By Simpson Global Media News Desk
Nigeria’s effort to strengthen primary healthcare has come under fresh scrutiny after a field investigation found that only 22 of 290 primary healthcare centres assessed across six states had functional ambulances, while nearly one-third of the facilities examined had either not been started, stalled, been abandoned or remained unused despite being listed as revitalised.
The findings are contained in the 2026 Primary Health Centre Operational Capability Report produced by Orodata Science and presented at a town hall meeting in Lagos. The investigation physically assessed facilities in Abia, Benue, Cross River, Kano, Osun and Taraba, comparing official descriptions of revitalisation with conditions observed on the ground.
The report does not represent an assessment of every primary healthcare centre in Nigeria. Instead, it focuses on 290 facilities selected from six states and forms part of a broader body of work by Orodata examining the operational condition of frontline health facilities.
Its findings nevertheless highlight a central challenge facing Nigeria’s healthcare reform efforts: building or renovating a health facility does not necessarily mean that the facility is fully equipped, staffed and operational.
A Gap Between Revitalisation and Functionality
According to the investigation, 153 of the 290 facilities assessed were recorded as having completed work. Another 41 were described as having work ongoing.
However, 17 facilities had not been started, 21 had stalled, and five had reportedly been completed but remained locked or had not been put into use.
Taken together, 91 facilities fell into one of these categories, meaning that substantial numbers of the centres listed under revitalisation programmes were not operating in the condition that communities would ordinarily expect from a completed health facility.
The investigation also examined the quality and functionality of completed projects.
Of the 153 facilities where work was reported to have been completed, 73 had visible defects, according to the report. The defects included structural problems, poor finishing and issues with standard installations.
Orodata’s researchers therefore assessed the facilities not simply on whether construction work had taken place, but on whether the resulting centres were capable of providing the services associated with a functional primary healthcare facility.
Only 85 of the 290 facilities met the benchmark used in the assessment, while 170 partially met it and 35 did not meet it at all.
That translates to approximately 29 per cent meeting the benchmark.
The findings underline the distinction between physical revitalisation and functional healthcare delivery. A building may have a new roof, freshly painted walls or renovated rooms, but patients still require electricity, water, trained health workers, medicines, equipment, emergency transportation and other essential services before the facility can reliably perform its role.
Ambulances Remain a Major Weakness
One of the clearest findings concerned emergency transportation.
Only 22 of the 290 facilities assessed had functional ambulances.
That represents roughly 7.6 per cent of the facilities in the assessment.
For primary healthcare centres serving rural and underserved communities, the availability of emergency transportation can be particularly important because a PHC may not have the personnel, equipment or specialist capacity to manage complicated cases.
A patient experiencing severe complications during childbirth, for example, may require rapid referral to a secondary or tertiary hospital. The same can apply to patients suffering serious injuries, severe infections, obstetric emergencies or other conditions requiring specialist treatment.
Without a reliable referral system, the distance between a community health centre and a higher-level hospital can become a major factor in the outcome of an emergency.
The Orodata findings therefore raise questions about whether some facilities classified as revitalised have the practical capacity to connect patients to higher levels of care when necessary.
The ambulance finding also needs to be interpreted carefully.
It does not mean that only 22 ambulances exist in Nigeria or that only 22 PHCs nationwide have ambulances. The figure applies specifically to the 290 facilities physically assessed in the six states covered by the investigation.
It nevertheless exposes a weakness within that sample and raises broader questions about the readiness of frontline facilities to handle emergencies.
Government Has Also Invested in Emergency Transport
The findings come against the background of significant government investment in primary healthcare and emergency transportation.
In May 2026, the Federal Ministry of Health and Social Welfare announced the launch of 145 tricycle ambulances for deployment to primary healthcare centres, particularly in rural areas.
The ministry said the vehicles were intended to improve emergency response and referral services, with trained drivers and health workers attached to the ambulances.
That initiative demonstrates that emergency transportation has been recognised at federal level as an important component of primary healthcare strengthening.
The new field findings, however, suggest that the existence of an ambulance programme alone is not enough.
