Sixteen-year-old Rabi Saleh has never set foot inside a hospital. Born with multiple disabilities and unable to walk or speak, her mother, Binta, relies on traditional herbs to manage her condition. The family lives in Farin Masallaci, a village under Karari ward in the Bichi Local Government Area (LGA) of Kano State.
“We can’t afford the city hospital. I wish my daughter could get health access here so she can get better and be like every other girl,” said Mrs Saleh.
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For hundreds of people like Rabi, healthcare is a dream deferred by distance, poverty and inaccessibility of facilities.
The story is the same for Taraba Rabiu, 28, who resides in Sabaru, a resettlement under Dutsen Karya
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village in Bichi LGA. Mrs Rabiu faced complications with all three of her pregnancies. She delivered each baby at home.
She said the only PHC accessible to her lacked a ramp, making it impossible for her to wheel her wheelchair in, and the facility had neither a midwife nor a nurse.
“I prefer giving birth at home because it is more comforting and safer for me,” she told PREMIUM TIMES. “There is no aid or special attention for us. Before I gave birth, every time I went for antenatal, I had to go with my husband to help me. And on the days I went alone, someone had to carry me into the consultation room.
Her husband, Musa, a shoemaker who also lives with a disability, called his wife’s pregnancy periods the darkest of their lives. “We had no support system, not even drugs. So, what can we do?”
Existing laws ignored, lives at risk
On 23 January 2019, former President Muhammadu Buhari signed into law the Discrimination Against Persons with Disabilities (Prohibition) Act, 2018.
The Act, among other provisions, sought to eliminate employment discrimination, provide access to public buildings within five years, foster inclusive education, prioritise healthcare for PwDs and reserve five per cent of the employment quota for PwDs in all public organisations.
The Act imposes sanctions, including fines and imprisonment, for those who default. The Act also established the National Commission for Persons with Disabilities (NCPWD) to oversee the prevention of discrimination against persons with disabilities and to ensure inclusivity for persons with disabilities across all sectors.
For Nigeria’s about 29 million PwD population, the legislation has had little impact. For PwDs in Karari, Dutsen Karya, Kwamarawa, Bum Bum, Rimayen Rake, and Tsaure, all in Kano State, its promises remain unfulfilled. PWDs residing in these communities rely on poorly equipped PHCs, plagued by similar gaps in inclusive service delivery.
According to a 2022 Dataphyte data, 7.5 per cent of adults in the Northwest region of Nigeria—about eight in 100 people- live with functional disabilities.
These include 4.4 per cent with visual impairments, and 3.1 per cent with difficulty in walking, climbing steps, or standing without support. 1.7 per cent have hearing problems and 1.1 per cent experience communication difficulties– people who struggle with speech, understanding, or being understood.
Healthcare facilities across rural Kano remain inaccessible to this significant segment of the population, six years after the Disability Act came into existence.
Kwamarawa, Yan Gishiri
In Kwamarawa, about 20 kilometres from Dutsen Karya, 30-year-old Hadiza Tasiu, a pregnant woman who uses a wheelchair, recalls the trauma of her last childbirth. Mrs Tasiu had attempted to attend antenatal appointments, but the clinic had no ramp, and the staff were unsure how to assist her.
“There was no midwife, medicine or anything that could help me. When labour came, I gave birth at home with the help of an old neighbour,” she said.
Now pregnant again, her fears are deeper. “Even if I’m dying, I won’t go back there. They made me feel less than human, not because they hated me, but because that place was never built for people like me.”
Rakiya Ibrahim, from Dutsen Karya village, has walked with a stick for most of her life. About 20 years ago, her family took her to a hospital in Kano city. Since then, she has not returned there.
“We have a PHC here, but they don’t treat people like me,” she said with disdain, resting her thin frame on a wooden stool. “Going to the city is too far and too expensive. My husband can only provide food.”
Abashi Salihu, a 22-year-old suffering from mobility impairment caused by a childhood fever, lives in Yan Gishiri village, a settlement covered by the Dutsen Karya PHC. His father, Salihu Ibrahim, stated that they initially visited Bichi town for care, but it became unaffordable as years passed and life became expensive.
“I cannot afford to take him to the city hospital again. Since Dutsen Karya PHC doesn’t treat his condition, we have no choice but to use herbs.”
But Abashi is not getting any better, according to the father.
“He falls often, and I’m growing old. I’m afraid of what will happen next,” his father said, with tears in his eyes.
Bakiru Musa, a nine-year-old who cannot walk or talk, has spent the last eight years bedridden. His caregiver, Idris Bala, now sees no future for him. To him, the PHC is not different from a local pharmacy “The PHC is like a pharmacy. It cannot help us.”
For Ibrahim Rabiu, a 22-year-old hearing-impaired man of Santar Kumao village, a settlement under the Dutsen Karya PHC, healthcare is not just physically inaccessible; it is culturally isolating.
“People like me are ignored because they feel that since I can walk and see, my issue is nothing. Dutsen Karya PHC has no sign language interpreter, and my family says it’s a jinn (that is disturbing me). So, they give me herbs,” he said, with a family member interpreting.
Facilities without foundation
Despite these sad realities, both Karari, Dutsen Karya and Kwamarawa PHCs lack even the basics for a health facility. No nurses, no doctors, and no assistive equipment.
