Despite billions spent, over 6,500 PHCs still non-functional

In spite of years of federal and state government investments running into billions of naira to revitalise Nigeria’s primary healthcare system, at least 6,516 Primary Healthcare Centres across the country remain non-functional, exposing millions of Nigerians — particularly those in rural communities — to limited access to basic medical services.

An analysis of data obtained from the National Primary Health Care Development Agency by The PUNCH shows that Katsina and Osun states account for the highest number of inactive facilities, while findings indicate that the crisis is even deeper in conflict-ravaged Borno, where hundreds of PHCs destroyed by insurgency are yet to be rebuilt.

The report also reveals that beyond dilapidated infrastructure, chronic shortages of health workers, insecurity, poor funding and weak maintenance continue to undermine years of revitalisation efforts.

According to the NPHCDA data from the agency’s Primary Health Care Dashboard Katsina State tops the list with 442 non-functional facilities, followed by Osun with 406, Benue (343), Enugu (335), Adamawa (286), Jigawa (282), Delta (278), Yobe (248), Lagos (246), Ogun (246), Bauchi (229), Edo (221), Rivers (218) and Borno (159).

Others are: Bayelsa (120), Kwara (87), the Federal Capital Territory (68), Nasarawa (58), Sokoto (45), Oyo (40), Niger (35), Imo (34), Kebbi (32), Cross River (30), Kano (26), Zamfara (23), Plateau (18), Kogi (14) and Akwa Ibom (10), among others.

However, separate findings by The PUNCH revealed that the situation in Borno may be significantly worse than reflected on the national dashboard.

While the NPHCDA dashboard lists 159 non-functional PHCs in the state, the Director of Community and Family Health at the Borno State Primary Health Care Development Board, Dr Mala Wahab, disclosed that 358 primary healthcare facilities remain destroyed after more than a decade of Boko Haram insurgency.

According to Wahab, Borno had 735 PHCs before the insurgency but now has only 377 functioning facilities following years of destruction.

“Before insurgency, we had 735. Insurgency destroyed a lot of primary healthcare facilities,” he said.

He added that the administration of Governor Babagana Zulum had increased the number of operational PHCs from fewer than 100 to 377.

“Before Zulum assumed office, we had less than 100 primary healthcare centres, but now we have 377,” he said.

Wahab disclosed that three additional PHCs are about 70 per cent completed and would increase the number of functional facilities to 380 upon completion.

“When they are finished, we will have a total of 380. They are spread across all the local government areas. All of them are accessible and serving residents where they are located,” he added.

He noted that despite significant investments in infrastructure and equipment, manpower shortages driven by brain drain continue to affect service delivery.

“The state government was able to provide human resources for all of them as well as equipment and modern infrastructure, while development partners are complementing our efforts.

“Recently, the state employed more than 1,400 health workers deployed across the locations. Although we are affected by brain drain and people leaving in search of greener pastures, we have lost many workers, especially in hard-to-reach areas where people are afraid to work,” he said.

The NPHCDA dashboard further showed that Nigeria currently has 3,128 functional Level 2 PHCs, 3,275 revitalised PHCs and 5,141 facilities supported through the Basic Health Care Provision Fund.

The figures highlight the widening gap between infrastructure investments and actual service delivery at the grassroots, where millions of Nigerians depend on primary healthcare centres for essential medical services.

Primary healthcare centres are regarded as the foundation of every functional health system because they provide preventive, promotive, curative and rehabilitative healthcare close to where people live.

They offer routine immunisation, antenatal and postnatal care, skilled birth attendance, family planning services, treatment of malaria and common childhood illnesses, nutrition services, tuberculosis and HIV screening, disease surveillance, health education and referral services.

For many rural communities, PHCs represent the first—and sometimes only—point of contact with the healthcare system.

Health experts have consistently warned that when PHCs become non-functional, residents are often forced to travel several kilometres to secondary or tertiary hospitals, delay seeking treatment, patronise unqualified healthcare providers or resort to self-medication.

Such delays contribute significantly to maternal deaths, infant mortality, vaccine-preventable diseases and poor health outcomes, particularly among children under five years and pregnant women.

The development comes despite sustained investments by the Federal Government and development partners to revive Nigeria’s primary healthcare system over the last decade.

One of the flagship interventions is the Primary Health Care Revitalisation Programme, coordinated by the NPHCDA in collaboration with state governments.

The initiative was introduced to rehabilitate thousands of dilapidated PHCs by renovating buildings, providing potable water, electricity, staff accommodation, delivery rooms, laboratories, cold chain equipment for vaccines, solar power installations and essential medical equipment.

The programme also seeks to ensure that every ward in Nigeria has at least one fully functional primary healthcare centre capable of delivering a minimum package of health services.

A major financing mechanism supporting the initiative is the Basic Health Care Provision Fund, established under the National Health Act.

The BHCPF receives at least one per cent of the Federal Government’s Consolidated Revenue Fund and is designed to strengthen service delivery at PHCs by financing essential drugs, vaccines, consumables, equipment maintenance, emergency transportation, healthcare worker incentives and facility upgrades.

The fund is implemented through agencies including the NPHCDA, the National Health Insurance Authority and the Nigeria Centre for Disease Control and Prevention, while states are required to meet accountability and counterpart funding requirements before accessing the intervention.

Since the commencement of BHCPF implementation, thousands of PHCs have benefited from rehabilitation works and operational funding aimed at improving service delivery across the country.

Successive administrations have also launched several programmes to strengthen primary healthcare, including the “PHC Under One Roof” policy, which seeks to integrate fragmented PHC management under a single state authority to improve governance, financing and accountability.