LARA ADEJORO writes on the daunting challenges confronting expectant mothers in Nigeria due to limited healthcare facilities and the urgent need for improved infrastructure and healthcare services in underserved communities
It was early March 2024, when Salamatu Musa, seven months pregnant with her first child, felt a slight headache and stabbing abdominal pain. She knew she needed to go to General Hospital, Jahun, Jigawa State, where she received her antenatal.
Twenty-two-year-old Musa arrived at the hospital after a 25-minute journey through the bumpy road from Wurmawa, on the outskirts of Jahun.
The primary healthcare centre in Wurmawa could not provide immediate essential maternal care for Musa and other pregnant women in the community.
The doctors measured her packed cell volume and confirmed that she was suffering from maternal anaemia – a preventable and treatable health condition but a major cause of maternal mortality in Nigeria.
“The doctors transfused her with the first pint of blood and they were getting ready to transfuse her with the second pint the following day but she died,” her sister, Hadiza Yahaya recounted the tragedy.
Unfortunately, the baby could not be saved either. The death of both mother and child left their family mourning.
“Everyone is pained because Salamatu never missed her antenatal appointments, and she has all the support she needs,” Yahaya said.
In the same month Musa died, 50-year-old Magajiya Danjummai from Wurmawa died too, when she was due to have her baby.
Her family took her to the General Hospital in Ringim – before the hospital finally referred her to Jahun General Hospital. But Danjummai never lived to see her baby. The baby died too.
“When we took her here, the hospital tried to save her but she died,’’ Zainab Sahad, her sister stated.
Many pregnant women in Jahun, Wurmawa, and other nearby communities find solace in Jahun General Hospital because of the optimum care they receive, in partnership with an international, independent organisation, Médecins Sans Frontières, also known as Doctors without Borders.
Usaina Gali, 30, thought having her third child would be an easy ride but the health facility in her community – Majia–could not save her baby.
“I had a long labour, and I was referred here, but before I got here my baby had died. I went for antenatal, but the health facility in my community is not adequately equipped for optimum maternal and delivery services,” she explained.
It was the MSF-supported primary health centre that helped in removing the foetus.
MSF in partnership with the Jigawa State Ministry of Health has been managing medical activities in emergency obstetrics, newborn care, vesicovaginal fistula care, and rehabilitation in Jahun General Hospital since 2008. Since 2016, MSF initiated a decongestion strategy supporting Basic Emergency Obstetric and Newborn Care and engaging with communities with health promotion activities.
The Medical Activity Manager at MSF, Dr Fatima Aliyu, explained that the organisation’s role in the hospital was to provide maternal care. “We help women who come in for deliveries and complications associated with obstetrics. Then, we also offer surgical intervention.
“We provide neonatal care, for those babies in their first 28 days of life, if for any reason they would require admission. We also provide services and vesicovaginal fistula services. So, in general, we provide maternity care or obstetrics, emergency obstetrics, and newborn care, including VVF,” she said.
Saddening statistics
The unimaginable loss, hardship, and pain Musa, Danjummai, and Gali experienced during pregnancy are tragically typical in Nigeria, especially in rural communities where they have no access to a primary healthcare centre.
This lack coupled with a shortage of skilled healthcare professionals put many women at risk of complications during pregnancy and childbirth. In Nigeria, maternal mortality remains a critical public health concern, marked by significant disparities across the 36 states and the Federal Capital Territory, Abuja.
The adjusted data from the District Health Information System indicates that Kaduna and Jigawa States report over 300 maternal deaths per 100,000 live births at healthcare facilities, with many northern states falling between 150 and 299 deaths.
The Maternal and Perinatal Death Surveillance and Response report identifies Jigawa, Yobe, Gombe, the FCT and Kogi as states with the highest death rates, whereas some states report zero maternal deaths.
“This disparity underscores the urgent need to enhance data quality and establish a unified source of truth to inform effective decision-making. It is, however, critical to implement collective actions to drastically reduce maternal deaths by improving the quality of healthcare services,” the report revealed.
The 2024 NPHCDA PHC assessment report reveals substantial variability in the functionality and distribution of Nigeria’s PHC facilities, with significant regional disparities affecting healthcare access and quality.
“Nationally, of the 8,470 facilities assessed, 65 per cent are categorised as Functional Level One, providing essential services, and 21 per cent as Functional Level Two, offering more advanced care.
“However, 14 per cent of the facilities remain either non-functional or partially functional, limiting consistent access to care. Southern states, including Lagos, the Federal Capital Territory, and Delta, lead with a high concentration of Level One and Level Two facilities, while northern states, particularly Zamfara, Kebbi, and Taraba, struggle with low functionality and a higher prevalence of partially functional or non-functional facilities,” the report further stated.
