Primary Health Centres in Crisis: The broken backbone of Nigerian healthcare

Saidi Suara

Nigeria’s Primary Health Centres (PHCs) were envisioned as the cornerstone of the health system, a network of facilities that would bring affordable and essential services directly to communities.

They were designed to serve as the first point of contact for pregnant women needing antenatal care, children requiring immunisations, and families seeking preventive health education or treatment for common illnesses.

In a country where higher-level hospitals are distant, costly, and often overcrowded, PHCs were supposed to offer a lifeline by delivering care close to where people live.

Yet, decades after this vision was set, the reality is starkly different. Instead of being the backbone of healthcare delivery, PHCs have become a symbol of neglect and dysfunction.

Across Nigeria, they are crumbling under the weight of poor infrastructure, chronic staff shortages, irregular drug supply, and weak governance. The result is that millions of Nigerians are left without reliable primary care, and the entire health system is destabilised.

Scope of Dysfunction: How Bad Is the Crisis

Nigeria boasts about 34,076 PHCs, representing more than 85 percent of all health facilities in the country. On paper, this network is vast enough to provide comprehensive primary care across the federation.

However, a recent assessment by PharmAccess Foundation revealed that only around 20 percent of these centres are functional. In practice, this means the overwhelming majority of facilities are unable to perform even their most basic functions.

Functionality is defined as the capacity to deliver essential services — from routine immunisation and maternal care to health promotion and minor emergency management. By this measure, most PHCs fall woefully short.

The World Health Organization (WHO) has reported that just 25 percent of PHCs in Nigeria have even a quarter of the minimum equipment package required to operate effectively.

Similarly, a 2023 federal government review found that of 25,843 PHCs assessed, only 463 had skilled birth attendants, accounting for barely 1.8 percent of the total.

In other words, more than 25,000 PHCs are unable to provide safe deliveries, even though maternal and neonatal care is a core reason for their existence.

The consequences of this systemic weakness are profound. Nigeria continues to record one of the highest maternal mortality ratios in the world at 1,047 deaths per 100,000 live births, according to UN data.

Many of these deaths occur because women are forced to give birth in ill-equipped centres or at home without professional support. Infant mortality rates remain stubbornly high as well, with preventable deaths from complications that should have been managed at the primary level.

This dysfunction also places tremendous pressure on secondary and tertiary hospitals, which are flooded with cases that could have been resolved at PHCs. Common childhood illnesses such as diarrhoea and malaria, routine immunisation, and uncomplicated deliveries are often referred upward because local PHCs cannot cope.

The result is overcrowding, long waiting times, and rising healthcare costs — a chain reaction that undermines the health system from the bottom up.

Root Causes: Why Are So Many PHCs Broken

The crisis facing PHCs is the outcome of multiple interrelated challenges. Infrastructure is perhaps the most visible problem.

Many PHCs are housed in buildings that are unsafe, with leaking roofs, broken windows, and no reliable electricity or running water.

Investigations in states like Sokoto and Bauchi have documented facilities where patients lie on mats because beds are unavailable, while delivery rooms are dark and unhygienic.

Without the most basic infrastructure, these centres cannot provide safe and effective care.

Staffing shortages compound the challenge. While PHCs were designed to be staffed with nurses, midwives, community health extension workers, and occasionally doctors, the reality is starkly different.

The majority of facilities have only one or two health workers on duty, often lacking the training or equipment to handle emergencies.

The shortage of skilled birth attendants is particularly alarming, as it directly contributes to maternal and neonatal deaths. Even where staff are present, poor remuneration, lack of career progression, and unsafe working conditions discourage retention.

The supply of drugs and essential commodities is another chronic weakness. Stock-outs of routine medicines, vaccines, and diagnostic kits are common, leaving patients with no option but to purchase drugs privately at higher cost.

For many rural families, this is unaffordable, leading to untreated illnesses and preventable deaths. Without reliable supply chains, PHCs lose credibility in their communities, as patients see little reason to visit facilities where medicines are consistently unavailable.

Financing and governance issues further entrench dysfunction. The Basic Health Care Provision Fund (BHCPF) was established to provide sustainable financing for PHCs, with one percent of Nigeria’s consolidated revenue earmarked for their support.

Yet, disbursement has been plagued by delays, bottlenecks, and insufficient allocations. Even when funds are released, weak accountability systems mean resources are often diverted before reaching the frontline. In rural wards, this translates into abandoned or under-resourced facilities that exist in name only.

Underlying all of these issues is the problem of policy implementation. While successive governments have pledged to revitalise PHCs, many initiatives have faltered due to inadequate follow-through, lack of coordination across federal, state, and local levels, and limited monitoring of results. Communities are rarely engaged in oversight, leaving facilities vulnerable to mismanagement and neglect.

Promises, Initiatives, and the Path Forward

Despite these challenges, there are recent signs of renewed attention to the plight of PHCs. The National Primary Health Care Development Agency (NPHCDA) reported in 2024 that 901 PHCs had been refurbished, with another 2,700 undergoing upgrades.

The government’s stated goal is to have at least one functional PHC in each of the country’s 8,809 political wards by the end of 2025.

Funding has also seen a boost. In 2024, the federal government disbursed ₦51 billion through the BHCPF, including ₦22 billion targeted specifically at PHCs. Earlier in 2025, a further ₦32 billion was approved to overhaul more than 8,000 centres nationwide.

These figures suggest a significant commitment to restoring functionality, but whether the money translates into meaningful improvements on the ground remains uncertain.

Revitalisation, however, must go beyond painting walls or refurbishing buildings. A PHC can only be considered functional if it is consistently staffed with trained personnel, stocked with essential medicines, and equipped to deliver care. Without these core elements, cosmetic upgrades achieve little.

Functionality should therefore be measured not just in infrastructure, but in outcomes such as improved immunisation rates, reduced maternal deaths, and higher levels of community trust.

The path forward will require tackling systemic issues. Predictable financing flows must be guaranteed to prevent disruptions in services.

Investment in workforce training and retention, especially for midwives and nurses in rural areas, is critical. Supply chains for drugs and vaccines need to be strengthened to ensure consistent availability.

Transparent monitoring tools, such as the government’s PHC dashboard, should be expanded and made publicly accessible, while communities should be empowered to hold local facilities accountable.

Perhaps most importantly, policymakers must resist the temptation to measure success by the number of facilities “revamped” and instead focus on the outcomes delivered.

Only when PHCs begin to reduce preventable deaths, improve health equity, and restore confidence among ordinary Nigerians will they truly fulfil their intended role as the backbone of the healthcare system.

Conclusion

Primary Health Centres were meant to anchor Nigeria’s health system, providing the first line of defence against disease and a safety net for vulnerable populations. Yet today, they stand as the weakest link. With only 20 percent of PHCs considered functional, and with critical gaps in staffing, drugs, and infrastructure, the system is failing those who need it most.

The consequences are severe: preventable maternal and child deaths, overburdened hospitals, and widening health inequities. But the crisis is not beyond repair. With sustained investment, structural reforms, and stronger accountability, PHCs can once again serve their purpose. The government’s current commitments are a step in the right direction, but their success will depend on political will, efficient execution, and community involvement.

The stakes could not be higher. If Nigeria fails to fix its PHCs, it risks perpetuating a cycle of poor health outcomes and fragile systems. If it succeeds, however, PHCs could yet become what they were always meant to be — the true backbone of healthcare, delivering affordable, accessible, and lifesaving services to every Nigerian, regardless of where they live.

Saidi Suara is a public health analyst, interventionist and a manager within the Institute of Church Office Management (ICOM).