INVESTIGATION: How Kwara Residents Struggle Against Health Challenges Amidst Shortage Of Healthcare Facilities

In this report, Buhari Ahmed writes on the dire state of healthcare facilities in Kwara State, focusing on communities in Asa Local Government Area. Despite government claims of improvements in the healthcare sector, residents face life-threatening challenges due to dilapidated and under-resourced healthcare centers.

Sa’adu Jimoh- Picture by Buhari Olanrewaju Ahmed

It was a cloudy morning with a light drizzle when this reporter arrived at the house of Sa’adu Jimoh, in Odo-Ode, Asa Local Government Area (LGA) of Kwara State. His home was filled with mourners who gathered to console him after the recent passing of his grandson on June 3, 2024.

Jimoh recounted the heartbreaking morning.

“It was around 5 a.m. when I woke up to check on my grandson for the morning prayer (Salat). I touched him, but he didn’t respond. I called his name, and shockingly, he cried out in fear.”

Jimoh said panic surged through him as he noticed his grandson’s leg was cold.

“It wasn’t right. Everything else felt normal, but his leg…it was so cold,” he recounted, his voice trembling.

Odo-Ode health facility- Picture by Buhari Olanrewaju Ahmed

“I knew I needed help immediately, so I ran out of the house to get some help. While rushing to find a bike to take him to a hospital in another community called Afon, his voice choked slightly, and he died on the spot. If the healthcare facility in our community was functional, he might still be alive today. The time it took me to find a bike could have been spent rushing him to the hospital for first aid, and he might have survived,” he said.

His grandson’s death, which Jimoh believes could have been prevented, exemplifies the harsh realities of limited healthcare faced by residents of Kwara State, especially those in rural areas.

Significant healthcare allocations in Kwara State unmatched by expenditure

While Kwara State has invested significantly in healthcare infrastructure in recent years, but many communities, particularly in Asa LGA, continue to struggle with inadequate healthcare services. Areas like Odo-Ode, Igboroko-Afon, Sapati-Oko, and Sholu have primary healthcare centres (PHCs) that are in poor condition and provide minimal services.

According to the state’s budget performance report, a total of N44.269 billion was allocated for capital expenditure in the health sector between 2023 and 2024. However, the execution has been inconsistent. While N18.875 billion was budgeted for 2023, only N9.4 billion was spent. In 2024, out of the N25.39 billion allocated, only N4.6 billion has been used in the first quarter.

Odo-Ode health facility- Picture by Buhari Olanrewaju Ahmed

Despite these substantial investments, the reality on ground tells a different story. Challenges in the sector remain stubbornly persistent, especially in rural and hard-to-reach areas.

Asa residents’ despair over failing medical services

Several accounts from residents emphasize the severe challenges faced by pregnant women in accessing essential prenatal care. This situation has heightened health risks for both mothers and infants.

Community leaders expressed deep concern over the deteriorating state of healthcare in the area, urging the government to address the underlying issues, including increased funding, improved management practices, and enhanced oversight.

Odo-Ode Health dilapidated facility- Picture by Buhari Olanrewaju Ahmed

According to Jimoh, the neglected Odo-Ode health facility also caters for 18 communities.

“The healthcare centre has been abandoned for a long time, and the government has refused to renovate it, equip it, or employ more staff. The community is unable to renovate it; many of us are struggling to make ends meet. Where do they expect us to go if we experience any health challenges?”

Another resident, Balikis Issa, who witnessed Jimoh grandson’s death, narrated in an interview how the absence of a functional primary healthcare centre in Odo-Ode affects women, children and elderly.

Balikis Issa- Picture by Buhari Olanrewaju Ahmed

“People really want to use healthcare services to access treatment for various ailments rather than relying on local treatment methods. But the government has abandoned the building structure, which has become dilapidated,” she said.

“How can we get good treatment when the building is falling apart and there are no staff? People who don’t have money for transportation to Afon have to trek far to receive treatment. Tell me, how can someone who needs healing trek for miles to get treated, then trek back home? They would be back to square one due to the stress they endured. However, if our hospital was functioning, the process would be seamless.”