The PHC revitalisation and Quality of Care update also showed that none of the PHCs, secondary or tertiary health facilities in Nigeria possess a certificate of standard, a critical benchmark for ensuring quality healthcare.
It said the absence of the certification implies that the health facilities may not consistently meet essential standards for infrastructure, equipment and patient care practices.
“Without such certification, there is limited assurance that these facilities operate with the necessary quality control, potentially impacting patient outcomes and eroding public trust in the healthcare system.
“Additionally, the lack of standardised oversight limits the capacity to address issues like resource shortages, safety protocols, and skilled personnel development, all of which are essential for delivering reliable, high-quality healthcare,” it noted.
We gave birth in the bush – Ebonyi women
For weeks leading up to the birth of her twins, Modesta Uchenna was disturbed about the fate of her unborn twins and her life. Many women in her community, Amaogudu, in Ebonyi State, miss antenatal and postnatal care because the nearest PHC to her community is about an hour’s walk.
Many women have given birth in the bush en route to the health centre. Uchenna’s labour started at midnight, escalating through the early morning.
“I started labour at midnight but there was nothing I could do, my husband was not home. I had to wait till about 7 am to go to the health centre,” she recalled. “There is no health centre here at all. As I returned to the village, the babies’ heads were already coming out. I didn’t know what to do.”
Modesta gave birth to her twins on a narrow dirt road that leads to the Ugwulangwu PHC, the nearest centre, about an hour’s walk from her village, Amaogudu.
“There is no motorcycle at all, it is only by luck that one gets a motorcycle here if they are not busy with their duties,” she added.
Chidinma Ogbonnaya’s motherhood journey is similar to that of Modestas. The 27-year-old lady also gave birth on her way to the Ugwulangwu PHC.
“I used to go there for antenatal, but that is once in a while because of the distance. The health centre is far away, and I don’t have the strength always to visit there.
“When I was in labour, I was on my way to the centre when I gave birth on the road. Thank God for the woman I met on the road, she was the one who assisted me when she saw me in pain. I gave birth on the road,” she emphasised.
She said other women in the community have almost the same experience while giving birth.
Grueling journey to delivery
Expectant mothers in Idolorisa, Ipokia LGA, Ogun State, face significant challenges due to the poor road conditions leading to their nearest healthcare facilities. The journey to Agosasa General Hospital, which is approximately 30 minutes away, is fraught with difficulties due to the patchy and uneven road, which exacerbates the discomfort and pain of labour.
For those who need to travel to the General Hospital in Ota, the situation is even more dire, as it is 45 minutes farther. The road conditions not only add to the physical strain of labour but also heighten the risks associated with delayed medical care, posing a serious threat to both mother and baby.
When labour started for Adenike Alade at about 10 pm in December 2023, she had to endure the pain till dawn before she could go to Agosasa General Hospital, a 30-minute trip from her community.
“I waited till about 7 am the next day before leaving for the hospital,” she said. “My husband took me on his motorcycle to the hospital with my baby’s items.’’
Also, women in the Obalaja community have to travel significant distances to reach the maternity centre in Tube for childbirth. Despite the urgent need for accessible maternal healthcare services locally, women from Obalaja must make this arduous journey to ensure safe delivery.
The lack of a nearby facility means they face the additional strain of long travel times, often under stressful conditions.
Data on Antenatal Care visits in Nigeria also shows disparities across states, with varying access to and utilisation of maternal healthcare.
The Joint Annual Review report on Antenatal Care visits in 2023 showed, “High coverage in states like Lagos (95 per cent), Anambra (92 per cent), and Osun (85 per cent) indicates strong healthcare access in the South-West and South-East regions, suggesting well-developed infrastructure and positive healthcare-seeking behaviour.’’
Ironically, the data showed 63 per cent for Ebonyi and 66 per cent for Ogun States.
“In contrast, coverage is much lower in the North-West, with states like Kebbi (14 per cent), Zamfara (22 per cent), and Sokoto (23 per cent) facing substantial barriers to ANCC access, likely due to limited healthcare facilities, cultural attitudes, and socioeconomic challenges.
‘’Also, the 2023 NDHS survey data on postnatal checks within the first two days after birth shows that only 43 per cent of women nationally receive this healthcare service, which is essential in addressing early maternal and newborn complications.
“States like Lagos (87.3 per cent), Edo (86.3 per cent), and FCT (82.3 per cent) lead in postnatal care coverage, reflecting robust healthcare infrastructure, and greater awareness. High-performing states are mostly in the South-West, and South-South, where 75 per cent of new mothers receive timely postnatal checks, indicating a concentration of healthcare resources, and effective maternal health outreach,” it revealed.
