Nigeria’s Primary Healthcare Centres Face Fresh Maternal Care Test as Staff, Power and Equipment Gaps Persist

By Simpson Global Media News Desk

A System Under Pressure

Nigeria’s effort to reduce maternal deaths is facing a difficult test at the very point where many women are expected to receive their first and most accessible level of care: the primary healthcare centre.

A field investigation published on Monday, October 5, 2026, has documented persistent shortages of health workers, unreliable electricity, inadequate equipment, deteriorating infrastructure and weak emergency referral arrangements at primary healthcare centres visited in the Federal Capital Territory, Kano and Plateau states.

The findings are significant because primary healthcare centres are supposed to provide the foundation of Nigeria’s health system.

For pregnant women, they are particularly important. A functioning PHC can provide antenatal care, identify complications early, support normal deliveries and refer women who need more advanced treatment.

But the investigation found that having a PHC building in a community does not necessarily mean that a woman has access to a fully functional maternity service.

In some of the facilities visited, health workers reportedly relied on volunteers to keep services operating. Some centres lacked reliable electricity and water. Some equipment was out of service, while emergency ambulances were not always stationed at the facilities that needed them.

The result is a gap between infrastructure on paper and healthcare that is actually available when a woman goes into labour.

The Journey Some Women Still Have to Make

One of the clearest examples came from Iddo in the Federal Capital Territory.

Hannatu Yakubu told investigators that when she went into labour, she had to travel by motorcycle at night from Iddo to Kuje because the primary healthcare centre serving her community was no longer functioning.

The journey reportedly lasted more than 40 minutes.

Her experience illustrates one of the central problems confronting Nigeria’s maternal-health system: when a nearby facility cannot provide dependable care, distance becomes a medical risk.

A woman experiencing an uncomplicated pregnancy may be able to travel elsewhere for routine antenatal appointments.

Labour is different.

Complications such as severe bleeding, obstructed labour, eclampsia or other emergencies can require rapid intervention. A delay in reaching a facility capable of providing appropriate treatment can have serious consequences for both mother and baby.

That is why the functionality of the first-level health facility matters.

It is not enough to know how many PHCs exist.

The more important question is whether those facilities can provide the services they are supposed to provide, around the clock, with qualified personnel, electricity, water, medicines, equipment and a reliable referral system.

The Human-Resource Problem

One of the most persistent issues identified in the field investigation was the shortage of health workers.

At Alayita Primary Healthcare Centre in the Abuja Municipal Area Council, a staff member told investigators that only seven workers were on the facility’s payroll, while about 80 per cent of the workers were volunteers.

That situation raises a fundamental question about continuity of care.

Volunteers can play an important role in communities and can help extend the reach of health services.

But a maternity service cannot depend indefinitely on informal staffing arrangements when women require skilled and continuous clinical care.

The National Association of Nigerian Nurses and Midwives’ FCT chairman, Jama Medan, attributed part of the staffing problem to the long gap since recruitment into PHCs by the FCT Area Councils.

He said the last recruitment exercise into PHCs by the area councils took place in 2008.

If that assessment remains representative of many facilities, it points to a workforce problem that cannot be solved simply by constructing more buildings.

Health facilities need people to operate them.

They need nurses, midwives, community health workers, laboratory personnel and other professionals according to the services being offered.

For maternal care, the presence of skilled birth attendants is especially important because childbirth can move from normal to dangerous very quickly.

When Electricity Becomes a Medical Issue

Electricity may appear to be an infrastructure issue, but in maternity care it can become a direct patient-safety issue.

The field investigation found facilities where electricity was unreliable or absent.

At Piwoyi PHC in the Abuja Municipal Area Council, investigators reported that pregnant women were receiving antenatal services in a facility without reliable electricity or water.

A staff member appealed for electricity or solar power, particularly because women can arrive in labour at night.

The concern is straightforward.

A delivery room cannot function safely if medical workers have to depend on mobile-phone lights, torches or lanterns to see what they are doing.

Electricity is also needed for far more than lighting.

Health facilities require reliable power for laboratory equipment, refrigeration, communication, sterilisation, computers, medical devices and other essential services.

Where power is unreliable, every part of the care chain can become more difficult.

Nigeria’s National Primary Health Care Development Agency recognises this in its own definition of a fully functional Level 2 PHC. The agency says such a facility should have reliable 24-hour power, backup solar power and adequate water, alongside the staff and infrastructure required to support safe deliveries.

That standard is important because it demonstrates that electricity is not an optional convenience.

