Fuskar Gabas Primary Healthcare Centre (PHC) located in Shahuci Ward in Kano Municipal Area Council of Kano State, was among the over 217 PHCs in Kano state that were revitalised under a programme spearheaded by the Federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA).
The Federal Government had in 2023 unveiled plan to revitalise 17,600 Primary Health Care (PHC) facilities across the country, which was aimed to make basic maternal, newborn, and child health services accessible to communities.
The upgrades focus on infrastructure, equipping health workers, and securing a reliable power and water supply.
After revitalisation, the Fuskar Gabas PHCs’ infrastructure was upgraded with standard infrastructure, skilled health workers, reliable electricity through a solar power system and regular water supply from a dedicated borehole.
As such, when Sadiya Muhammad conceived her fourth pregnancy, she visited the facility for her antenatal services.
According to her, she conducted the antenatal services and delivered her previous three pregnancies at a private hospital due to the then poor condition of the Fuskar Gabas PHC.
‘But when my husband noticed that the condition of the facility has significantly improved, he told me that we would be relieved of spending more money in a private hospital.
‘In fact, even people that are not living far away from Shahuci ward, are now visiting the facility for healthcare services. Because we got our prescribed drugs from the hospital, and sometimes there are categories of people that are given the drugs to them for free, like those under the BHCPF programme,’ she narrated.
According to her, there is no delay in seeing a health personnel, they are always on their post to render the required services.
Our correspondent who visited Fuskar Gabas PHC, reports that two years after the revitalisation, the facility now records a high influx of patients who hitherto had to patronise private facilities at exorbitant prices.
For instance, when Hassana Hassan Abubakar, brought her 16-year-old brother to the Fuskar Gabas PHC in Shahuci over complaints related to stomach ache, the health workers promptly attended to him.
According to her, before the revitalization, people of the area hardly visited the facility, despite its proximity to them, but preferred to attend private hospitals or other secondary health facilities located many kilometres away.
‘But since the renovation was completed sometime in 2024, people from our area find it easier and are attending the PHC to get a qualitative healthcare service. There are a lot of changes, starting from the facility’s building, equipment and manpower.
‘In the past people had to spend a whole day waiting in a queue before they could be attended to, but now within one hour, a patient can be attended to, admitted and start receiving treatment,’ she said.
According to her, the pharmacy is always stocked with required and prescribed drugs, which are also affordable.
‘There is adequate electricity and clean water supply, there is enough equipment and other facilities that make it comfortable for both the health workers and the patients,’ Hassana said.
Thugs’ unrest prevents 24-hour service at the facility
However, our correspondent learnt that despite the qualitative healthcare service offered by the facility to the community, it cannot operate a 24-hour service due to lack of adequate security.
As such, by 4pm when the drip administered on Hassana’s brother had not yet finished, the health workers told them that they have to remove it and discharge him because the facility operates only between 8am and 4pm.
They have no choice than to find a commercial tricycle and take the hapless patient, who was yet to fully recover, home hoping to return the following day to continue with the medication. Similar to Hassana, a three-month-old pregnant Sadiya, said her nightmare is the lack of 24-hour service at the facility.
‘My fear is that in the event I start labour in the night hours, we don’t have a choice than to patronise private hospitals that charge exorbitant prices or go to the general hospital, which is very far and risky considering the security situation in the area. Sometimes it is even difficult to get a tricycle during the night time,’ she lamented.
She, therefore, appealed that the facility should be providing a 24-hour service, especially for people like her, the pregnant women.
Also, when Hauwa, (not real name) a pregnant woman was brought to the Fuskar Gabas Primary Healthcare Centre (PHC) in labour, it was already 6pm and couldn’t be admitted for delivery, because it was already 4pm, the time the facility closed because it cannot run a 24-hour service.
As such, Hauwa couldn’t be admitted and the two watchmen on duty that evening directed them to visit the Murtala Muhammad Specialists Hospital, a distance of about 10 kilometres.
This was a great risk, considering the maternal mortality rate in the state, which according to a report is currently estimated at 570 deaths per 100,000 live births.
Daily Trust learnt that once it is 4pm, the Fuskar Gabas PHC closes for the day, and all patients on admission have to be discharged prematurely, to either return the following day or go elsewhere.
Therefore, despite the upgrade and the qualitative services offered at the facility, a resident of the area lamented that, ‘the lack of 24 hours services is affecting our people. Whenever there is an issue at night, we have to visit Murtala Muhammad General Hospital, because the facility cannot run 24-hour services.
‘This is very challenging, especially for pregnant women, especially when the labour started during night time. We have to go to other places, despite being close to the facility, and it is frightening due to insecurity issues. So, we are appealing to the government to improve it and make it a 24 hours PHC, a resident of Shahuci, Maryam Ibrahim said.
The Technical Officer of the Fuskar Gabas PHC, Malama Asiya Nasidi Adam, explained the reason the facility closed by 4pm.
‘The PHC is located in a densely populated area notorious for thuggery activities, the thugs frequently launch attacks in the area. So, it is very risky to operate a 24-hour service, because of the fear of the unknown, especially during the night time.
