The delivery of essential health services across Nigeria is under severe threat due to a combination of critical challenges plaguing the nation's Primary Health Centres (PHCs). This alarming situation was highlighted by the Civil Society in Malaria Control, Immunisation and Nutrition (ACOMIN), which pointed to acute shortages of healthcare workers, frequent stock-outs of vital commodities, and dilapidated infrastructure as the main culprits.
Crisis in the Health Workforce and Supply Chain
Speaking at an Advocacy-Focused Media Dissemination meeting in Abuja, Mrs. Fatima Kolo, ACOMIN's Senior Programme Manager, detailed the findings from the organisation's Community Engagement and Strategic Initiative (CE-SI) activities. She revealed that Nigeria's health workforce density remains critically below global standards, failing to meet the World Health Organisation's benchmark of one doctor for every 600 people.
The situation has been exacerbated by the "japa" phenomenon, where skilled professionals emigrate, coupled with generally poor working conditions. This exodus has left numerous primary healthcare facilities critically understaffed, resulting in excessive workloads, burnout among remaining staff, longer patient waiting times, and an overall decline in the quality of care provided.
"The impact is not abstract. It affects availability, accessibility, affordability and quality of services," Kolo stated. She painted a grim picture of mothers trekking long distances only to find no health worker on duty and patients being turned away because essential medicines were out of stock.
These supply gaps extend to crucial commodities like antimalarial drugs, HIV and TB medications, as well as diagnostic tools such as malaria rapid tests and HIV/TB test kits. These shortages directly disrupt service uptake and the continuity of care for patients.
Infrastructural Decay and Its Ripple Effects
Beyond human resources, the physical state of many PHCs is a major concern. Kolo highlighted the impact of dilapidated health facilities, poorly maintained equipment, lack of clean water, and unreliable electricity. Many centres fail to meet minimum operational standards, which discourages community members from using them.
This underutilisation of primary care services creates a domino effect, leading to unnecessary overcrowding at secondary and tertiary hospitals and causing avoidable delays in treatment. Weak last-mile distribution systems for medicines further worsen disease outcomes, often forcing patients to abandon treatment or seek care far from their homes.
Kolo connected these systemic failures to broader socio-economic burdens. "When healthcare systems are strained, the consequences go far beyond shortages," she explained. "Communities suffer from disrupted essential services, worsening health outcomes, increased morbidity and mortality."
A Call for Collaboration and Community Empowerment
ACOMIN is actively working to address these gaps. With support from the Global Fund through Impact Santé Afrique (ISA), the group is implementing the CE-SI project under the Global Fund’s Grant Cycle 7. This initiative employs a customer lifecycle management strategy across 10 states: Adamawa, Anambra, Delta, Enugu, Kebbi, Kwara, Niger, Ogun, Ondo, and Oyo.
The project empowers local communities to identify service delivery gaps, advocate for practical solutions, and hold government officials and other duty-bearers accountable. Mr. Ayo Ipinmoye, the National Coordinator of ACOMIN, stressed the indispensable role of communities in extending the reach and impact of health systems, particularly for tuberculosis, malaria, and HIV prevention and care.
He noted that the Global Fund currently supports Community-Led Monitoring (CLM) under its GC7, with Catholic Relief Services as the principal recipient. This approach goes beyond mere service delivery; it enables communities and civil society organisations to actively participate in policy formulation and decision-making by generating and using community-driven evidence.
ACOMIN issued a strong call to action, urging government agencies, the private sector, philanthropists, and traditional and religious leaders to collaborate in rebuilding Nigeria's community health system. Strengthening healthcare delivery, Kolo concluded, is not just a social obligation but a fundamental requirement for national development, economic productivity, and social stability.