During a recent visit to the facility in June by SOLACEBASE the healthcare facility was found in a state of disrepair. The once-functional building now stood deserted, with goats wandering freely and using the structure for shelter.

Odo-Ode Health dilapidated facility- Picture by Buhari Olanrewaju Ahmed

Wahab Raimi, a resident of Odo-Ode, expressed the community’s dire need for healthcare services. He noted that Odo-Ode is a big community but its major challenge is the lack of accessible healthcare. Many pregnant women and children struggle to receive medical care due to the abandoned state of the health facility in the area.

“Getting a vehicle to take a pregnant woman or a sick person to Afon for treatment is a big problem, especially with our unmotorable roads,” Raimi said. “If we had a functioning healthcare centre here, it would make a significant difference.”

Igboroko-Afon cottage hospital, now a symbol of neglect

Igboroko-Afon Cottage Hospital- Picture by Buhari Olanrewaju Ahmed

The Igboroko-Afon Cottage Hospital, also in Asa LGA, was once a beacon of hope for surrounding communities but now it is barely functional. During a visit to the health facility, its deteriorated state was evident with broken windows, crumbling walls, and outdated medical equipment gathering dust.

Although the hospital has extensive facilities, including over 15 rooms and a staff quarters, large sections of the building require a complete overhaul or reconstruction. Despite having operational rooms for surgeries, the hospital’s capacity for patient care lies dormant due to decaying beds and equipment.

The village head of Igboroko-Afon, AbdulWahab Ahmad- Picture by Buhari Olanrewaju Ahmed

According to the village head of Igboroko-Afon, AbdulWahab Ahmad, the story of the cottage hospital is one of squandered potential. He said the hospital was built decades ago with facilities that can rival private hospitals where residents are now forced to patronize due to government neglect.

“There is only one doctor in the entire building who has been helping the community to the best of his abilities. Many pregnant women and women in labor are referred to private hospitals due to lack of equipment to cater for them.  There is also an obvious problem of shortage of qualified manpower.”

Igboroko-Afon Cottage Hospital- Picture by Buhari Olanrewaju Ahmed

This lack of resources has dire consequences. Residents face significant challenges accessing proper medical care. Patients often require transport to distant city hospitals, and tragically, some succumb to their ailments during these long journeys.

Ahmad, however, applauded the dedication of the only doctor at the facility adding that he is dedicated and committed to the health care of residents.

Igboroko-Afon Cottage Hospital- Picture by Buhari Olanrewaju Ahmed

“Unlike others who left due to the lack of basic amenities like good roads and electricity, this doctor has remained, tirelessly serving the community.”

Pregnant women, elderly affected by poor healthcare

Fatimah Saheed- Picture by Buhari Olanrewaju Ahmed

Fatimah Saheed, a resident of Igboroko-Afon, expressed her dismay over the lack of medical care services, explaining how patients, especially pregnant women, lose their pregnancies due to the dilapidated state of the community hospital.

“The government often focuses on urban areas while neglecting hard-to-reach communities like ours. Getting a vehicle to take a pregnant woman or a sick person to Afon for treatment is a big problem. Sometimes, patients don’t make it to the hospital because of the distance and bad roads,” she said.

Igboroko-Afon Cottage Hospital- Picture by Buhari Olanrewaju Ahmed

“Our hospital is nothing to write home about. We would appreciate it if the government could send a representative to assess the hospital.”

Similarly, Sapati community in Asa LGA also suffers from severe healthcare challenges. The road leading to the community is in poor condition, and the absence of vehicles or motorcycles worsens the difficulty of transporting patients, even in emergencies.

Sapati Community Healthcare Centre- Picture by Buhari Olanrewaju Ahmed

When this reporter visited, the hospital was locked, with no medical staff available. Residents noted that critically ill patients struggle to reach the nearest hospital due to the shortage of medical personnel.

Muritala Gbadamosi, a community leader, revealed that the hospital was built by the community after state government approval, yet it remains neglected and under-resourced.

Muritala Gbadamosi- Picture by Buhari Olanrewaju Ahmed

“Life has been very difficult for pregnant women. They walk several miles for antenatal care, and sometimes end up giving birth at home due to the absence of medical personnel,” several community sources affirmed.