‘There are a lot of patients that are patronising the hospital, but we have to close and discharge patients whenever it is 6pm, because we cannot guarantee security of our patients and staff,’ she explained.
According to her, there was a time they had to spend the night at the facility when a fight erupted between rival thugs’ groups.
She said, ‘We were about to close for the day, when a crisis erupted between rival thugs’ groups, they later started attacking innocent passers-by, a development that forced us to lock the gate from inside and sleep in the facility.
It was gathered that only two watchmen are engaged through local arrangement by the facility to provide security.
Lack of adequate manpower, equipment derailing gain of revitalisation
Daily Trust reports that the PHC is providing services in areas like Antenatal, labour and delivery, family planning, laboratory, OPD, Pharmacy and A/E, as well as the BHCPF, but there are not enough staff to handle the units.
The technical officer said the facility has only 17 permanent staff, with over 20 working as casual staff, being paid meagre allowances on money generated by the hospital.
‘Running 24 hours service, inadequate manpower and provision of security is the impediment stopping the hospital from running a 24-hour service.
‘Although, we have a solar system installed, it is not enough considering the size of the facility and the equipment that requires electricity to function optimally,’ Asiya Nasidi said.
Our correspondent reports that, although they are receiving an average of seven birth deliveries in the facility daily, they don’t have a blood bank, nor trained medical personnel to handle blood transfusion.
As such, in the event of a complication in delivery or any other case that requires such services, a patient has to be quickly referred to a general hospital, located some kilometres away from the facility.
‘What we usually do is to study the pregnant woman or patients records even before the admission, if we notice there will be possible complications, we will not even admit them, but ask such patients to visit another facility that can handle such issues.
‘To ensure that there is no any form of delay complication, there is a programme introduced by the NPHCDA, where we engage the services of Commercial Tricyclists that assists us in evacuating such patients to other secondary facilities, especially pregnant women,’ she said.
We are worried over sunset closure – WDC Chairman
On its part, the Ward Development Committee Chairman of Shahuci, Malam Inuwa Nasidi, said as representative of the community in the day-to-day running of the PHC, they are worried that the facility does not render 24-hour service.
‘We have recorded a great development in the facility, when it was renovated two years ago. Water was provided, with functioning toilets and regular power supply through a dedicated solar system.
‘And because of the renovation, the hospital is now providing qualitative healthcare services to people from far and near wards, like Tudun Nupawa, Zango, Zaitawa, Dukawa, ‘Yan Awaki, Kofar Wambai and other locations surrounding the facility.
Malam Nasidi lamented, ‘But despite these developments, once it is 4pm the hospital closes for the day. And it is a great set back to our communities.
‘Often pregnant women would be brought to the hospital in labour, but when the child delivery is not ready until closing time, they have to be referred to another facility, which is a great inconvenience.
He also added that there is need for additional staff which are inadequate because of the high number of people that are visiting the hospital.
Plan underway to employ more staff, provide security at PHCs – SPHCMB
On his part, the Director General of the Kano State Primary Health Care Management Board (KSPHCMB), Professor Salisu Ahmed Ibrahim, said the board is working to resolve the security threats restraining PHCs from operating 24-hour service.
He, however, explained that factors prevent the board from operating 24-hour service in most of the facilities.
‘Number one is the issue of human resources. If we don’t have a required and adequate number of skilled healthcare workers, especially for services like maternal and child health. Another thing is the security issue, which we have and it is scattered around the state. As such, if we don’t have adequate numbers of these critical categories of manpower, there is no way we can run a 24-hour service,’ he said.
‘We also need skilled birth attendants, that is a midwife, a nurse or a Community Health Extension Worker (CHEW), who are recognised to take delivery services.
Prof. Ibrahim said they are having security threats across the three senatorial districts of the state. ‘So, we cannot risk our staff to go there to work at night. Another thing is hard to reach areas.
‘There are areas that are really difficult to reach even during the day, based on the terrain of the road and the bushy nature of the area. So, this factor actually negates us from allowing our staff to work for 24 hours.’
However, the director general said the board is making plans to have a local arrangement with vigilante groups in the facilities where they want to start providing a 24-hour service.
‘We are planning to have interim arrangements with local vigilante groups, where we will be able to provide local vigilante groups around the facilities, especially at night to allow the PHC to provide 24-hour service,’ he said.
On the issue of manpower, Prof. Ibrahim said there is a comprehensive plan by the state government to employ more health workers to be posted to the facilities.
‘Presently, Governor Abba Kabir Yusuf has approved the employment of 2,500 medical healthcare personnel across all the cadres. Doctors, pharmacists, nurses, CHEW, JCHEW, laboratory and pharmacy technicians.
‘But most of them will be posted to secondary health facilities, because they are the referral centres for the PHCs across the 44 LGAs.
‘However, there is another plan to employ another 3,000 health workers that will work under primary health care. Already the proposal has been submitted to the governor and we are waiting for his approval,’ he explained.
The director general added that, ‘the model recruitment we are trying to do is a localised recruitment based on the local government of origin. We employ staff from there so that they will be able to attend to the people even at night.’