Tzar Oluigbo (Lead writer)
“The goal of citing Primary Health Centres is that people should not have to walk for more than 5 kilometres to access them,” — World Health Organization recommendation.
Beneath the shade of a mango tree, a group of women in Otuku, a small community in Enugu East Local Government Area (LGA) of Enugu State, sit on low stools near the recently built Type 2 Primary Healthcare Centre (PHC) fanning themselves as the midday heat settles on the red-sand roads winding through the community. A Type 2 PHC is a fully functional facility with skilled health workers, essential drugs, 24 hours service, reliable power, water, sanitation and hygiene (WASH) facilities, and staff quarters, providing quality care round-the-clock.
Children run barefoot, dodging potholes and the occasional Okada (commercial motorcycles) zipping past. Otuku is one of three communities in Emene, an urban community in Enugu East Local Government Area (LGA) and home to over 66,000 people, had been without a single Primary Healthcare Centre(PHC) for more than 20 years, according to the Enugu’s Primary Healthcare Development Agency.
For residents, especially pregnant women and children, reaching the nearest PHC in Abakpa meant travelling at least 10 kilometres and spending about 3,000 Naira for a return trip, an inconvenience for many, made worse by the bumpy and dusty roads. The absence of a functional PHC led to the rise of birthing homes and private hospitals that charged between 65,000 Naira for vaginal deliveries and 120,000 Naira for caesarean sections.
Image credit: Nigeria Health Watch
This burden of high out-of-pocket expenses for childbirth is precisely what Enugu’s Type 2 PHCs are designed to address. Through initiatives such as the state health insurance scheme, costing just 12,000 Naira per year or 1,000 Naira per month, and the free 10,000 Naira Mama Kit, vaginal delivery at a Type 2 PHC costs 5,000 Naira.
However, things are changing. Slowly, but steadily, Enugu State is rewriting the healthcare story for Otuku and many other wards by establishing functional, well-equipped Type 2 PHCs.
Once a decaying PHC System
Before the current intervention, a comprehensive assessment of Enugu’s 566 primary healthcare facilities by the State Primary Health Care Development Agency revealed a dire situation:
- 87% of facilities were critically dilapidated, often operating out of makeshift structures, rendering them unfit for essential services like childbirth.
- The healthcare system suffered from a workforce shortage, exacerbated by the “Japa syndrome”, a Nigerian term for mass emigration of healthcare professionals.
Image credit: Nigeria Health Watch
Bringing healthcare to forgotten wards
Otuku PHC is one of the 100 already completed facilities under Enugu’s plan to build 260 Type 2 PHCs. According to Chief John Ndubuisi Ogwo, an indigene of Otuku, “access to healthcare before was very difficult for us because there’s no healthcare centre around, just private hospitals and birthing homes that extort us. I have witnessed the loss of women during childbirth because there was no [clinic] close [enough] to take them in times of emergencies.”
Enugu State is not only establishing Type 2 PHCs as the minimum standard across all wards, while scaling up care through Type 3 PHCs that are larger, better-equipped facilities that serve as referral hubs in each LGA. “The minimum standard is a Type 2 primary health care facility,” explained Dr. Ifeyinwa Ani-Osheku, Executive Secretary of the Enugu State Primary Healthcare Development Agency.
“However, we also have Type 3 PHCs, which provide a more advanced level of care, with facilities like an [operating] theatre, and serve as the hub in our hub-and-spoke model,” Each Type 3 PHC serves as a referral point for multiple Type 2 PHCs, which function as the spokes.
According to Dr. Ugwunweze Cinta, the Chief Medical Director of the Otuku PHC, “since March 14th, 2025 we have recorded 369 outpatient and antenatal care visits, conducted nine deliveries, and administered 316 immunisations. What these numbers tell us is that people are willing to access care when it is brought closer to them and that is the entire philosophy behind this intervention.”
Tackling maternal mortality head-on
In a conversation with journalists last month, Dr. Ani-Osheku revealed that Enugu State once recorded one of the highest maternal mortality rates at over 700 in 2023. However, ongoing efforts show significant progress through:
- Recruitment of 2,200 PHC workers, including specialists, marking a shift from relying solely on community health extension workers (CHEWs).
- Upskilling the workforce with 1,200 health workers trained in safe delivery practices and neonatal resuscitation.
- Training over 600 staff on modern contraceptive methods to reduce unsafe abortions and promote healthy pregnancy spacing.
- Establishing AI-assisted ultrasound services using handheld, wireless probes that generate 99.9% accurate auto-generated reports, enabling early detection and referral of high-risk pregnancies. In its first month, January 2025, 14 out of 148 scanned pregnant women were referred, potentially saving 14 maternal or foetal lives.
Image credit: Nigeria Health Watch
Land, leadership and community
When Enugu first set out to construct 31 Type 2 PHCs as the first phase of the 260 types 2 PHCs across its 17 LGAs, the plan was to test, learn, and refine the approach before scaling.
What the government learned quickly was that securing land was not just about logistics, it required trust, transparency, and community buy-in. “We realised that our initial approach to securing land for these facilities was not yielding the best results. The resistance we faced in Otuku was because the traditional ruler known locally as the Igwe (a respected community leader and custodian of local customs) wasn’t convinced if this was another empty promise from the government,” Ani-Osheku said. “So, we changed our strategy.”
Instead of approaching the process purely through formal channels, the agency adopted a grassroots strategy engaging not only commissioners and local leaders, but going deeper into the communities themselves. “We sat with the traditional rulers and other power brokers in each community. We explained the vision and the benefits these health centres would bring,” she explained.
“This shift in engagement paid off. Many communities responded by donating land. Not just any land, but land in central, easily accessible locations,” she added, which is in line with the state’s push for maximum accessibility.
In urban and metropolitan areas where land is a premium commodity, the state government purchased sites to ensure that no ward was excluded from this health transformation effort.
However, land is just one side of the equation. Funding remains a key challenge. “Primary healthcare is the fulcrum of the entire health sector. It takes care of up to 95% of an individual’s lifetime health needs. Simple Malaria or routine deliveries should not end up in tertiary hospitals,” Dr. Ani-Osheku said. “When PHCs are well-resourced, we free up higher institutions to focus on research and complex cases.”
In these communities, the government is also partnering with the local stakeholders to ensure the availability of vehicles or means of transportation. “So, the community has availed us a line list of maybe the tricycle owners where we can easily call them in the event that a woman needs to be transported to a hospital and they are not supposed to pay for this. At the back end, the community and the agency finds a way to incentivise these stakeholders such that being able to transport a patient should be the least of our problems as the case may be” Dr. Ani-Osheku said.
The transformation in Otuku, where a newly launched Type 2 PHC has served over 690 people in just a few months, is a testament to what is possible when government prioritises community-based care. However, this must remain an exception. For progress to be sustainable and far-reaching, functional primary healthcare must become the standard, rather than an unexpected success. Anything less keeps communities like Otuku vulnerable to preventable tragedies.