Sick Health Centres Keep Rural Dwellers in Agony as Nigeria’s PHCs Struggle

Primary healthcare centres across Nigeria are struggling to provide the basic services they were created to deliver, leaving rural residents with limited access to treatment, medicines and emergency care. A survey of facilities and communities in several states found that many centres are poorly equipped, understaffed and unable to meet the needs of the populations they serve.

Primary healthcare centres are expected to form the foundation of Nigeria’s health system. They are designed to provide accessible preventive, promotive and basic curative services at community level, including immunisation, antenatal care, treatment of common illnesses, family planning and health education. However, many rural facilities are reportedly operating in conditions that make effective service delivery difficult.

The problems cut across several states, including Imo, Bayelsa, Anambra, Edo and Ogun. In many communities, residents face long distances, poor roads and limited transportation before they can reach a health facility. During the rainy season, the journey can become even more difficult, delaying patients who need urgent attention.

Poor infrastructure is one of the most visible challenges. Some centres operate from dilapidated buildings with damaged roofs, inadequate ventilation, limited waiting areas and poor sanitation. Others lack reliable water supply and electricity, making it difficult for health workers to provide safe and consistent care.

The absence of dependable power also affects the storage of vaccines, operation of medical equipment and provision of care at night. Where electricity is unavailable or generators cannot be fuelled, health workers may be forced to refer patients to larger hospitals, even when the condition could have been treated at the primary healthcare level.

Staffing is another major gap. Many rural centres do not have enough trained doctors, nurses, midwives, laboratory personnel or community health workers. In some facilities, a small number of workers are expected to handle large patient populations, work long hours and provide services across several areas of care.

The shortage is worsened by the fact that many qualified health professionals prefer urban postings, where living conditions, salaries, accommodation and career opportunities are generally better. Rural facilities are often left with minimally trained assistants or workers who lack access to regular professional development and specialist support

The situation affects pregnant women and children especially. Nursing mothers may travel several kilometres to seek antenatal services, vaccination or treatment for childhood illnesses. Some are forced to pay for transport and private care, while others delay treatment because they cannot afford the cost. Delays can increase the risk of complications during pregnancy, childbirth and early childhood.

Although primary healthcare is often presented as free or affordable, residents interviewed for the report said they were sometimes charged for treatment and vaccination. Such payments can discourage poor households from visiting health centres and push them toward self-medication, traditional remedies or unlicensed practitioners.

Research has shown that rural Nigerians face multiple barriers to healthcare access, including inadequate facilities, a shortage of medical personnel, poor equipment, limited drug supplies and high costs. Older people are particularly affected because many live far from health centres and may have difficulty travelling long distances.

The failure of PHCs also increases pressure on secondary and tertiary hospitals. Patients who should have been treated at community level are referred to general or teaching hospitals, contributing to overcrowding and longer waiting times. By the time some patients arrive at larger facilities, their conditions may have deteriorated because of delays in obtaining care.

The problems also weaken disease prevention. Primary healthcare centres are critical for immunisation, maternal health, malaria control, disease surveillance and early detection of outbreaks. When facilities lack staff, equipment or medicines, they cannot perform those functions effectively.

Experts say fixing the problem will require more than constructing new buildings. Existing facilities need regular maintenance, reliable water and electricity, essential drugs, functional equipment and adequate staffing. Rural workers also need incentives such as accommodation, hardship allowances, training opportunities and clear career paths.

Improved funding and accountability are equally important. Government must ensure that money allocated to primary healthcare reaches facilities and is used for its intended purpose. Communities should also be involved in monitoring services and reporting shortages.

Technology could provide additional support through telemedicine, digital patient records and remote consultations, but such solutions will only work where facilities have electricity, internet access and trained personnel.

For rural residents, the need is urgent. A primary healthcare centre should be the first place a family turns to for basic medical care, not a building that offers little beyond a signboard. Unless governments address the weaknesses in infrastructure, staffing and funding, Nigeria’s rural communities will continue to suffer the consequences of sick health centres.