INVESTIGATION: In Kwara, neglected PHCs condemn rural community residents to death (Part II)

This story is the second part of the investigative series revealing the gaps and challenges facing the healthcare system in Kwara State. You can read the first part of the story here:

Isiaq Ayinde, 60, was unable to bury his pains while recounting his life experience. All was good until March 2021 when he lost his eldest child Ibrahim to a minor illness. He blamed lack of access to healthcare for the tragedy.

“I can never forget the day because Ibrahim was very helpful and supportive to the family. He helped me a lot in my farming activities,” Isiaq sobbered, while he noted that Ibrahim’s mother is yet to recover from the pains since 2021, a reason she declined the interview as her eyes soaked with tears from remembering.

Hailing from Alajagusi, a remote community in Asa local government area of Kwara State, Nigeria, he had to travel for 15km or more to reach the town, where he could get health medications for his ill-child. The second option available to him then was to take his child to Ilorin, the state capital, a journey of about 30 km from his settlement.

 

“Ibrahim complained of stomach pain. Before we reached the hospital in Ilorin, he had died. If there was at least a functioning health center here at that time, he would have survived,” he said in a bereaved voice.

Unfortunately, the only PHC in Ajagusi which was commissioned in 2000 and caters for more than 10 settlements was outdated and in total collapse. It remained abandoned for years until 2023 when a new building was constructed for the PHC by the Federal Lawmaker representing Ilorin West and ASA Federal Constituency, Hon. Yekeen Sadiq Alajagusi.

 

Isiaq’s situation is similar to that of many citizens interviewed by this reporter in remote areas in Kwara State, North Central of Nigeria.

According to the National Primary Healthcare Development Agency (NPHCDA), PHCs are expected to offer 24-hour services, be fenced, and have staff quarters or accommodation for the workers within the community. They should also have essential drug supplies, a waste disposal system, equipped laboratories, and connections to the national grid. The PHC must also have a minimum of four nurses/midwives, nine community health extension workers (CHEW), a laboratory technician, a pharmacy technician and a medical officer (if available). However, neither Kusomunu PHC nor other PHCs in different rural communities of Kwara State visited by this reporter meet these minimum requirements.

New Structure, Shady Job

“When they finished the building, we were very happy that our hospital was back. Our hope was renewed and we thought we won’t need to seek medical attention elsewhere. But as soon as the project was completed, we didn’t get what we envisaged. The health officer told us that they didn’t have necessary equipment to treat us,” Ibrahim Musa, a resident, lamented bitterly.

The facility’s glowing colour of yellow and green also welcomed this reporter in March 2025 during a visit. But upon entrance, it is discovered that the PVC ceiling at the entrance of the building, waiting area, wards and even toilets is collapsing, showing that the project was shallowly done as the building is about 2 years old. Despite the building, essential services such as electricity and potable water are missing.

Inside the building are the patient observation area, consulting room, delivery room, injection room, lying-in ward, pharmacy, record section, store, and toilets, most of which PVC ceilings were soaked in water, leaking and broken with damaged doors.

Yahya Hafsat, a health worker in the facility, noted that lack of drugs and other medical supplies continue to hinder the health service of the PHC.

“The building was just constructed without supplying drugs, other medications and necessary tools. We can’t work without these equipment and even if we want to treat ordinary Malaria, we do not have the drugs. We often refer patients who need emergency attention to another PHC within the local government,” Hafsata said, explaining that the PHC does not even have paracetamol, gloves, bandages, and others.

Hafsat noted that lack of power supply, source of water, perimeter fence, and dearth of medical supplies and equipment are some critical deficits facing the PHC.

“We prefer to visit nearby chemists rather than the PHC whenever we notice a health issue. This is because we get drugs which always work for us from the chemist while the PHC only refers us to other places or writes drugs for us to buy elsewhere,” Musa added, stating that the PHC is partially abandoned by the members of the community, except for routine immunization of children.

Jamiu Shukurat, a woman in the community, told this reporter how she abandoned antenatal care due to the inadequacies of the medical health center in their community.

“The day I came back from Ilorin and saw the building, I was so happy that our community would finally have a functioning health center. However, since it was completed, we’ve not enjoyed the service as expected.”