Samaila Sule, the officer in charge of Dutsen Karya PHC, explained why the facility offers little to people with disabilities. “We have more than 40 persons with disabilities on our records, but those are the few that came.
Most of them don’t even come because we don’t have infrastructure or drugs—not even a wheelchair or slope.”
Karari Health Clinic has the same reality. Its head, Umar Ibrahim, stated that treating PWDs requires training, equipment and specialists, but they have none.
At Bum Bum PHC, 120km from Kano city, the ‘second facility-in-charge,’ Aminu Isiyaku, stated that he had worked for 10 years without receiving disability-specific training. “We always try to help when they come, but we have no ramps, no wheelchairs, no essential drugs, and not even enough staff. It’s heartbreaking.” Mr Isiyaku lamented.
He recalled one case where a man took his blind brother on a motorcycle for an over-an-hour ride to the hospital, only to be told no doctor was available.
“The man cried. That memory still haunts me,” Mr Isiyaku said.
Too far, no specialists, drugs or support
For persons with disabilities in rural Bichi, the problem isn’t a single barrier—it’s a chain of obstacles. From long distances and broken infrastructure to absent personnel and inadequate equipment, every step toward accessing healthcare is a significant challenge.
Villages like Gyauro and Kwamarawa are over 120 kilometres from Kano city, while others, such as Karari (65km) and Dutsen Karya (90km), are difficult to reach, especially during the rainy season.
But for PWDs, reaching a clinic brings little relief. At many PHCs, there are no ramps, handrails, or wheelchairs; delivery beds are also too high to climb. Most centres lack trained specialists, just a handful of overburdened community health extension workers (CHEWs) doing the best they can.
Essential drugs are often unavailable. And for patients who are deaf, physically impaired, or cognitively challenged, there are no interpreters, no assistive devices, and no emotional support.
As one PWD patient put it: “It’s like they built these clinics for everyone except us.”
Even at Badume PHC, a health centre in Bichi, which serves over eight surrounding settlements, the facility has only one functional wheelchair and no inclusive infrastructure.
Herbs: A dangerous shift
With formal healthcare out of reach across many villages in Bichi LGA, PWDs are increasingly turning to traditional herbs. Many say they have little choice, even when the consequences are uncertain.
At Gyauro village, this reporter met a traditional herb seller, seated by a small corner where bundles of roots, leaves, and bottled concoctions were carefully arranged. After a conversation, he agreed to speak under the condition of anonymity.
“We just give them what our fathers used,” he said, as he arranged small jars filled with a brownish liquid. “People come when they can’t find medicine. We don’t ask too many questions; if they say headache or weakness, we give what we think helps.”
When asked whether he considers factors like pregnancy, diabetes, or other underlying conditions before prescribing herbs, he shook his head. “People don’t always tell you. Sometimes I guess. Some herbs are strong, but that’s what makes them work fast.”
He added that most of his customers are women, persons with disabilities, and the elderly.
This kind of trial-and-error approach, though deeply rooted in cultural and inherited knowledge, carries significant risks. According to Fatima Baba, a public health researcher in Kano, such unregulated practices can worsen chronic conditions or trigger new complications.
Ms Baba said most traditional herbs are unregulated, some mixtures contain toxic plants that worsen chronic conditions, especially for persons with disabilities who need consistent, specialised care.
Meanwhile, this trend is not unique to Kano state. In a 2022–2023 survey of pregnant women in Ibadan, 56.5 per cent admitted to using herbal medicines at some point, while 27.1 per cent used them during their last pregnancy.
The study warned that such practices often displace essential treatments, such as folic acid and iron, putting mothers and children at risk.
Ms Baba warned that such cultural misconceptions, combined with systemic neglect, create “a perfect storm of medical misinformation, untreated symptoms, and worsening outcomes.
Government’s response to PWD’s cries
The Maternal, Neonatal and Child Health Coordinator at the Kano State Ministry of Health, Mansura Yahaya, stated that “there is currently no budgetary allocation for persons with disabilities.”
However, she noted that the state is working on a policy to ensure access to healthcare at both primary and secondary levels. This, she said, includes training health workers and adjusting infrastructure to make facilities more inclusive.
But for communities that have waited decades, policy promises offer little comfort.
Musa Shaga, chairman of the Joint National Association of Persons with Disabilities (JONAPWD), Kano Chapter, believes that change will not come without a dedicated Disability Commission.
READ ALSO: Bayelsa governor, lawmakers spend millions on foreign medical care while women, children die in neglected PHCs
Mr Shaga confirmed that advocacy is ongoing to get the state to establish a Disability Commission, a move he says will help protect the rights and amplify the voices of persons with disabilities.
Meanwhile, community leaders are also not left out in the struggle. Nasiru Abdulkadir, head of the Farin Masallaci community, said, “We used to meet with the Deputy Hakimi of Bichi every month and raise the issues to the emir. But nothing has changed yet, not even a hope.”
Dutsen Karya’s community leader, Samaila Ibrahim, added, “Even when we raise awareness, what’s the point if there’s no access? The people are hopeless.”
This reporting was completed with the support of the Centre for Journalism Innovation and Development (CJID)
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