In the late evening of a Friday, on 14th September 2024, shortly after the Maghrib prayer, a resident of the Damɓa community of Zamfara state, Bashir Muhammad, a 34-year-old father of seven who has been suffering from typhoid fever for a decade, sat down innocently, contemplating where to seek medication the next day.
He had previously relied on the Primary Health Care (PHC) center for treatment. However, for the past five years, he has been unable to visit due to the facility’s poor condition.
Muhammad was initially hopeful when the PHC in the Damɓa community, was converted into an infectious disease facility in 2020, believing it would improve his access to treatment. However, his optimism faded as both the new facility and the original PHC continued to be neglected.
For nearly a decade, Muhammad visited the center regularly for medical services. But now, he has spent five years without using the PHC due to its deteriorated state. His faith in the facility has been eroded as its condition worsened with an empty pharmacy.
Currently, Muhammad relies on a local chemist in the Damɓa Community for medical care, although he’s getting better despite the rising costs of living. He described his situation:
“The illness began more than a decade after I got married. Whenever it flares up, I experience fever, abdominal pain, and yellow vomiting. I used to visit the center for injections and other medications, but now I avoid it because of the facility’s condition. Instead, I turn to a local chemist in Damɓa, as there is no functional health facility nearby and traveling to Gusau is too costly given the current cost of living.”
A report published by the National Library of Medicine showed that typhoid remains a global public health problem, with a higher burden in low- and middle-income countries due to poverty. It is estimated to cause between 9.9 and 24.2 million cases and 75,000–208,000 deaths per year globally.
Another report published on ResearchGate also indicated that in Nigeria and other developing countries, the incidence of typhoid fever is estimated at 540 per 100,000 annually, with an annual mortality rate of 2.5 per 100,000 persons. The disease is believed to be caused by drinking contaminated water and poor personal and environmental hygiene.
Damɓa Community, located in the Gusau Local Government Area of Zamfara, Nigeria, is about 4–5 kilometers from the Gusau metropolis and has a population of around 14,000. It borders the ancient town of Kwatarkwashi, surrounded by mountains and rivers within the Bungudu Local Government Area.
Despite its sizable population, the Damɓa community continues to struggle with inadequate infrastructure, including poor road access and a severely under-equipped health center.
This facility lacks essential medical equipment, latrines, and reliable electricity, though it is appropriately staffed. Consequently, residents face significant health challenges and frequent crises due to limited access to quality healthcare services.
This could hamper the Federal Government’s efforts in actualizing one of its strategic policies—Universal Health Coverage (UHC)—to provide quality healthcare delivery at the grassroots level in Nigeria.
Residents in frustration
This situation has caused serious frustration and anxiety among many residents of the Damɓa community, who face significant health risks due to inadequate healthcare services. Balkisu Shu’aibu, a mother of two, shared her distressing experience after spending five years using the neglected PHC.
“I was brought here for labor with my first child but had to run away because they lacked a proper delivery room and toilets,” she recounted. She noted that while in the labor room, the leaking roof made the situation even worse by drenching her.
For her second child, she was compelled to stay and deliver at the PHC despite the poor conditions.
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“I had to deliver on the bare floor with no bed and no toilets. When I needed to relieve myself, I had to go to neighboring houses because I had no other option,” Balkisu said, clearly upset.
Balkisu lamented that they have no other viable options and find the hospital only manageable due to its proximity, urging the government to assist.
“Life is becoming more costly, and we have nowhere else to go,” she said.
Another 25-year-old nursing mother, Shamsiya Tukur, who brought her child for immunization, reported that aside from immunization and prescriptions, getting medicine in the PHC has become an unachievable dream for her.
“I have come here more than 20 times without receiving any medicine. The doctors simply prescribe the medication and ask us to buy it ourselves,” she said annoyingly.
She expressed her frustration at having to seek out a chemist for medications rather than receiving everything at the center when she comes for antenatal and other medical services.
For Umar Bello, 40, a resident of Damɓa, the situation in the health center is unbelievable despite it being a public healthcare facility.
“Look at the uprooted roofing, look at the ceiling, doors, and windows, and this is where we are being treated. This is very unfortunate,” he said with a frustrated face.
He added:
“There are only six beds in the center, and that is where men, women, and young children are being admitted. We want the government to help us to make this PHC look as beautiful as that COVID-19 center which remains inactive for four years,” Bello implored.
Health workers’ struggles
Dr. Rabi’u Ibrahim, the officer in charge of Damɓa Primary Healthcare, has dedicated more than a decade working in the PHC with his team of health professionals.
Despite the overwhelming challenges of inadequate infrastructure and medical supplies, they remain committed to providing healthcare to the community.
“Our main concern is that whoever comes to this hospital with their family and sees the condition we are in, they would never come back, despite the fact that we have the technical staff to treat the patients,” said Dr. Ibrahim in a pitiful tone.
The facility, with 25 staff members, operates out of a dilapidated hall and four small rooms with rotted, leaking roofs. These rooms are used for consultations, a ward with just six beds for both male and female patients, and a pharmacy with nearly empty stock.
Due to the poor conditions of the center, its workers are forced to admit patients for only a day.
“We only admit patients for a day because we don’t run shift duty, and the condition of the PHC is totally bad. However, we only have six beds in our ward,” he added pathetically.
A relocation nightmare with a failed COVID-19 Center
The COVID-19 pandemic brought a new challenge for Damɓa residents as their beacon health center converted to covid-19 center, they were equally left without a functional health facility after it was relocated to a new site.