It is part of what makes a maternity facility functional.

The Gap Between a Building and a Functional PHC

Nigeria has invested heavily in primary healthcare infrastructure.

The National Primary Health Care Development Agency says 1,163 PHCs had been completed and fully revitalised by June 2025, while another 2,774 were at various stages of revitalisation. It also reported that thousands of bills of quantities had been cleared for additional work.

Those numbers demonstrate the scale of the national effort.

But they also highlight the challenge.

A health centre can be renovated, painted and equipped with new infrastructure without necessarily becoming a dependable 24-hour service.

The NPHCDA's own functional criteria recognise this distinction.

For a Level 2 facility, the agency requires not merely a building but a combination of skilled birth attendants, accommodation, power, water, delivery and labour facilities, laboratory services, pharmacy services, secure premises and other infrastructure.

The objective is to create a centre capable of safely handling deliveries at all times.

The new field findings therefore raise a broader policy issue: Nigeria must measure success by functionality, not construction alone.

The Emergency Referral Problem

Maternal healthcare does not stop at the PHC.

Some complications cannot be treated safely at a primary facility.

A woman may need surgery, blood transfusion, specialist obstetric care or neonatal services that are available only at a general or teaching hospital.

That makes the referral system an essential part of primary healthcare.

But investigators found concerns about ambulance availability in some communities.

At Alayita PHC, for example, an ambulance was not permanently stationed at the facility. Workers said an ambulance based at the AMAC headquarters could be requested through a WhatsApp group when needed.

The arrangement may appear workable under ordinary circumstances.

But emergencies are not ordinary circumstances.

A woman suffering severe bleeding cannot wait comfortably while administrative arrangements are made, a vehicle is located and a driver is mobilised.

Every minute can matter.

Medan argued that a centralised ambulance arrangement could create significant delays for communities located far from the ambulance base.

This illustrates a critical principle in maternal healthcare: referral systems have to be designed around emergency speed, not administrative convenience.

Roads Can Also Determine Survival

The referral problem becomes even more complicated where roads are poor.

Medan identified bad roads, insecurity, inadequate water, electricity and accommodation as factors discouraging health workers from accepting postings in remote areas.

Poor roads also affect patients.

If an ambulance must travel over a badly maintained road to reach a woman in labour, the quality of the receiving hospital becomes less important if the patient cannot get there in time.

This means maternal healthcare policy cannot be separated completely from transport and rural infrastructure.

A functional maternity system needs roads that allow women and ambulances to move.

It needs communications systems that allow PHCs to contact referral hospitals.

It needs drivers who can respond quickly.

It needs facilities prepared to receive referred patients.

And it needs health workers who know where to send a woman when complications exceed the PHC’s capacity.

Kano’s Different Challenge

The problems identified in the Federal Capital Territory were also visible in Kano, although the circumstances differ.

The field investigation found unreliable electricity, shortages of skilled birth attendants and inadequate equipment at rural PHCs.

Some facilities reportedly carried out deliveries using torchlights when electricity failed.

The power problem has consequences beyond maternity care.

Investigators reported that unreliable electricity was also affecting cold-chain facilities, raising concerns about vaccine storage and contributing to situations in which vaccines could expire before being administered.

That creates a connection between maternal health, child health and broader public-health infrastructure.

A facility that cannot maintain reliable electricity cannot easily provide the full range of services expected from a modern PHC.

Kano’s Maternal Mortality Challenge

The investigation cited Kano State Surveillance for Evidence and Policy data indicating that maternal mortality remains above 3,000 deaths per 100,000 live births in the state.

That figure is extraordinarily high and, because maternal-mortality estimates can vary depending on the measurement system and period used, should be understood as a state-level figure reported by the cited surveillance source rather than automatically treated as a current national rate.

Even with that qualification, the underlying concern is clear.

Kano has a large population, extensive rural communities and a major need for accessible maternal healthcare.

Abdulkadir Abdulsalam, the state commissioner for rural and community development, said about 40 per cent of Kano’s 484 PHCs require rehabilitation.

He said the state government plans to rehabilitate and adequately staff more than 400 ward-level PHCs from 2027.

The proposed intervention is expected to include solar power, trained midwives and cold-chain infrastructure.

If implemented fully, such measures could address several of the problems identified by the investigation at the same time.

Plateau Offers a Different Picture

The situation in Plateau State provides a more mixed picture.

At PHCs visited in Tudun Wada and Kobong in Jos North and Bukuru Central in Jos South, health workers described some improvements in maternal services.

