Prudence Enema and Hadiza Mohammed (Lead Writers)
In Maitumbi, a community in Niger State, mothers continue to give birth on mats laid on the floor of the local health centre, a level two facility meant to benefit from the Basic Health Care Provision Fund (BHCPF). When it rains, patients are forced to huddle in corners to escape water dripping from the leaky roof, while part of the building, destroyed by fire years ago, still lies in ruins.
The situation in Maitumbi reflects a challenge faced across the country, where thousands of primary health centres (PHCs) are in disrepair. A former Executive Director of the NPHCDA observed that over 70% of Nigerians live in rural areas where the nearest facility is a primary healthcare centre. Yet, data from various health surveys consistently highlight gaps in service delivery, drug availability, infrastructure, and staff motivation at the PHC level.
However, amid this bleak picture, an innovative initiative is helping Nigerians hold the primary health care system to account. Through the Strengthening Community Engagement and Accountability for PHC (SCEAP) Project, BudgIT is leading a community-driven accountability model that combines civic technology with grassroots participation.
At the centre of this effort is the PHC Accountability Tracka , a digital platform that enables citizens to review and report on the state of their community’s health facilities. The tool captures key details, from facility location and available services to the names of those in charge and the condition of basic amenities such as toilets, water, electricity, and drug dispensing units.
being reported is located. Image credit: BudgIT
From data to action
The core issue driving Nigeria’s PHC system crisis is not just a lack of resources, but a critical deficit in social accountability, particularly the absence of community-based mechanisms that allow citizens to provide direct feedback and hold health providers accountable for the quality of care.
The PHCTracka goes beyond collecting data. Patients and community members can provide real-time feedback on service gaps, whether a clinic needs medicines, urgent repairs, or additional staff.
This feedback forms the basis for structured advocacy meetings with local authorities and health officials, often resulting in documented responses such as the restoration of boreholes in Niger State and repairs to damaged PHC infrastructure.
As Dr Biobele Davidson, Strengthening Health Systems -Lead at BudgIT Nigeria explained, “It shows you the state of the infrastructure, captures what people are saying and provides an undiluted feedback mechanism that captures the voices of the community.” By making this feedback visible to both citizens and policymakers, the PHCTracka bridges the gap between local experiences and critical national accountability conversations.
Since its launch in July 2023, the PHCTracka has generated an unprecedented volume of citizen feedback. “We have been able to generate close to about 40,000 feedback,” explained Biobele.
What began as a pilot in 75 facilities in five states; Kano, Kaduna, Gombe, Niger, and Yobe, has now expanded to over 400 facilities, with a national rollout underway to cover nearly 6,000 facilities across Nigeria.
Image credit: BudgIT
This reflects the growing role of civic technology in strengthening health accountability, consistent with global evidence that community-led monitoring strengthens service delivery in resource-constrained health systems. By providing near real-time data on drug availability, staff attendance, and facility functionality, the PHCTracka moves the conversation beyond casual complaints to actionable, evidence-based reform.
In Gwagarwa Primary Health Centre (PHC) in Kano, service delivery has improved remarkably compared to previous years. According to Binta Ismail, the Officer in Charge, these positive changes are a direct result of the SCEAP Project. “Before, the PHC faced multiple challenges, lack of electricity, no access to clean water, and inadequate facilities,” she explained. “But today, things are different.”
Through the project’s intervention, the antenatal care (ANC) building has been renovated, and the centre now has a steady supply of clean water and uninterrupted electricity available round the clock. These upgrades have created a more enabling environment for both health workers and patients, significantly improving the quality of care delivered at the facility.
Similar improvements are being recorded in other communities. At Doka PHC in Kaduna, staff member Christiana David noted that the addition of more health workers has significantly reduced the workload on existing staff. This increase in manpower has reduced patient waiting times and enabled the centre to deliver more efficient and responsive care — unlike in the past, when staff struggled to keep up with the heavy workload.
According to Biobele, when residents see that their feedback translate to visible improvements, such as restored boreholes, better staffing, or renovated buildings, they are more motivated to use these services. What was once passive scepticism is giving way to active participation, demonstrating how accountability mechanisms can rebuild trust and increase use of PHCs.
Challenges along the way
Despite its successes, the PHCTracka model has faced challenges that highlight the complexity of implementing accountability systems within Nigeria’s health sector. A persistent challenge is that needs assessments are often carried out without meaningful community involvement, resulting in interventions that do not reflect local realities.
Context matters because what works in one community may not work in another. Without community participation, ownership and sustainability are weakened and sustainability remains a key challenge. Although the model has delivered notable results, including borehole restoration in Niger State; the renovation of antenatal care buildings and provision of water and electricity at Gwagarwa PHC in Kano; improved staffing and reduced waiting times at Doka PHC in Kaduna; and the generation of over 40,000 citizen feedback reports across 400 facilities, it cannot serve as a one-size-fits-all template.
To promote genuine ownership, the project prioritised community champions over external coalitions. While this approach-built grassroots capacity, it also required continuous training, deeper engagement, and context-specific adaptations to remain effective and relevant.
Technology presented another barrier at the early stages. Poor internet connectivity in remote communities made it difficult for residents to access the portal, while the reliance on high-end devices excluded people without smartphones or computers.
Language was another obstacle. Since the tool was initially designed in English, participation was limited among residents who primarily speak local dialects.
Image credit: BudgIT
Barriers into opportunities
These challenges, however, prompted creative solutions. Community champions and local organisations were trained to assist residents, collect feedback offline, and upload the information once internet access became available.
Over time, the platform was adapted to include local languages, allowing citizens to submit responses in Hausa, Yoruba, and other dialects. These adjustments demonstrated that digital accountability platforms are most effective when they are flexible, inclusive, and supported by trusted intermediaries who bridge the gap between technology and community realities.
Perhaps the most striking lesson from PHCTracka is that accountability itself can serve as a health intervention. By giving citizens, a structured platform to voice their concerns and ensuring that these voices reach decision-makers, PHCs that were once neglected are beginning to regain community trust.