Kenneth Ibe and Abara Erim (Lead Writers)
For years, residents of Ikot Nkwo community in Akwa Ibom State sought healthcare in the most challenging conditions, with a community town hall building serving as their health post.
The story was no different for the people of the Udot community in Nsit Atai Local Government Area (LGA). A resident recalled that, “there were times we had to travel long distances to other communities, just to find a functional PHC. Even then, the conditions were not much better.”
Image credit: Nigeria Health Watch
Across Nigeria, Primary Health Centres (PHCs) are meant to be the first point of care and the foundation of the health system. Yet, in many communities, that promise has not been fulfilled. In 2021, Nigeria Health Watch launched the Community Health Watch project to drive for PHC accountability in Niger and Kano State. The goal was to gain insights into how health workers provide care and understand community members’ experiences when accessing healthcare services in PHCs.
Four years on, the project has revealed a stark reality: Nigeria’s PHC system is falling short of its potential and purpose to reduce health disparities and to improve health outcomes. Many PHCs are under-resourced, poorly managed, and unable to meet the needs of the communities they serve. The consequences include persistent poor health outcomes, preventable illnesses, and deepening mistrust in the health system, particularly in communities.
The 2019–2022 State of Primary Healthcare Service Delivery in Nigeria report revealed the strengths, weaknesses, and critical gaps in PHC delivery nationwide while also highlighting the level of Basic Health Care Provision Fund (BHCPF) implementation in PHCs across Nigeria. These findings are echoed in the 2024 BudgIT State of States report, which highlights continued underfunding, poor infrastructure, and governance challenges that undermine PHC services across Nigeria
According to the report, Akwa Ibom state was one of the 16 states with the lowest PHC service delivery. This means the state scored poorly on key performance indicators such as availability of essential drugs, skilled health personnel, functionality of PHC facilities, and implementation of the Basic Health Care Provision Fund (BHCPF), indicating critical gaps in service readiness and accessibility for its population.
However, recent developments show a remarkable turnaround for the state, thanks to the initiatives of the Akwa Ibom State Government through the State Primary Health Care Development Agency (AKSPHCDA). These initiatives included constructing of Model PHCs, effectively implementing the Basic Health Care Provision Fund (BHCPF), improving immunisation services, maternal care, and nutrition programmes.
Image credit: Nigeria Health Watch
Leading the charge in strengthening PHCs
The Model PHCs are part of a strategic drive to strengthen healthcare at the grassroots, aiming to upgrade facilities and services. The goal is to ensure at least one fully functional PHC in every local government, improving access to quality healthcare for communities across the state.
Dr Eno Angela Attah, Executive Secretary of AKSPHCDA, noted that the state is driving this reform through the agency by prioritising infrastructure upgrades, strengthening healthcare workforce capacity, and ensuring the availability of functional medical equipment aimed at making the Model PHCs client-centred and fully operational for rural and underserved communities.
Before the establishment of the Model PHCs in Udot community, existing health centres were often flooded, making it hard for people to access essential services when they needed it most. Despite the commitment of health workers’, both Udot and Ikot Nkwo communities faced challenges in delivering care due to inadequate tools and deteriorating infrastructure. The only PHC in the Udot community, which had previously provided services such as family planning, antenatal care, immunisation, child welfare clinics, and HIV testing, had become dilapidated and non-functional after years of neglect and repeated flooding.
However, the model PHC in these communities are beginning to change the story, making it easier for residents to access the care they need.
Mrs Edet Afereke, a resident of Ikot Nkwo, shared that the facilities are better equipped, health workers are more present, and essential medicines are available. “People say they no longer have to wait endlessly or travel far to get help. It shows that when the right support is provided, primary health care can truly serve the people it’s meant for,” she said.
Equipment and infrastructure
The Model PHCs are equipped with motorbikes to provide faster, more affordable emergency transport for patients, especially in hard-to-reach communities. This has made it easier for patients to access urgent care during emergencies, significantly reducing delays that could cost lives. So far, over 200 patients have benefited from the emergency transport service since its inception in June 2024.
A section of the male ward has been upgraded to serve as an urgent care unit, equipped with five beds, essential medical supplies, and basic life-saving equipment such as blood pressure cuffs and oxygen cylinders. According to Mrs Udofia of the Ibesikpo Austan Model PHC, the facility now provides immediate treatment for critical conditions and has recorded over 150 emergency admissions since its launch in April 2024. She stated that overall, patient patronage at the Model PHC has increased from 40% to 80%, as community members trust they can access timely and quality healthcare services close to their communities.
Image credit: Nigeria Health Watch
The Model PHCs in the state are equipped with a standard delivery room, which is a clean and conducive space where new lives begin. It is designed to provide a safe and supportive environment for mothers during childbirth.
Sexual and reproductive health is also one of the essential services provided at the Model PHC. In this safe and supportive space, a healthcare provider engages openly with a patient, offering guidance, answering questions, and ensuring she can access the information and care she needs to make informed decisions about her health.
“Before this new PHC opened, we struggled with space and resources,” Peace Blankson, a nurse at the Ibesikpo Model PHC, said. “Now, the quality of care we provide has improved greatly. Patients from near and far get the help they need on time.”
Mrs Ekemini Udofia, the Officer in Charge of the Ibesikpo Austan Model PHC, noted that the upgraded infrastructure, availability of medical supplies, and better-trained staff have helped improve provision of patient needs.
The lack of adequate staff quarters for Nigerian PHCs is a significant challenge impacting the availability and quality of healthcare services, particularly in rural areas. However, newly built doctors’ and nurses’ lodges in the Model PHCs are designed to improve healthcare delivery. These lodges ensure that healthcare professionals are readily available to respond to emergencies. This enables them to provide round-the-clock care, enhancing service delivery and improving patient outcomes within the community.
Image credit: Nigeria Health Watch
Some challenges in the PHCs
One of the foremost gaps to bridge in PHC service delivery in Nigeria is insufficient human resources, a fact corroborated by Dr Eno when sharing some of the limitations and challenges of the PHC reforms in Akwa Ibom State.
She cited poor attitude of healthcare workers, poor power supply in communities, and irregular supportive supervision mechanisms as major barriers to providing quality healthcare in the Model PHCs.
However, the successful renovation of Model PHCs in Akwa Ibom present a blueprint for sustainable healthcare reforms across Nigeria. These PHCs, designed to be accessible, well-equipped, and community-driven, offer solutions to long-standing challenges in the communities’ access to quality healthcare.
To build on these gains, there is an urgent need for the federal and state governments to increase funding for PHCs ensuring consistent infrastructure improvements and the provision of essential medical supplies.
In addition, private-sector partnerships are vital in sustaining these facilities through innovative financing and corporate social responsibility initiatives. Community members also have a key role to play by actively participating in managing these centres, providing feedback on service delivery and advocating for their needs.
primary health care is based on the prevailing conditions such as malaria, diarrheal diseases, malnutrition, lack of knowledge regarding causes of common conditions and how to prevent them. To provide these services, you don’t need a building, you need a knowledgeable health worker who may be a chew, nurse, midwife or retired doctor like myself to visit individuals in their homes, children in a school, others at their workplace. the next most important thing is to have a transport system to refer pregnant women and critically sick people. I looking to adopt a village to demonstrate how it is done.