An emergency vehicle has to be available at the point where it is needed, maintained, fuelled, staffed and integrated into a functioning referral system.
It must also be supported by roads and communications systems that allow health workers to coordinate transfers.
The difference between having an ambulance on an inventory list and having an ambulance that can respond to an emergency is therefore significant.
The Orodata report is essentially testing that distinction at facility level.
What Nigeria Means by a Functional PHC
The National Primary Health Care Development Agency has established a framework for revitalising primary healthcare facilities.
Under the agency’s PHC revitalisation programme, the objective is not simply to renovate buildings. The programme covers infrastructure, human resources, essential drugs and commodities, basic equipment, service expansion, ambulance services and an environment conducive to healthcare delivery.
The NPHCDA says its broader strategy is to ensure at least one functional Level 2 primary healthcare centre per ward, with the programme eventually targeting thousands of facilities across the country.
The agency’s description of a Functional Level 2 PHC goes well beyond the existence of a building.
Such a facility is expected to be capable of providing antenatal care and routine immunisation as well as facility-based deliveries.
The requirements include adequate skilled birth attendants, reliable power, backup solar power, water, sanitation facilities, consulting rooms, toilets, inpatient wards, a delivery or labour ward, a pharmacy or dispensary and laboratory services.
Other requirements include secure premises, a borehole and water storage, staff accommodation and solar power capacity.
This framework helps explain why the Orodata investigation treated equipment, services, staffing, electricity, water and operational readiness as important measures of revitalisation.
A renovated structure without the corresponding services does not fully satisfy the purpose of revitalisation.
The Problem of “Completed” Facilities
The report raises another important issue: what happens after a project is officially described as completed.
According to the field assessment, some facilities where construction work had reportedly been completed still lacked the equipment and supplies required to deliver healthcare services.
In other cases, defects were visible even after work had supposedly been finished.
The problem, therefore, is not necessarily limited to whether money was allocated for a project.
It also involves whether the project delivered what was intended, whether the facility was equipped after construction, whether health workers were available and whether the centre became operational.
This distinction matters because healthcare infrastructure ultimately exists to serve patients.
A completed construction project is an input.
A functioning health centre is an outcome.
The two should not automatically be treated as the same thing.
Funding and Accountability
Orodata’s investigation also examined the financing of the facilities.
The researchers found that State Ministries of Health funded the largest number of interventions among the facilities examined, followed by the Basic Health Care Provision Fund, the Federal Ministry of Health and other government agencies.
The report also identified facilities with multiple funding sources.
According to the findings, 53 of the 290 facilities listed as revitalised had no intervention at all, while 43 had five or more funders.
Orodata argued that multiple funding streams without sufficiently clear public records can make it more difficult to determine which organisation is responsible for a particular intervention and whether promised work was delivered.
The organisation has called for greater transparency, including publication of contracts and payment records and physical verification of facilities.
The objective, according to the researchers, is not simply to criticise government spending but to establish whether resources allocated to primary healthcare actually translate into functioning services in communities.
That question becomes especially important where different levels of government and development partners contribute to the same health facility.
The Basic Health Care Provision Fund
The Basic Health Care Provision Fund is one of the major financing mechanisms supporting primary healthcare in Nigeria.
Government has increasingly linked the fund to efforts to improve service delivery and strengthen PHCs.
The Federal Ministry of Health said in July that the federal government’s HOPE-PHC programme would use the BHCPF as an anchor for strengthening primary healthcare service delivery.
The ministry also said that 3,026 PHCs had been revitalised nationwide and that 43,417 women and newborns had been transported through rural emergency and maternal transport services between October 2024 and March 2026. It further reported that more than 78,000 frontline healthcare workers had been trained.
These figures illustrate the scale of the government’s investment and the ambition of the current reform programme.
They also make independent field verification important.
If thousands of facilities are officially classified as revitalised, assessments of what those facilities can actually provide help determine whether investment is translating into usable services.
The Orodata investigation does not invalidate the federal government’s figures on its own. Rather, it provides a separate field-level picture of selected facilities and identifies areas where official classifications and conditions observed by researchers do not always correspond.
