For Hannatu Yakubu, childbirth meant travelling by motorcycle at night from Iddo to Kuje in the Federal Capital Territory (FCT) because the Primary Healthcare Centre (PHC) serving her community had stopped functioning.
With labour pains, Yakubu endured over 40 minutes on the motorcycle just to deliver her baby.
‘It was only God that saved me. My husband had to take me on a motorcycle at night because the health centre here is no longer functional,’ she said while narrating her ordeal to our correspondent.
Her experience reflects a wider failure BusinessDay found across PHCs in the FCT, Kano and Plateau states, where facilities exist but many lack the staff, electricity, equipment and emergency referral systems needed to provide reliable maternal care.
BusinessDay visits to PHCs found women receiving antenatal care in facilities without reliable electricity or water, workers relying on volunteers to keep centres open, equipment lying unused or out of service, and communities sharing ambulances that can take long to reach emergencies.
At health facilities visited in the FCT, BusinessDay found shortages of health workers, reliance on volunteers, unreliable electricity, deteriorating infrastructure and equipment that staff said was not functioning.
Patients and residents also described difficulties obtaining care, particularly at night or during emergencies.
At Alayita PHC in the Abuja Municipal Area Council, patients waited for hours for basic care as the shortage of health workers stretched the time women and other patients had to spend at the facility before they could be attended to.
A staff member, who spoke on condition of anonymity, said only seven workers were on the facility’s payroll and estimated that about 80 percent of the workers were volunteers.
Jama Medan, chairman of the National Association of Nigerian Nurses and Midwives (NANNM) FCT chapter, said the shortage of health workers has left many PHCs struggling to provide adequate coverage.
Medan said the last recruitment into PHCs by the FCT Area Councils took place in 2008.
He argued that investment in buildings and equipment would have limited effect without enough skilled workers to operate the facilities.
‘I had an emergency, I had to go to the clinic myself, and it was a lantern they were using as a source of power,’ he said.
Medan added that poor roads, insecurity and the absence of water, electricity and suitable accommodation also discourage health workers from accepting postings in remote communities.
‘You have primary health care centres down in the hard-to-reach areas, and then you want to pick someone and send him to that place where the person is exposed to the risk of being kidnapped.
‘The roads to those places are bad. And then the basic amenities are not there, no water, no good houses, no electricity, nothing.’
Our correspondent also discovered that apart from a shortage of staff, Alayita PHC does not have an ambulance permanently stationed at the facility in cases of emergency.
One worker at the hospital told this paper that an ambulance based at the AMAC headquarters could be requested through a WhatsApp group when needed.
Corroborating him, the NANNM chairman said such a centralised arrangement could delay emergency referrals from communities far from where an ambulance is stationed.
‘You have one ambulance situated in town, you know the bureaucracy involved to even file for it, to even send it to that village, you are talking about someone’s life.
‘It will take more than two hours before the ambulance will get set up or before they get the driver, and it will take another two hours before the driver can have access to that particular community,’ he said.
In 2025, Muyi Aina, the Executive Director and Chief Executive Officer of the National Primary Health Care Development Agency (NPHCDA), said the government was prioritising workforce development, with a target of deploying at least four skilled birth attendants to every functional PHC.
The previous year, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, said the government had disbursed about N45 billion directly to PHCs across the country through the Basic Health Care Provision Fund (BHCPF).
Pate also said N32.880 billion had been approved under the BHCPF to enhance healthcare delivery.
Yet the situation at several PHCs visited by BusinessDay shows that shortages of staff, power and equipment persist despite these commitments.
Power failures leave PHCs relying on lanterns
At Piwoyi PHC in AMAC, along Airport Road, BusinessDay observed pregnant women receiving antenatal care in a facility without electricity, water or adequate security.
A staff member said the facility could conduct basic tests for conditions including malaria, typhoid and blood sugar, but cases beyond its capacity were referred to Kuje General Hospital.
A pregnant woman who is seeking care at the facility said she had to clean a bed full of dirt and dust before receiving treatment.
‘Yesterday, I came for antenatal care and was put on a drip. The bed was covered in dust, if there were cleaners, it would be much better,’ she said.
Another worker in the facility appealed for electricity or solar power, particularly for women delivering at night.
‘Please, the government needs to provide the PHC with electricity or solar power. When a woman comes to deliver at night, we shouldn’t have to rely on torchlights. It’s dangerous,’ she said.
At other Abuja PHCs visited by BusinessDay, our correspondent observed damaged floors, poorly maintained infrastructure and equipment that workers said was no longer functioning.
Residents’ accounts indicated that the deterioration has persisted across different periods of government.
