to lobby the government to construct a hospital there.

“This is a problem we have spent a lot of time calling on the government to attend to, but it has not been attended to…We have written, we have gone to the primary health care board,” he said.

“We are hoping this new (present) government will do that, because for us, any government that does that for us is the new government.”