In August 2021, Nigeria Health Watch initiated a community engagement project with the aim of monitoring and reporting on the state of healthcare delivery in rural communities around Nigeria. Primary healthcare is the bedrock of any health system, and the hope is that this project will enable the voices of community members to be heard, as they share their experiences accessing healthcare and further provide a platform for accountability in the health sector, especially at the PHC level.
The Community Health Watch initiative is currently taking place in three Local Government Areas (LGAs) in Niger State. To get underway, a team from Nigeria Health Watch visited Tunga Malam village in Paiko Local Government Area (LGA) and Ejiko community in Gbako LGA and Lemu LGA, all in Niger State.
Tunga Malam village is well known for its large farmlands and market day. It has a small Primary Healthcare Centre (PHC) that serves it and the more than 10 communities around. However, the PHC does not function optimally, offering poor quality health services due to many challenges.
Paiko LGA: One PHC, many challenges
During a town-hall meeting, aimed at engaging with the community members, challenges such as a shortage of health workers, lack of a dispensary and laboratory, lack of medication and inadequate water, sanitation, and hygiene facilities were highlighted as factors contributing to the ineffective provision of healthcare services by the PHC. To discuss these challenges in detail, the team sat down with Larai Usman, a health worker assigned to the Tunga Malam PHC.
“There is only one toilet for the PHC”, Usman said. According to her, both patients and health workers, male and female, use the one toilet and this is inadequate for the number of people using the facility. As a result, patients, especially women, use the toilet in the community leader’s house which is across the road from the facility. The challenge of the lack of toilet facilities is the most worrisome according to Maryam Adamu, the women leader of Tunga Malam. “Imagine someone coming to the health facility with diarrhea and there is only one toilet which is almost always occupied, what will the person do?” she asked.
According to Usman, another worrying challenge is the absolute lack of water in the PHC. “We always buy water. It is a challenge on our resources. When we are delivering a child, we must buy water. To clean, we must buy water”. In addition, the PHC does not have a medical waste disposal site and health workers must make do with an open waste disposal area close by. This is a health hazard for the local community, due to the risk of infectious diseases spreading. According to, Usman, it is also a threat for the community as the waste disposal area is close to the market, and children often play around it.
According to the 2016 Multiple Indicator Cluster Survey (MICS), 24.3% of children under the age of five in Niger State are underweight. The PHC has never been supplied with ready-to-use therapeutic foods to treat children with malnutrition even though malnourished children are sometimes brought to the facility. Usman said, “We refer them to the hospital in Paiko. Because it is a bit far, some parents cannot afford taking the children there”. However, uptake of family planning is high in Tunga Malam PHC as women access the services when they bring their children for immunisation. This, she said, is because of continued sensitisation to the women on the benefits of child spacing.
On market days, Usman complained, the health workers are overburdened as people from neighbouring communities use the opportunity to attend antenatal and bring their children for immunisation. “We are only two and we provide all the services to these people. Some days we just cannot cope, and some women and children go back unattended to”, she said.
Gbako LGA: A mere structure
For Ejiko community in Gbako LGA, the community members had to contribute money to construct a health facility for themselves. According to Isa Muhammad, youth leader, after multiple calls to the government to build a health facility went unanswered, the community built the facility to enable them to access healthcare. However, even though Lemu LGA posted two health workers to the facility, community members are still unable to access quality healthcare services. “The health workers come in the morning from Lemu and close in the afternoon around 4PM”, Muhammad said. He added that the community was only able to raise money to construct the structure and could not afford to provide a ceiling or adequate flooring. The building also lacks plastered walls.
Abdullahi Abubakar is one of the two health workers at the health facility. He narrated that the facility could best be described as a mere structure due to its inability to meet the varied health needs of the local community. “We conduct deliveries on a mat on the floor. There is no bed. We don’t have water or toilet. We are always out of medications even routine drugs, and there is no fence”, he said.
According to Aishatu Salihu, women in Ejiko community attend antenatal at the facility. However, because the delivery room is not well equipped, some women prefer not to give birth at the facility. “The road is bad, and that is how women are transported through it to Lemu to give birth. Sometimes there is no vehicle to transport the women and they must give birth at home”, she said.
Niger is one of the states with some of the poorest health indices in Nigeria. At 25.8%, the state has one of the lowest health facility delivery rates in the country, and only 41% of pregnant women in the state receive antenatal care from skilled a provider according to the 2018 National Demographic Health Survey. However, with health facilities such as the ones in Tunga Malam and Ejiko communities, these statistics are not surprising. The state and its LGAs must make a deliberate effort to invest in primary healthcare to improve access and the delivery of quality healthcare to people in the local communities. Only then, can the state improve on its poor health indices.