She explained the challenges and stress she experienced: “The experience I had during the birth of my last child was not pleasant to share. On the day I went into labor, I was taken to the hospital with a bike which was not convenient at all due to the bad road conditions. If this PHC is working, I won’t need to be transported to another health center for the labour process.”

“We truly appreciate the person who facilitated this project, but the challenges we face as pregnant women are overwhelming. Often, we have to give birth at home. We know this is risky for both the baby and the mother but we do not have options,” she added.

Our investigation revealed that although the main building in use at the PHC was built about two years ago, the PHC infrastructure is gradually damaging due to non-quality words done for the roofing, and doors. Lack of water, medical supplies and adequate medical personnel in the PHC makes it inaccessible to the host communities.

In February 2025, the Kwara State Government announced a commendable initiative to upgrade 70 Primary Health Care facilities across the state’s three senatorial districts to Level 2 PHCs, backed by a significant N5 billion investment. This ambitious plan promised infrastructural upgrades, solarisation, provision of staff quarters, potable water supply, and ultra-modern hospital equipment across all benefiting facilities, according to the Kwara State Government’s statement.

However, during recent visits to Kusomunu and Ajagusi PHCs, a stark and heartbreaking reality emerged. Despite the tangible presence of newly constructed or renovated structures, the core promise of quality healthcare remains agonizingly unfulfilled. Residents recounted harrowing stories of lives being lost due to the continued lack of access to essential health services. The newly built walls stand, yet inside, the shelves remain empty of drugs, vital equipment is absent, and there are insufficient medical personnel. This profound gap between monumental investment and actual service delivery has dashed the hopes of residents, exposing a critical flaw in the state’s healthcare revitalization strategy and leaving communities as vulnerable as they were before the billions were spent.

Kusomunu PHC

Kusomunu PHC, which seven Kwara communities in EDU local government area rely upon, does not enjoy government interventions. The health facility is in shambles; it is bushy, the roof is dilapidated, no restroom for both patients and staff members and no source of power connected to the clinic. The mattresses and injection boxes in the hospital wards had become dusty.

Amos Reuben, a health worker in the PHC, noted that the facility needs urgent critical intervention as many residents have stopped seeking health services due to the collapsing structure and lack of medical supplies.

“As you can see, It is so bad to the extent that we can’t even admit a patient because we don’t have a drip stand. The walls stand as our drip stand. We get drugs with our money and we get them from the town. Many residents couldn’t afford the payment. They often questioned us that the government is responsible for supplying us with the medications anytime we asked them to pay,” Reuben noted.

N1000 Naira for Transport Fare, N100 for Medication

Uthmanu Ayinde, a youth in the community, decried the lack of access to health service in their community, bemoaning the long distance to access any kind of health care.

“Health center is very far from us. The worst part of it is that there is not a single chemist in this community and its environs to purchase drugs for minor illnesses. If we perceive any sickness, we would head to Lafiagi,” he said, explaining that they spend more than N1000 naira for transportation to get a common paracetamol drug that costs N100 naira in Lafiagi, the Local Government capital.

Corroborating this sad development, Tijani Adio, a resident of the Community, narrated how lives have been hard for sick people in their community due to the far distance of health centers, while he also noted the sufferings of pregnant women in the community on delivery.

“The transportation is very costly because the distance to Lafiagi is far. Many pregnant women in this community have suffered a lot. Many pregnancies have been lost before we reach hospitals in Lafiagi and the journey to Ilorin takes about 3 hours,” he narrated as he recalled his brother’s pregnant wife who lost her life due to the cause.

Accounts of Sorrow

Recounting a life incident in his community, Ishaya Julius remembered how the life of a pregnant woman was lost due to the long distance between his community and the nearest health center that would last for about 40 minutes.

“It was indeed a sad day. The wife of my neighbour once gave birth at home through traditional herbal means but the placenta refused to come out after all efforts. We tried to get a car in a short time but we couldn’t. After we later got one, before we reached the government hospital in Lafiagi, she gave up.”

Iyabo Ayinde, another resident, recalled how she was unconscious when she was bitten by a snake on her way to the river early this year.

“It was in the morning while I was going to fetch water in the river. Suddenly, a snake bit me on my left leg. If not that people are closer by, I might not have survived the injury,” she said, while pointing to the scars on her left leg.