The data showed 56 per cent for Ebonyi and 81 per cent for Ogun States.
“In contrast, northern states, particularly in the North-West, show alarmingly low coverage, with states like Kebbi (11.3 per cent) and Sokoto (11.6 per cent) at the lowest end.
“Addressing these gaps requires targeted strategies, including expanding healthcare infrastructure in underserved regions, culturally sensitive education campaigns, and improving healthcare accessibility. Enhancing early postnatal care is vital for reducing maternal and neonatal complications, underlying the need for equitable access to maternal healthcare across Nigeria,” the report recommended.
According to BudgIT, In 2023, Jigawa’s actual health expenditure was N19.76bn, which is 63.3 per cent of the budgeted allocation of N31.22bn, and the total health spending per capita stood at N2,767.34. From the total health expenditure, Capex captured 47.16 per cent at N9.32bn, personnel took 45.11 per cent at N8.91bn, and overhead cost got 7.73 per cent at N1.53bn.
Some of the health sector capital expenditures allocations include the completion and equipping of the orthopaedic hospital, Gumel, which cost N2.bn, the equipping of three general hospitals at Garki, Gantsa, and Guri, at N730.16mn, and the construction and equipping of three new general hospitals at Gwiwa, Gagarawa, and Kiri Kasamma at N600mn. The state spent a total of N2.7bn on the purchase of health and medical
equipment and N514.13mn on drugs and medical supplies.
In 2024, the state allocated N36.2bn to its Ministry of Health, according to BudgIT. The CSO also noted that the Ebonyi State government spent N4.59bn on its health sector, accounting for 3.66 per cent of its total expenditure in 2023.
“84.59 per cent of the N5.42bn allocated to the health sector in the state was disbursed and spent,” it stated.
In 2024, the state budgeted about N13bn for the health sector, according to the data on the state government’s website.
BudgIT revealed that Ogun’s spending on its health sector in 2023 was N12.94bn, representing 3.65 per cent of the state’s total expenditure. In addition, implementation of the state’s health budget was abysmal, as just 26.04 per cent of the N49.7bn allocated to the health sector was implemented. In 2024, N81.5bn was allocated to the Ministry of Health in the state.
A Consultant Obstetrician and Gynaecologist, Dr Joseph Akinde, acknowledged that the PHCs in the country are not only enough, but are short-staffed, and not readily accessible to the public.
Akinde, who is also a former Chairman of the Society of Gynaecology and Obstetrics of Nigeria, Lagos State chapter, noted, “If you look at the National Democratic Health Service, it’s only about 37 per cent of our women that have their delivery with skilled-birth attendants, so what happens is that the majority of our deliveries take place at home, under the supervision of traditional birth attendants, or even under the supervision of fellow women and grandmothers and grandmothers.
“So, we lose a large number of our women especially when complications arise because their labour and antenatal care are not supervised by skilled birth attendants. The maternal mortality figures in Nigeria are woefully high, and unacceptable.’’
He added, “The government should stop paying lip service to providing primary health care. Primary health care is the bedrock of the health care system, not only should they be provided in places where they are accessible to the public, but they should be well-staffed and well-stocked with the necessary equipment and drugs. So, the government should lay a lot of emphasis on primary health care. They should make sure we have a solid plan.”
The reproductive health expert also recommended that healthcare workers in the rural areas should be encouraged, and be paid rural postal allowance.
“When you do such, they will be encouraged to stay and render quality services,” he pointed out.
The Executive Director and Chief Executive Officer of the National Primary Health Care Development Agency, Dr Muyi Aina, explained that the Federal Government is working towards increasing PHCs in the country from 8,400 to over 17,000 in the next couple of years.
“When we came, what we did was to ask ourselves questions, and we said what are the results that we want? We want to reduce maternal mortality. For example, if you look at the evidence and the data, what are the correlates? What are those factors that are associated with poorer outcomes? Then we found among many things, the two most important were the distance that they have to travel to a high-quality health facility, as well as access to skilled birth attendants.
‘’So, we are increasing the quality of the PHCs, we’re expanding from 8,400 to 17,600. In expanding to 17,600, we’re not doing it evenly, we’re trying to move towards more equity so that where the facilities are farther away, we want to put more facilities than where they are not farther away, or where there are alternatives.
“If you go to many parts in Abuja or Lagos; if you set up a PHC, you’re not going to change any life because there are a lot of other facilities, private facilities, that people will go to, anyway. So, we’re working to increase the number and access to good quality PHCs,” Aina said.