According to a document obtained by UDEME, in 2020, the Muhammad-led administration allocated the sum of N48.96 million for the conversion of Damba Primary Healthcare Center into a COVID-19 Center.
The contract which was assigned under the state ministry of Health was awarded to AKA Dino Multi Biz Ltd company with a duration of three months to be completed.
As you approach the newly converted COVID-19 center, located along Gusus-Zaria Road, in Damɓa, Gusau local government, the impressive building will welcome you. The center is well-constructed, fenced, interlocked and painted, but surprisingly, it has remained inactive.
When touring the Centre, this reporter observed that although the PHC had been completely converted into a COVID-19 center with an amazing look, there was not a single staff in the center apart from the watchman while the center remained locked since the completion.
While speaking with the watchman in the facility, who spoke under condition of anonymity due to fear of intimation, he said although he was employed to overlook the centre early last year, there were only a few people he used to see in the centre.
“There are some health workers that used to come and prescribe drugs for patients but they don’t admit,” he said. He added that after converting the PHC to covid-19 center, the old PHC was relocated to another site in the Damba community.
UDEME learned that the Primary Health Center (PHC), which the Central Bank of Nigeria (CBN) renovated and equipped in 2019, was demolished and repurposed as an infectious disease center.
Health workers were instructed to leave the PHC and find alternative accommodations. They are now operating in an old, abandoned government stock building constructed during the Shagari administration.
This building lacks proper doors and windows. Consequently, they had to set up tents to store some of their evacuated property, which had been damaged due to the poor conditions.
Sambo Chiroma, a leader from the Damɓa community, noted that initially, the Primary Health Center (PHC) had been renovated with new beds and essential infrastructure, significantly benefiting residents.
However, in 2019, the state government repurposed the PHC into an infectious disease center due to the COVID-19 pandemic.
According to him, the conversion of the PHC led to its relocation, with a promise to renovate the new site. Unfortunately, the PHC remains neglected, leaving the new facility unusable. This has created major difficulties for the community in accessing medical services.
Chiroma expressed concern about the impact on the approximately 14,000 residents who rely on the PHC.
“The situation has severely impacted the approximately 14,000 residents who rely on the PHC. For serious cases, we must travel 4-5 kilometers to FMC Gusau or Yariman Bakura Specialist Hospital.”
Community leader cries out for help
Sambo Chiroma, said as community leaders, they have done all they could to see that the hospital is taken back to its old site, stating however that, their findings revealed that there are no desks, chairs and toilets in the newly converted covid-19 center.
They laid complaints to the former Permanent Secretary of the Ministry of Health but to no avail because they wanted the PHC to be upgraded to General Hospital.
He lamented that as Damɓa is rapidly developing with more than 10 villages it is equally struggling with different ailments such as malaria, diarrhoea, hypertension and a lot more, which need urgent attention from the government.
In his words: “Damba continues to develop rapidly with more than 10 villages including Gidan Ɓaido, Kuraje, Gidan Kwagiri, Sami-naka, and Mareri. All these villages can come to the hospital if all the necessary infrastructures are provided but now people are suffering because of the current status of PHC, quick action needs to be taken,” he lamented, imploring the government to address the inadequate facilities and alleviate the suffering of the residents.
The situation at the PHC worsened as the rainfall persisted. The veranda and some rooms showed signs of leakage, while health personnel and patients were seen struggling in decayed and cramped conditions.
Government efforts
When contacted, Bashir Ahmad, the Health Director for Gusau Local Government, confirmed awareness of the Primary Health Center’s condition but directed further inquiries to the Primary Healthcare Board.
At the Zamfara State Primary Healthcare Development Agency, the Director of Planning declined to comment and recommended reaching out to the Executive Secretary, who was unavailable at the time of the visit, for more information.
According to a Premium Times report, Zamfara is Nigeria’s worst-performing state in Primary Healthcare delivery services. The report showed that Zamfara and other 17 states in Nigeria are weak in health services delivery, most essential in public facilities.
In response to the challenges bedevilling the health sector in the state, on January 30, 2024, the Zamfara state government declared a state of emergency on the health sector but still several hospitals and PHCs across the state are facing serious infrastructural crises and lack of staffing among others.
However, despite the declaration of a state of emergency in the health sector by the present administration in the state, a report indicated that the government has decreased the budgetary allocation for the health sector from 9% in 2023 to 7% in the 2024 proposed budget. A situation condemned by CSOs in the state.
Health expert’s weight
Gadanga Bala, Director of the Health Services Department at Saisa University of Medical Sciences and Technology, Sokoto, stated that primary health care (PHC) centers are designed to provide treatment and healthcare services at the grassroots level.
He warned that “if immediate action is not taken on such neglected health centers, there is a possibility of outbreaks of communicable and non-communicable diseases such as cholera, meningitis, measles, malaria, dengue fever, typhoid fever, and all immunization-preventable diseases.”
He further noted that this neglect could pose serious health risks to the community, leading to increased cases of maternal and infant mortality due to the absence of antenatal care, hospital deliveries, postnatal care, family planning activities, and immunizations.
Additionally, the lack of disease surveillance would result in high state health indices.
Established in 1983 during Shagari’s presidency, the Damɓa Primary Health Care Center is now one of the most dilapidated and neglected facilities in rural Nigeria, despite being just 4-5 kilometers from Gusau, the capital city of Zamfara. state.
This story was produced with support from the Centre for Journalism Innovation and Development (CJID)