Furthering her narration, Iyabo said the injury was compounded as it took them about 25 minutes to get a car to convey her to the nearest health center in Lafiagi.

“It took about 25 minutes to get a car because we only have bikes. Due to the severity of the injury, I spent almost a week at the general hospital in Lafiagi,” she said.

This reporter noticed that the deplorable state of the road alongside the ongoing road construction is contributing to this situation.

Shocking Data

Nigeria currently ranks as the country with the second highest number of maternal deaths globally, according to a 2023 WHO report. The maternal mortality ratio (MMR) in Nigeria is 1,047 deaths per 100,000 per 100,00 live births. A related study found that among 76 maternal deaths in Nigeria, 64 infants were born alive. However, only 31.3% survived beyond five years, while 68.6% did not.

Pregnant women who had lost their lives in these communities are among 10 percent of Nigeria women the United Nations Children’s Fund (UNICEF), in its official data, said to account for the world’s maternal deaths.

As a result of no access to health care services, high cost transportation fare and far distance of health centers, many residents have settled for self-medication and herbs for their diseases, while losing hope in obtaining modern health services.

Meanwhile, data collected by Orodata shows that out of 88 PHCs assessed, 69% reported having no functional pharmacy while 31% reported having one.

According to the WHO, the fundamental premise of primary health care is that all people, everywhere, have the right to achieve the highest attainable level of health. Primary health care is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. But, the premise is not realistic in Kwara rural communities like Kusomunu, Ajagusi, among others, where PHCs failed to meet up with these health expectations.

PHCs are Indispensable in Rural Healthcare Services

Dr. Abel Ojo, a health expert, said PHC is an important first contact healthcare facility in a given community where a trained, certified and licensed community health practitioner should be available to attend to minor ailments and make appropriate referrals.

Ojo bemoaned the poor state of PHCs investigated, noting that such development was dangerous.

Lack of adequate edifice; basic amenities like potable water supply, electricity and qualified health personnel are great hindrances to quality health care services for children and pregnant women,” he said, advising the government to retain health workers in rural areas by creating an enabling environment such as job security, good pay, rural allowance and many emoluments.

“The long and short effects of poor and/or non-functional PHC in our community include, but are not limited to, premature death of a baby, death of pregnant women in related pregnancy issues, inadequate treatment of illnesses, miscarriages, abortion of all types, non-quality service and many more.”

“My advice to the communities is that they should see the healthcare facility as their own and be ready to patronise it, and the government should be ready to finance the facilities and equip them with human and material resources,” Ojo added.

The Executive Director of the Kwara State Primary Healthcare Development Agency (KPHCDA), Prof. Nusirat Elelu, said the government has conducted an extensive assessment of all PHC facilities in collaboration with the National Primary Health Care Development Agency (NPHCDA) and is working to address the critical challenges facing primary healthcare services in the state.

“Kwara has over 500 PHCs with a large number of the PHCs requiring rehabilitation works due to neglect over the years, thus a need to prioritize interventions. Prioritizing PHCs for revitalization is primarily determined by infrastructural deficit coupled with patronage and the total catchment population served by the facility,” Elelu noted in a statement made available to Orodata.

She also noted that aside from the 70 PHCs currently undergoing renovation under the IMPACT project, the Kwara State Government has renovated over 60 PHCs, while a few new ones have also been renovated by the LGA Chairmen with several others to be renovated by development partners supporting the state.

“Our focus is to prioritise the ongoing revitalization of at least 1 functional PHC in each of our wards for equity. It is also not possible to have a PHC in all the communities in the State as this would require several tens of thousands of health workers. One of the indicators for tracking of availability of PHC services in a country as designed at Alma Ata is availability of PHCs within 5KM radius to a settlement or within 30 minutes trek and NOT availability in every community; as this will be a very tall and unattainable ambition in the face of other equally essential services and intervention the government is expected to provide.”

She further added that the agency is actively committed to improving healthcare access in rural areas and also exploring innovative strategies to enhance the living and working conditions of health workers, ensuring their full engagement and presence in these communities.

By Abdulganiyu Abdulrahman Akanbi

This story was produced for the Frontline Investigative Program and supported by the Africa Data Hub and Orodata Science.