A Broader National Picture
The new findings form part of a wider pattern identified by Orodata in its assessment of Nigerian primary healthcare.
Earlier in September, the organisation reported that 97 per cent of 1,480 PHCs assessed across 16 states failed to meet the national minimum staffing requirement.
Only three per cent of the facilities in that broader assessment met the staffing standard, while 11 of the 16 states had no assessed PHC that met the minimum requirement.
The larger assessment covered 277 local government areas across Nigeria’s six geopolitical zones and examined issues including staffing, infrastructure, equipment, electricity, water supply and accessibility.
Although it was based on fieldwork conducted between October 2023 and June 2025, its findings provide important context for the newer investigation of 290 facilities.
Together, the assessments point to a health system challenge that is broader than buildings.
A PHC requires people to operate it, equipment to treat patients, medicines and commodities to provide care, power to support clinical services, water and sanitation to maintain hygiene, and referral arrangements for cases beyond its capacity.
Weakness in any one of these areas can reduce the practical value of investment in the others.
Staffing Is as Important as Infrastructure
A newly renovated facility cannot function without healthcare workers.
The federal government has acknowledged workforce shortages as one of the issues affecting healthcare delivery and has introduced recruitment, training and retention initiatives as part of its broader health-sector reforms.
The NPHCDA’s own definition of a Functional Level 2 PHC includes specific human-resource requirements.
For maternity services, the agency identifies the need for skilled birth attendants and appropriate accommodation arrangements. Reliable service delivery therefore depends not only on the physical structure but on the availability of qualified personnel.
This is particularly important in remote communities.
A facility may be physically attractive but unable to provide services if there are insufficient nurses, midwives, community health workers, laboratory personnel or other staff.
The result can be a health centre that is technically open but practically limited.
Patients may still have to travel long distances for services that the revitalised facility was intended to provide.
Electricity and Water Are Clinical Issues
Electricity and water may sometimes be treated as infrastructure concerns separate from healthcare, but in a health facility they are directly connected to patient safety and service delivery.
Electricity is required for lighting, refrigeration, laboratory equipment, communications, sterilisation and other clinical functions.
Water is essential for hygiene, sanitation, cleaning and infection prevention.
The NPHCDA includes reliable power, backup solar power and WASH facilities among the requirements associated with a Functional Level 2 PHC.
Orodata’s broader research has similarly identified power and water shortages as recurring weaknesses in primary healthcare facilities.
Its earlier 2024 assessment of 345 PHCs found that 34 per cent had no power supply and that only nine per cent had ambulances, while half of the facilities faced at least seven medical supply shortages.
These recurring findings suggest that Nigeria’s primary healthcare challenge cannot be solved by construction alone.
The Rural Dimension
The consequences of weak PHC functionality can be especially serious in rural and hard-to-reach communities.
People living in urban centres may have access to several hospitals within relatively short distances.
In remote communities, the nearest secondary or tertiary hospital can be considerably farther away.
For pregnant women, children, older people and patients with acute illnesses, the time required to travel can become an important part of the healthcare equation.
That makes the role of primary healthcare centres particularly important.
A functioning PHC can provide preventive services, immunisation, antenatal care, treatment for common illnesses and early identification of more serious conditions.
It can also serve as the first point of referral when a patient needs higher-level treatment.
But if the facility lacks trained personnel, equipment, electricity, medicines or transportation, its ability to fulfil that role is weakened.
Why Emergency Referral Matters
Emergency referral is one of the clearest areas where different parts of the health system have to work together.
Consider a patient arriving at a rural PHC with a condition beyond the facility’s capacity.
The first requirement is that health workers recognise the need for referral.
The second is that a receiving hospital is available and able to accept the patient.
The third is transportation.
The fourth is communication between the referring and receiving facilities.
The fifth is the ability to keep the patient stable during transfer.
An ambulance therefore represents only one part of a wider emergency-response chain.
The Orodata finding that just 22 of the 290 assessed facilities had functional ambulances highlights a weakness at one point in that chain.