Nurses reported increased antenatal attendance and greater use of health facilities for deliveries.

One breastfeeding mother, Blessing Domtu, described receiving adequate care during labour.

Such experiences demonstrate that improvements are possible when staffing, service availability and community confidence begin moving in the right direction.

But the state still faces significant maternal-health challenges.

Plateau Commissioner for Health Nicholas Ba’amlong said the state’s maternal mortality ratio had fallen to about 500 deaths per 100,000 live births from an estimated 900.

He attributed the improvement to measures including the recruitment of nurses and midwives, free antenatal screening, Mama Kits, improved access to Caesarean sections and increased health education.

The state also reported that it had revamped 80 primary healthcare centres.

The Plateau experience suggests that PHC investment can produce results when infrastructure improvements are accompanied by personnel and direct maternal-health interventions.

The Importance of Staffing the Investment

The contrast between facilities is important.

Nigeria can spend money renovating health centres, but the investment can produce limited results if trained professionals are not available.

The NPHCDA has already set a national ambition around staffing.

In its Priority PHC Initiative, the agency says a functional ward-level primary healthcare facility should have at least four skilled birth attendants, alongside basic equipment, commodities, reliable water and electricity and accommodation for health workers so that services can operate continuously.

That standard gives policymakers a useful benchmark.

It also makes clear why workforce shortages are so serious.

If a facility has a building but does not have enough nurses, midwives or other skilled staff to operate it continuously, the facility cannot deliver the standard of care the policy intends.

The Government’s Maternal-Health Response

The federal government and its agencies have introduced several programmes intended to reduce maternal and newborn deaths.

The NPHCDA’s National Emergency Maternal and Child Health Intervention Centre coordinates reproductive, maternal, newborn, child and adolescent health and nutrition activities at primary and community levels.

The agency has also established the Maternal Mortality Reduction Innovation Initiative, known as MAMII.

The programme identifies 172 local government areas with the highest maternal-mortality rates for intensive interventions.

According to the NPHCDA, the approach includes mapping pregnant women, linking them with dedicated healthcare teams, strengthening maternal and newborn services and providing free Caesarean sections and treatment for complications under the programme in targeted areas.

The strategy reflects a shift away from treating maternal mortality only as a hospital problem.

Women need support before they reach a hospital.

They need information, antenatal care, skilled birth attendants and a reliable route to emergency care.

The Basic Health Care Provision Fund

Financing remains central to the discussion.

The Basic Health Care Provision Fund is designed to support primary healthcare delivery.

The NPHCDA says its gateway receives 45 per cent of BHCPF resources for primary healthcare implementation through state and local structures.

The agency says 35 per cent of that gateway is decentralised facility financing, including allocations for essential drugs, vaccines and consumables as well as facility maintenance, equipment and transportation.

The broader BHCPF architecture also allocates funds through other channels for health insurance services, emergency medical treatment and public-health security.

The purpose is to ensure that money reaches the levels where services are delivered.

But the field investigation shows why funding mechanisms need strong monitoring.

A budget allocation does not automatically translate into a functioning delivery room.

Money must reach the facility.

The facility must be able to procure what it needs.

Equipment must be maintained.

Workers must be recruited and retained.

Power systems must operate.

Ambulances must be available.

And communities must be able to see tangible improvements.

Accountability at Facility Level

Medical practitioners interviewed in the investigation emphasised accountability.

Abraham Agbo said adequate financing was essential because PHCs require medicines, equipment and infrastructure in addition to personnel.

Erundu Fred stressed the need to track funds through the entire chain, from budgeting and release to disbursement and actual utilisation.

That is particularly important for primary healthcare because responsibility is distributed among federal, state and local authorities.

The structure can make accountability difficult for ordinary residents.

A community may know that a government announced funding for a health centre but not know which agency received the money or who was responsible for implementing the work.

Greater transparency could help communities monitor progress.

PHC committees, local government authorities, state primary healthcare agencies and federal institutions all have roles to play.

The objective should not be to create another layer of bureaucracy.

It should be to make it easier to answer basic questions.

Was the money released?

Did it reach the intended facility?

What was it spent on?

Was the equipment delivered?

Is it working?

Were the required staff posted?

Can a woman give birth safely at the facility at night?

If not, what is being done?

Maternal Care Cannot Wait for Perfect Conditions

The urgency of maternal healthcare lies in the nature of childbirth.

A woman may begin labour without any obvious warning sign of serious complications.

A normal delivery can become an emergency.