In Sholu community, also in Asa, the situation is similar. The community lacks both medical personnel and consistent access to healthcare, leading to preventable deaths and worsening health conditions.

Sholu Community Healthcare Centre- Picture by Buhari Olanrewaju Ahmed

Wosilat Muibi, an elderly woman in Sholu, described the dire circumstances caused by the shortage and inconsistency of medical staff.

Wosilat Muibi- Picture by Buhari Olanrewaju Ahmed

“Most of the time, when we get sick, particularly those that are pregnant, we go to the hospital for treatment but we always find the place locked. As a result, our children often use their motorcycles to take us to Afon Hospital. Many patients are frequently disappointed due to the poor medical service delivery in the community.

“Despite our limited resources, the community pooled money together to renovate the hospital. But we need more support from the government to ensure consistent medical care,” she said.

Abdulrahman Jimoh, a sexagenarian partially affected by a stroke, emphasized the urgent need for qualified medical personnel in the community. He thanked the government for building a hospital but questioned its value without access to medical services.

Abdulrahman Jimoh- Picture by Buhari Olanrewaju Ahmed

“Most of the time, patients wait for a doctor, but no one is available. Often, when we call, they don’t answer. Just yesterday, some people brought a patient, but the hospital was locked,” he said.

He explained that the medical personnel are rarely available. He added that whenever they do come, they leave before 2 pm and often work only three days a week. “What happens to those who fall sick during the night or a pregnant woman who needs to deliver without encountering problems?” he asked.

He urged the state government to prioritize medical services for communities, especially those that are hard-to-reach.

“It is more than neglect” – CSOs react

Picture by Buhari Olanrewaju Ahmed

Experts point to a web of problems beyond neglect. Chronic underfunding, severe staff shortages, and poor infrastructure like impassable roads all contribute to the crisis.

Olasupo Abideen, head of the Global Brain Builders Youth Development Initiative (BBYDI), highlights the lack of basic facilities in Kwara’s primary healthcare centres. He said that even with existing assessments, the government needs a fairer approach to resource allocation.

Picture by Buhari Olanrewaju Ahmed

Abideen emphasized that it is crucial for the state government to focus on the democratization of resources. “For instance, if an assessment shows that around 500 PHCs in Kwara State need support, the government must prioritize some of the PHCs that have never felt its presence or benefitted from any initiative in the past,” he said.

Abdulrasak Olayemi is the Deputy Coordinator, Elites Network for Sustainable Development (ENetSuD), a Kwara-based Civil Society Organization. Olayemi said that many communities in the state, especially in Asa LGA, are in dire condition due to poor access to medical services.

Picture by Buhari Olanrewaju Ahmed

“Residents of many communities facing these challenges need to know their rights and responsibilities. If they have evidence that funds allocated to maintain or renovate a healthcare centre in their community have been embezzled, they have the right to write a petition to challenge the person in charge,” Olayemi added.

He stressed that the government must be diligent in fulfilling its promises and delivering on basic healthcare needs.

Mallam Abubakar Usman, a health worker who has worked at Igboroko-Afon Cottage Hospital in Asa Local Government, Kwara State, for a decade, lamented the shortage of staff, dilapidated buildings, and lack of equipment in the area.

Picture by Buhari Olanrewaju Ahmed

He said most doctors transferred to the community leave because the community lacks social amenities. Most of the medical staff seek transfers to better places.

“Things are not easy here at all. I am the only staff member left here in Igboroko-Afon, and the workload is overwhelming. Sometimes, I have to refer patients to private or general hospitals. We are facing numerous challenges, including staff shortages and a lack of equipment to examine patients’ conditions.

“We cannot admit a patient here because the structure is dilapidated, as you can see. So, I always advise pregnant women to prepare ahead if they notice that the time for delivery is near. They should quickly go to a private hospital or to the state capital because we don’t have the facilities and equipment to deliver their baby.”

Picture by Buhari Olanrewaju Ahmed

He called on the state government to look into the situation and intervene, adding that many women experience complications after giving birth at home, while many others have lost their loved ones because they lack access to healthcare services within their community.