But it also demonstrates why ambulance numbers should be considered alongside staffing, equipment, referral protocols, roads, communications and receiving-hospital capacity.
Government Says Reform Is Underway
The field findings come at a time when the federal government says substantial progress has been made in primary healthcare.
The Ministry of Health reported in July that more than 3,000 PHCs had been revitalised nationwide and that emergency medical transport had been expanded.
The ministry also said the HOPE-PHC programme would strengthen service delivery through the BHCPF and that the reforms were designed to improve healthcare outcomes, especially for vulnerable populations.
In another July update, the Ministry of State for Health and Social Welfare said more than 8,300 PHCs were being supported through performance-based financing linked to defined indicators.
It also said more than ₦339 billion in cumulative BHCPF resources had been released and disbursed since inception, including ₦32.9 billion in the second quarter of 2026.
The government’s position is therefore that the country is making substantial investments in strengthening the health system.
The challenge highlighted by the Orodata report is whether those investments consistently translate into facilities that are operational at community level.
State Responses
Officials from some states covered by the investigation have provided context to the findings.
Dr Shina Igbalaye, Executive Secretary of the Osun State Primary Health Care Development Board, said not all PHCs in the state were supported through the BHCPF.
He said Osun had about 800 PHCs, of which 332 were supported through the BHCPF, leaving more than 500 dependent on state and local government financing.
He also said the state was only beginning to receive its first-quarter 2026 disbursement at the time of the discussion, highlighting the importance of the timing of health financing.
In Lagos, Ibrahim Mustapha, Permanent Secretary of the Lagos State Primary Healthcare Board, said the state remained open to scrutiny and continued to invest in PHC infrastructure and staffing.
He said Lagos had renovated at least 72 PHCs in the previous year and had approximately 346 PHCs, with further improvements planned.
Such responses are significant because they show that facility-level findings can have different explanations depending on the funding structure, project stage and responsibilities of different authorities.
The Need for Independent Verification
The Orodata report has also highlighted the value of independent field verification in public-sector projects.
Official records can indicate that a facility has been approved, funded, renovated or completed.
But field visits can answer a different question: what does the facility actually look like and what can it currently do?
The investigators said they used physical visits, geo-coordinated photographs, interviews with health workers and community members, and assessments of infrastructure, water, electricity, staffing, equipment, services and accessibility.
This type of verification can identify problems that may not be visible in administrative records.
It can also help policymakers distinguish between projects that have not started, projects that are incomplete, projects that have been completed but not commissioned and projects that are operating below the intended standard.
What Happens Next
The immediate challenge is to convert the findings into corrective action.
For facilities that were not started or stalled, authorities need to establish why work stopped and determine whether projects can be completed.
For facilities that were completed but remain unused, the reasons for non-use need to be identified.
Where structural defects exist, remedial work may be required.
Where buildings have been completed but lack equipment, the next stage should involve equipping them.
Where staff are insufficient, workforce deployment and retention become necessary.
Where power and water are unreliable, infrastructure improvements must accompany the physical rehabilitation.
And where emergency transport is inadequate, ambulance provision needs to be linked to a functioning referral network.
These steps are more demanding than simply announcing the completion of construction projects, but they are necessary if revitalisation is to produce measurable health benefits.
A Question of Value for Money
At the centre of the debate is value for money.
Nigeria faces competing demands across healthcare, education, infrastructure, security and other public services.
Every naira committed to a health facility is expected to contribute to improved access and better health outcomes.
If a facility is renovated but remains unused, the expected benefit is delayed.
If a facility is operational but lacks equipment, the investment produces only part of its intended value.
If equipment is available but there are no trained personnel, the same problem arises.
And if a facility can treat patients but cannot refer emergencies quickly, its effectiveness remains constrained.
The Orodata report therefore moves the conversation away from the number of facilities renovated and toward a more practical measure: how many communities can actually access safe, reliable and timely healthcare from those facilities?
Beyond Buildings
The broader lesson from the assessment is that primary healthcare should be treated as a system rather than a collection of buildings.
