Reported by: Oahimire Omone Precious | Edited by: Gabriel Osa
Mallagum 1 Primary Health Care Centre, located in the rural heartland of Kauru Local Government Area in Kaduna State, stands as a stark illustration of the divide between government health sector promises and lived realities for millions of Nigerians. Situated roughly 180 kilometres from Kaduna city, the facility is the sole formal healthcare access point for an estimated 10,000 residents. Yet, despite recurring official assertions that vast sums have been released for revamping primary health care (PHC) infrastructure nationwide, this centre has languished without meaningful rehabilitation for more than two decades.
A recent field assessment by civic accountability group Tracka – which monitors public project delivery across all 774 local government areas in Nigeria – revealed conditions at Mallagum 1 that health experts describe as “untenable.” Walls are visibly cracked, parts of the roof are collapsing, and the facility lacks basic medical equipment necessary for even routine care. These hazards not only limit effective clinical services but also pose immediate safety risks for both patients and staff. Residents report that critical gaps in electricity, sanitation and clinical supplies are routine rather than occasional, forcing many to resort to informal healers or travel long distances to secondary health providers when illness strikes.
These findings come amid broader debates on the effectiveness of Nigeria’s PHC revitalisation initiatives. The Federal Ministry of Health and National Primary Health Care Development Agency have publicly underscored efforts to revitalise tens of thousands of PHC facilities through funding streams such as the Basic Health Care Provision Fund and health sector investment plans. Independent fact‑checks and monitoring campaigns, however, have documented that while certain centres have seen visible upgrades, significant disparities persist – especially in rural and underserved regions. Many facilities lack qualified personnel, necessary medical tools, and functional infrastructure even after being listed for renovation, raising questions about the pace and quality of implementation at the grassroots level.
Kaduna State, under the administration of Governor Uba Sani, has articulated an ambitious agenda to strengthen primary healthcare. In 2025, state health authorities announced plans to recruit 1,800 additional health workers to fill chronic staffing gaps and committed to upgrading 255 PHC facilities to “Level 2” status – a classification intended to broaden service capability to include maternal, newborn and child health services, basic diagnostics, and emergency care.
Taken at face value, these initiatives align with Nigeria’s broader health policy frameworks and global best practices urging equitable access to healthcare for all citizens. Yet, the persistent dilapidation at centres like Mallagum 1 suggests that policy intentions have yet to translate into consistent, measurable improvements on the ground. Experts stress that without effective oversight, transparent fund distribution, and community‑driven accountability mechanisms, large budgetary allocations risk yielding minimal impact in the very communities they intend to serve.
The World Health Organization and other public health bodies recognise primary care as the cornerstone of resilient health systems, essential for disease prevention, routine immunisation, maternal and child health, and early detection of outbreaks. In Nigeria, where only about one in five of the estimated 30,000 PHC facilities are fully operational, gaps in PHC functionality risk straining higher‑level health institutions and contributing to avoidable morbidity and mortality.
In nearby communities, similar stories echo the challenges faced in Mallagum. Mahuta Health Clinic in Giwa LGA, for instance, struggles with unreliable water supply, inadequate staffing, and dilapidated infrastructure. Pregnant women and children there often travel long distances for care or receive inadequate service due to resource limitations. Another facility, Kujama PHC in Tudun Wada, reportedly faces severe drug stockouts and crowded wards even as renovations are underway, highlighting the problem of partial or phased interventions that disrupt service delivery rather than sustain it.
There are, however, examples of progress within Kaduna State. Badarawa PHC in Kaduna North has reportedly regained community trust following renovation and service expansion, with increased patient attendance and more reliable services, including 24‑hour care, since upgrades were made. Yet these successes underscore the uneven nature of reform: while some facilities demonstrate the potential benefits of targeted investment, others remain in states of disrepair or limited functional capacity.
Public health advocates and civil society groups argue that bridging the gap between budgeting and on‑the‑ground service delivery requires robust monitoring frameworks that go beyond paper commitments. They advocate for community participation in planning and evaluation, strengthened data systems to track facility performance, and accountability mechanisms that tie disbursement of funds to measurable improvements in infrastructure and service quality.
Nigeria’s PHC challenges intersect with broader systemic issues within the national health sector, including workforce shortages, supply chain weaknesses, and gaps in health information systems. The Federal Government’s deployment of Performance and Financial Management Officers to each local government area aimed to improve financial oversight and service delivery at PHCs, but the effectiveness of this initiative depends on local governance capacity and sustained political commitment.
In Mallagum 1, residents voiced frustration not only with the physical state of the facility but also with the perception of neglect from successive tiers of government. “We are often told that funds have been released, but we see no change here,” said a local community leader, echoing a sentiment common in many rural Nigerian communities. For many families, particularly those living in poverty, the local PHC is the only viable access point to professional healthcare. When that facility fails or underperforms, the health consequences can be dire, with maternal deaths, untreated infections and preventable complications counting among the most immediate risks.
Addressing these deficits will require more than isolated rehabilitation projects. Systemic reform must prioritise integrated planning, sustainable financing, and accountability structures that ensure equitable resource distribution. It must also embrace the lived experiences of rural communities, recognising that the value of health investment is measured not by budget figures alone but by improved health outcomes, functional facilities, and trust in public services.
As Nigeria pursues its Health Sector Renewal and universal health coverage goals, the condition of facilities like Mallagum 1 serves as a critical test of whether policy commitments can be translated into tangible improvements that protect lives and strengthen community health resilience. Rural and underserved populations have waited too long for quality care; their health outcomes depend on substantive, sustained action that matches rhetoric with reality.
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