Mr Lawal AbdulGaniyu, a health expert, said public health challenges have contributed to the persistent and high levels of poverty and the weakness of the health system in the state.

AbdulGaniyu explained that households and individuals in Nigeria are burdened by a dysfunctional and inequitable health system, and often have to delay or forgo seeking medical care due to unaffordable out-of-pocket expenses.

Picture by Buhari Olanrewaju Ahmed

He stated that political candidates frequently promise free healthcare services during campaigns, but these pledges often fail to address the health needs of the most vulnerable populations.

Mr. AbdulGaniyu said that the quality of healthcare services delivered is poor and remains a source of concern. Many primary healthcare facilities, which are meant to serve the needs of the poor and rural communities, are in a deteriorated state due to inadequate budgetary allocation. He added that Nigeria has not yet adopted innovative methods to shield the poor and vulnerable populations from the financial risks associated with ill health.

Kwara Health Agency Silent

Efforts to reach Dr. Nusirat Elelu, Executive Secretary of Kwara’s Primary Healthcare Development Agency (KWSPHCDA), were met with silence. Despite numerous phone calls, text messages, and even an in-person visit to her office, Dr. Elelu was unreachable. Her Chief Press Secretary (CPS) attributed her unavailability to prior commitments.

 Freedom Of Information Request 

To this end, this newspaper submitted a Freedom of Information (FOI) request to KWSPHCDA on July 21, 2024 seeking detailed insights into healthcare expenditures and the challenges faced in implementation across the state. Specifically, the FOI sought clarification on the total amount spent on healthcare in the first quarter of 2024 and the number of Primary Healthcare Centres (PHCs) that had benefited from state health interventions, including those receiving direct funds from the World Bank.

The Agency responded through Dr. M.S. Oguntoye, the Immunization Plus and Malaria Progress by Accelerating Coverage and Transforming Services (IMPACT) Project Manager, who clarified that under the first phase of the Multiphase Approach (MPA) of the IMPACT project, Kwara State had received N887,800,000.00. He said the funds were allocated to 193 Basic Healthcare Provision Fund-supported facilities, with each receiving N4,600,000 as an investment fund.

Freedom Of Information Request

The IMPACT project is a World Bank-supported initiative aimed at strengthening primary healthcare and reducing under-5 mortality rates through a Multiphase Programmatic Approach (MPA). The project’s initial phase focuses on improving immunization and malaria control efforts.

Dr. Oguntoye explained that the funds were intended to elevate the standards of these PHCs, covering minor repairs, renovations, procurement of medical equipment, potable water supply, and the provision of essential data tools. These upgrades were guided by the specific needs identified by each facility and approved by the National Primary Health Care Development Agency and the World Bank.

Dr. Oguntoye further clarified that the funds were not allocated for staff recruitment. Instead, they were disbursed directly into accounts jointly managed by the Officer in Charge (OIC) and members of the Ward Development Committee (WDC) of each facility’s respective ward. He added that Kwara State Primary Health Care Development Agency oversees the proper utilization of these funds according to the pre-approved investment plans.

He said the IMPACT Project’s audit team conducts regular audits to ensure financial compliance across the 193 PHCs. While many facilities have utilized the funds for purchasing medical and outreach equipment, renovations have been delayed pending the finalization of the Environmental and Social Safeguard guidelines by the World Bank. As a result, funds earmarked for renovation remain in the health facilities’ bank accounts.

On the question of the overall healthcare expenditure for the first quarter of 2024, Dr Oguntoye noted that the state health ministry would be better positioned to provide accurate figures from the N25.54 bn earmarked for the health sector.

“As contained in the background above funds for renovation are still seated with the health facilities as they do not have clearance to embark on renovation. However, this hopefully will commence in the next few months upon approval by the World Bank.”

Attempts to seek further clarification from the Health Commissioner, Dr. Aminat Al-Imam, were unsuccessful. Despite her official vehicle and orderly being seen at the office, officials claimed she was unavailable.

This report publication is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the collaborative Media Engagement for Development, Inclusion, and Accountability Project (CMEDIA) funded by the MacArthur Foundation.