Tzar Oluigbo (Lead writer)
Primary healthcare (PHC) is the backbone of a resilient health system and should serve as the first point of contact with the healthcare system for most Nigerians. Yet, despite decades of investment, the PHC system continues to underperform, leaving many communities underserved and vulnerable.
According to a report by the PharmAccess Foundation, Nigeria has about 34,000 PHCs, accounting for more than 85% of all health facilities nationwide. However, only about 20% to 25% are functioning properly and able to deliver basic essential services.
The Federal Government has also taken steps to close this gap. Since the beginning of 2025, 1,295 PHCs have been revitalised and another 3,469 are undergoing upgrades, as part of a broader plan to scale up support from 8,406 to 17,600 PHCs under the Basic Health Care Provision Fund (BHCPF).
The ambition is to establish at least one functional PHC in every ward, but in reality many PHCs face absentee staff, frequent drug stock-outs, and poor infrastructure, all of which undermine trust and service delivery.
While national efforts to strengthen PHCs are ongoing, the lessons from Nasarawa demonstrate that localised, state-level interventions can deliver measurable improvements in healthcare delivery. Over an 18-month period, the Nasarawa State Primary Healthcare System Strengthening Project, led by Technical Advice Connect (TAConnect) and implemented by Sociocapital, has made significant strides in addressing many of the challenges faced by Nigeria’s PHC system, offering a promising example of what focused, context-specific interventions and reforms can achieve.
A project born from gaps
The Nasarawa PHC system strengthening project was borne out of a deliberate effort to design a tailored intervention based on evidential gaps. This led to a management capacity and system-strengthening assessment of the Nasarawa State PHC system, carried out by TAConnect in close collaboration with the Nasarawa State Primary Health Care Development Agency.
To address these weaknesses, the Nasarawa state government launched a focused initiative to strengthen management capacity, improve monitoring and evaluation (M&E) systems and ensure that 145 PHCs across 13 Local Government Areas (LGAs) of the state under the BHCPF could function effectively.
Findings from the project were shared at the Nasarawa State Primary Healthcare System Strengthening Project Dissemination Meeting, which brought together partners such as TAConnect, the Nasarawa State Primary Healthcare Development Agency (NAPHDA), Sociocapital as well as representatives from the World Health Organization (WHO), Malaria Consortium and the State’s Ministry of Health.
This approach aligned with the WHO’s health system strengthening framework, but more importantly, it was co-created with state stakeholders, ensuring ownership and alignment with local realities. As Dr. Bosede Ezekwe, WHO’s State Coordinator, put it “without a strong and well-prepared health workforce, Universal Health Coverage will remain out of reach. Investing in people is investing in health.”
For residents in Nasarawa, the changes are already visible. Moses Adetosoye, Senior Programmes Manager at TA Connect, noted that, “beyond the numbers, we have witnessed stories of real change, health workers who are now more motivated, and patients who walk into health centres confident that they will receive the best of care. Improving health systems is not a sprint; it is a marathon. Sustainability must be our watchword.”
Image credit: Nigeria Health Watch
This statement was echoed by frontline managers and community leaders. At facility level, absenteeism declined following engagement between PHC facility managers and the NAPHDA leadership, who advocated for stricter supervision and accountability. Attendance monitoring tools were introduced alongside supportive supervision visits to reinforce compliance and motivation. “Sustainability is less about money and more about effective management,” noted Aliyu Abdulmumudu, the Officer in charge (OIC) Manager, who also observed that data entry has become more timely and consistent, improving decision-making at the facility level.
For communities in hard-to-reach areas, the transformation was even more profound The Ward Development Committee (WDC) Chairman, Abdulahi Ramalan, reflected that before the programme, essential services were distant and irregular, today “the project has brought solutions closer to the people,” he stated. This change did not happen by chance, the project deliberately empowered WDCs to act as permanent community-level accountability and resource mobilisation mechanisms. By giving them the authority to monitor facility performance, mobilise resources, and ensure responsiveness to local needs, WDCs were able to improve operational efficiencies and strengthen the quality of care. In practice, this meant health facilities became more accountable to the very communities they serve.
According to Mr Livinus WDC chairman Kokona LGA, “Before, our clinic had no doctor and people suffered. With this project, we joined hands with the health center and brought a doctor. Now our people get care here in the community. We are happy things are better.”
Confronting the Human Resource for Health challenge
Nasarawa State has long grappled with Human Resources for Health (HRH) challenges, relying heavily on contract staff and volunteers to keep its primary healthcare facilities running. The project’s HRH intervention focused on reducing chronic absenteeism, which had hindered service delivery, by introducing attendance monitoring tools and promoting supportive supervision visits to reinforce compliance and motivation. PHC Iwagu in Keana LGA experienced reduction in staff absenteeism from 29 staff to 9.
According to Vera Yusuf, PHC Mentor, “during monitoring visits, we discovered high staff absenteeism of 35% weekly. Through the introduction of a “Healthcare Hero” recognition, peer learning sessions, and structured feedback meetings, staff retention improved by 80%, unapproved absenteeism dropped to 0% across all facilities as of December 2024 and patient satisfaction increased by 40%.”
As Dr. Sasetu Stephen, Director of Planning, Research, Monitoring and Evaluation, put it, “the most critical issue in the health sector is HRH; everything rises and falls on it. Addressing this will take more than the Primary Healthcare Development Agency; it requires collective effort from all stakeholders.”
This framing matters. It is not just about recruiting more workers, but ensuring equitable distribution, skill-mix, and accountability, while collaborating with training institutions to prepare the next generation.
Dr Stephen Sasetu, Dr Bosede Ezekwe). Image credit: Nigeria Health Watch
Why dissemination matters
Dissemination is often seen as the end of a project cycle. However, Sharon Madaki, Executive Director of Sociocapital, noted that, “this project represents a significant step towards advancing a stronger and more resilient primary health care system. Today, as we reflect on our collective achievements, we also share lessons, celebrate partnerships, and chart the way forward for sustainability.”
By making evidence visible, dissemination transforms numbers into shared lessons, highlighting what can be replicated and scaled. It also drives accountability, reminding policymakers, partners, and citizens of what has worked, what remains fragile, and what still needs to be done.
The discussions were supported by a detailed dissemination report, which documented how absenteeism was reduced, communities were mobilised, and data systems strengthened. The report is not only a record of what happened, but also serves as a guide for other states seeking to replicate these reforms.
Dr Danjuma Oyinaka Baba, Director of Health Planning, Research, and Statistics (DHPRS-SMoH), laid out the path forward which included strengthening HRH, improving data systems, and embedding partnerships into long-term state strategies.
The call to action was clear. Nasarawa’s progress is not an end point but a starting point. The absorption of volunteers, stronger M&E systems, and facility-level reforms must now be institutionalised through sustained budgets, supportive policies, and continuous community engagement.
As Elisha Maleeks of Malaria Consortium observed, in a country where PHC failure has been the norm, Nasarawa’s experience is a reminder that transformation is possible when evidence, leadership, and community converge.
If Nigeria is serious about achieving universal health coverage (UHC), the battle will be won or lost at the PHC level. The lesson from Nasarawa is not just that reforms are possible, urgent, and that sustainability depends on embedding today’s wins into tomorrow’s systems.