The NPHCDA’s revitalisation framework itself reflects this approach by combining infrastructure with human resources, medicines, equipment, services, ambulance provision and operational conditions.
That approach is particularly important as Nigeria seeks to strengthen universal health coverage.
Primary healthcare is the level of the system closest to most communities.
It is where children receive vaccines, pregnant women receive antenatal services, patients seek treatment for common illnesses and health workers identify conditions that require higher-level intervention.
A strong PHC network can reduce unnecessary pressure on secondary and tertiary hospitals while improving early access to care.
A weak PHC network can have the opposite effect.
The Challenge Ahead
The federal government has set ambitious targets for PHC revitalisation.
The NPHCDA says its strategy aims to have at least one Functional Level 2 PHC per ward and eventually expand the revitalisation effort to approximately 17,600 PHCs over four years.
As of June 2025, the agency reported that 1,163 PHCs had been completed and fully revitalised, with another 2,774 at various stages of revitalisation.
Those targets represent a substantial undertaking.
The latest Orodata assessment shows why implementation and verification will be as important as the targets themselves.
If revitalisation is measured only by construction activity, the country risks counting facilities that exist physically but remain unable to provide the full range of services expected.
If it is measured by functionality, policymakers can identify precisely where additional investment is required.
That may mean spending less attention on the appearance of facilities and more on the less visible components of healthcare: trained staff, reliable power, medicines, laboratory capacity, water, maintenance, data systems and emergency referral.
Communities Need Functional Services
For residents, the most important measure of a PHC is usually straightforward.
Can they receive the care they need when they arrive?
Can a child receive vaccination?
Can a pregnant woman receive antenatal care and safely deliver where the facility is designated to provide delivery services?
Can a patient receive essential medicines?
Is there electricity?
Is there clean water?
Are trained health workers available?
And when an emergency exceeds the facility’s capacity, can the patient be transferred quickly?
Those questions are ultimately more important to communities than whether a facility appears on an official list of revitalised centres.
The Orodata investigation has brought those practical questions into sharper focus.
A Test for Nigeria’s Health Reforms
Nigeria’s health-sector reforms are taking place on a large scale, with billions of naira in domestic and external resources being channelled into infrastructure, financing, workforce development, emergency transport and primary healthcare.
The federal government has reported measurable progress, including the revitalisation of thousands of PHCs, training of tens of thousands of frontline workers and expanded emergency transport.
The independent field assessment does not erase those investments.
Instead, it identifies a different part of the reform challenge: ensuring that money spent and projects recorded translate into functioning services at the point where Nigerians seek care.
That is a test that will require continued monitoring by government agencies, state authorities, communities, journalists, civil society organisations and health professionals.
The Road From Revitalisation to Results
The findings from the 290 facilities provide a clear message.
Nigeria’s primary healthcare challenge is no longer simply about whether facilities should be built or renovated.
It is about whether those facilities are functional, adequately staffed, properly equipped, connected to emergency referral systems and capable of delivering reliable services every day.
Only 22 of the 290 facilities assessed had functional ambulances.
Ninety-one were either not started, stalled, abandoned or completed but not put into use.
Only 85 met the benchmark applied by the investigators, while 170 partially met it and 35 failed to meet it.
And among the facilities where work was reported completed, 73 had visible defects.
Those numbers should not be interpreted as a verdict on every PHC in Nigeria. They concern a defined sample across six states.
But they provide evidence of gaps that policymakers can investigate and address.
The next phase of Nigeria’s PHC reform will therefore require more than announcing projects.
It will require verifying them.
It will require tracking whether funds reach their intended destinations.
It will require checking whether completed facilities open their doors.
It will require ensuring that equipment arrives after construction.
It will require recruiting and retaining the health workers who operate the facilities.
It will require reliable electricity and water.
And it will require emergency transport that works when patients need it.
The ultimate measure of revitalisation is not the number of buildings renovated.
It is the number of Nigerians who can walk into a primary healthcare centre and receive safe, timely and effective care.
That is the standard against which the next stage of Nigeria’s healthcare investment will increasingly be judged.
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