High blood pressure can develop into eclampsia.

Bleeding can become life-threatening.

An infection can worsen rapidly.

A newborn can require immediate resuscitation.

The healthcare system therefore needs to be prepared before an emergency happens.

That is why the NPHCDA’s Level 2 definition focuses on 24-hour functionality.

The objective is not simply to have a health worker present during normal daytime hours.

It is to have a system capable of responding when a woman arrives at 2 a.m. in labour.

The Community’s Role

Primary healthcare also depends on community trust.

If women believe a local PHC is not functioning, they may bypass it.

That can lead to delays and additional costs.

The NPHCDA’s community-based programmes are intended partly to address that gap.

Its community health-worker framework includes maternal, reproductive, newborn, child and adolescent health services and is designed to link households with PHCs.

Community-based workers can help identify pregnant women, encourage antenatal attendance, provide health information and facilitate referrals.

But they cannot replace a functioning health facility.

Community mobilisation works best when the service people are encouraged to use is actually available.

The Cost of Distance

For women in remote communities, the cost of seeking healthcare is not always measured in money.

There is the cost of transport.

There is the time spent travelling.

There may be the cost of accommodation near a hospital before delivery.

There may be the need for a relative to accompany the woman.

And in emergencies, there is the potentially devastating cost of delay.

This is why strengthening local PHCs can have an economic impact as well as a health impact.

If women can receive reliable antenatal care and safe basic delivery services closer to home, families can avoid some unnecessary travel and reduce the pressure on already crowded secondary and tertiary hospitals.

Why the Next Stage Matters

The federal government’s PHC revitalisation programme has established an important foundation.

The NPHCDA reports thousands of facilities completed or undergoing revitalisation.

The next challenge is ensuring that revitalised facilities remain functional.

A new building can deteriorate.

Solar equipment can fail.

Laboratory machines can break down.

Staff can leave.

Ambulances can become unavailable.

Medicines can run out.

Water systems can stop working.

Sustaining functionality therefore requires recurrent funding and continuous supervision.

This is more difficult than a one-time construction project.

But it is essential if Nigeria wants to convert infrastructure investment into measurable improvements in maternal and child survival.

A National Test of Primary Healthcare

The latest field investigation does not suggest that every Nigerian PHC is failing.

The experience in Plateau demonstrates that improvements can occur.

The NPHCDA’s revitalisation figures also show that substantial investment is taking place.

But the findings demonstrate that national progress can coexist with serious local failures.

A woman’s experience of the health system is determined by the facility she can actually reach.

If her local PHC has electricity, trained staff, medicines, water and a functioning referral system, government health reforms become tangible.

If it has a building but no dependable staff, power or emergency transport, the reform remains largely theoretical.

That distinction is critical.

What Must Happen Next

The immediate task is not necessarily to create more PHCs.

Nigeria already has a large network.

The priority should be to make existing facilities genuinely functional.

That means completing the facilities already under revitalisation.

It means recruiting and retaining skilled birth attendants.

It means providing staff accommodation in difficult-to-reach areas.

It means ensuring reliable electricity, including solar backup where appropriate.

It means maintaining water systems.

It means repairing and maintaining medical equipment.

It means establishing clear and rapid ambulance arrangements.

It means improving roads and communications around hard-to-reach communities.

And it means tracking financing down to the facility level.

The national target of functional primary healthcare must therefore be measured through service availability, not simply infrastructure statistics.

The Measure That Matters

For a pregnant woman, the most important question is simple.

If she goes into labour tonight, can she safely receive care?

Can someone qualified attend to her?

Is the delivery room properly lit?

Is there clean water?

Is essential equipment available?

Can the facility manage an emergency?

If it cannot, is there a functioning ambulance?

Can the receiving hospital be contacted?

Will the woman arrive there quickly enough?

Those questions are more meaningful than the number of buildings completed.

They are the real test of primary healthcare reform.

Nigeria has made maternal health a major policy priority, and agencies such as the NPHCDA have developed increasingly detailed strategies to address the problem.

The challenge now is execution.

The new evidence from the FCT, Kano and Plateau shows that the distance between policy and everyday healthcare remains significant in some communities.

Closing that distance will require sustained investment, stronger workforce planning, reliable infrastructure and transparent accountability.

Most importantly, it will require viewing every primary healthcare centre not simply as a government project but as a life-saving service.

For women waiting to give birth, there is no substitute for a facility that works.

And for Nigeria’s maternal-health ambitions to become reality, that functionality must reach the communities where the n