At Garki II PHC, staff said a laboratory machine used for culture had been out of operation for more than three months.
In Iddo, residents told BusinessDay that deterioration at their local PHC had forced pregnant women to seek antenatal and delivery services elsewhere.
Fatima Usman said she registered at the PHC but also registered at Wuse General Hospital because she feared what could happen if she developed complications.
She said the facility, built under a Millennium Development Goals intervention with support from the World Bank and the FCT Administration, had deteriorated over the years.
‘The roof is damaged, and parts of it have been blown off. Whenever it rains, there is no place to admit patients,’ Usman said.
Johnson Emmanuel, another resident, said pregnant women now travel to neighbouring Agweh community for antenatal care and delivery.
He noted, ‘We have written several times through our village head, but nothing has been done for over eight years.’
Other residents who spoke to BusinessDay said the staff quarters had also become uninhabitable due to leaking roofs and ceilings that have caved in.
‘During the rainy season, we are completely cut off. It is only during the dry season that we try to fix bad portions of the road ourselves to move farm produce,’ the resident said.
Kano’s rehabilitation challenge
Just as the challenges remain across PHCs in FCT, BusinessDay found that many health facilities in Kano State require rehabilitation.
It was gathered that unreliable electricity, shortages of skilled birth attendants and inadequate equipment continue to undermine rural PHCs in many parts of Kano.
In some facilities, our correspondent found that deliveries were carried out using torchlights when electricity fails.
Equipment supplied to some PHCs also remains unused or breaks down because of inadequate power.
This paper observed that the electricity problem extends to cold-chain facilities, with unreliable power contributing to vaccines expiring before they can be administered.
According to data from Kano State Surveillance for Evidence and Policy, the state’s maternal mortality remains above 3,000 deaths per 100,000 live births.
Abdulkadir Abdulsalam, commissioner for rural and community development, said about 40 percent of Kano’s 484 PHCs require rehabilitation.
Abdulsalam said the state government plans to rehabilitate and adequately staff more than 400 ward-level PHCs from 2027.
He said the intervention would include solar power systems, trained midwives and cold-chain facilities for vaccine storage.
The commissioner said the administration of Governor Abba Kabir Yusuf is targeting a substantial reduction in maternal mortality by 2030.
Mixed development in Plateau
In Plateau State, there are signs of improvement, but maternal deaths remain high.
At PHCs visited in Tudun Wada and Kobong in Jos North and Bukuru Central in Jos South, nurses told BusinessDay that despite increased antenatal attendance and access to skilled birth attendants, maternal mortality remains a major concern.
‘We have seen some improvement in the situation, but maternal mortality still needs serious attention,’ a nurse at Tudun Wada PHC said.
Another nurse at Kobong said more women were using health facilities for delivery.
‘More women are now coming to the health facilities for delivery, and this has helped in managing complications early,’ the nurse said.
Blessing Domtu, a breastfeeding mother, said she received adequate care during labour.
‘I was well taken care of while I was in labour. The nurses attended to me, and I received the care I needed,’ Domtu said.
According to Nicholas Ba’amlong, Plateau State commissioner for health, the state’s maternal mortality ratio had fallen to about 500 deaths per 100,000 live births from an estimated 900.
Ba’amlong attributed the reported improvement to recruitment of nurses and midwives, free antenatal screening, provision of Mama Kits, improved access to Caesarean sections and increased sensitisation on antenatal care and vaccination.
The state government also said it revamped 80 primary healthcare centres as part of efforts to reduce maternal and child mortality.
Funding without functionality
Meanwhile, health professionals noted that improving PHCs requires more than constructing buildings.
Abraham Agbo, a medical practitioner, said adequate financing was fundamental because facilities needed medicines, equipment and infrastructure in addition to personnel.
Without adequate financing, he said, a PHC could become little more than a building without the resources required to provide care.
Erundu Fred, another medical practitioner, said financing primary healthcare involves the federal, state and local governments.
He added that accountability should follow the money from budgeting through release, disbursement and utilisation.
‘The real question is, did the money come out? Did the money go through all the different processes? Everybody who was supposed to bring the money brought the money, and the money reached where it was supposed to reach,’ he said.
Fred noted that communities should be able to ask questions about money allocated to their PHCs and how it is used, including funding provided through the Basic Health Care Provision Fund.
Across the three states, the problem was not simply the number of primary healthcare centres on government records. It was whether those centres had the staff, power, equipment and referral systems needed to function when women needed them most.
For women like Yakubu, the consequence is measured not only in the number of PHCs built or the amount budgeted for primary healthcare, but in whether they can access affordable maternal healthcare when they need it most.