Primary Healthcare Centres (PHCs) are intended to be the first and most accessible point of care for Nigerian families, providing essential services that strengthen community health. In Buruku Local Government Area (LGA) of Benue State, however, many PHCs fall short of this purpose. Rather than functioning as the backbone of the local health system, these facilities are under-resourced, poorly equipped, and structurally ill-prepared to meet basic healthcare needs—particularly for persons with disabilities.
Facility-level data from the CheckMyPHC platform, developed by Orodata Science and corroborated with records from the National Primary Health Care Development Agency (NPHCDA), reveal critical deficiencies across Buruku’s PHCs. These gaps include limited access to electricity and water, the absence of functional delivery rooms, shortages of skilled birth attendants, inadequate sanitation facilities, and insufficient basic medical equipment. Beyond these systemic failures lies a deeper concern: the unintentional but persistent exclusion of persons with disabilities. Together, these shortcomings create invisible yet powerful barriers that limit access to routine care, antenatal services, immunisation, and emergency treatment for people with mobility, visual, or hearing impairments.
Utilities That Undermine Care Delivery
Across Buruku LGA, many PHCs lack the basic utilities required for safe and reliable healthcare delivery. Data from CheckMyPHC show that only a few facilities—such as Adi, Mbagen, Apesough, Ako, PHC Anvambe, and Agwabi—have access to electricity through the national grid or solar power. Others, including Uga PHC, rely on generators, while Adingi PHC has no power source at all.
NPHCDA data further confirm that Adingi PHC depends on rechargeable lanterns, a situation that severely compromises service delivery, particularly during emergencies. Water supply is similarly inadequate. While some facilities rely on streams or underground wells, only a few—such as Mbagen and Apesough—have functional boreholes. These conditions undermine infection control, compromise hygiene, and weaken the safety of both patients and healthcare workers.
Such utility gaps do more than inconvenience staff. They disrupt safe childbirth, compromise vaccine storage, and leave both routine and emergency care vulnerable to failure.
Staffing and Equipment Gaps at the Core of PHC Services
Beyond electricity and water, Buruku’s PHCs face deeper functional challenges that strike at the heart of primary healthcare delivery. NPHCDA data indicate that although some facilities have designated delivery rooms, many are poorly equipped and barely functional.
More troubling is the complete absence of Skilled Birth Attendants (SBAs) across the reviewed PHCs. Pregnant women are left vulnerable, especially during labour complications that require immediate, skilled intervention. Instead, facilities rely heavily on Community Health Extension Workers (CHEWs), a small number of nurses, and in Mbagen PHC, a single doctor—an inadequate workforce for the population they serve.
Equipment shortages further compound these risks. Essential items such as delivery beds, sterilisation tools, blood pressure monitors, cold-chain equipment, oxygen cylinders, and emergency supplies are either insufficient or entirely absent. These gaps disrupt antenatal and postnatal care, weaken immunisation services, and limit emergency response capacity. With no ambulance services available, patients are routinely referred to distant general hospitals, bearing transportation costs themselves. The cumulative effect is increased preventable deaths, eroded trust in PHCs, and a widening gap between rural households and essential healthcare services.
Invisible Barriers to Disability Inclusion
While infrastructural and staffing deficits affect all patients, persons with disabilities face additional, often invisible obstacles. Although CheckMyPHC and NPHCDA datasets do not explicitly measure accessibility features, observations of terrain, facility design, staffing patterns, and service delivery reveal persistent barriers for people with mobility, visual, or hearing impairments.
Many PHCs are physically inaccessible even before patients reach the consultation rooms. Surrounding terrains are often uneven, grassy, cobbled, or unpaved, with little or no stabilised walkways. For wheelchair users or individuals using mobility aids, these conditions transform a simple clinic visit into a physical challenge.
Even where ramps exist, design flaws limit their usefulness. At Uga PHC, for example, the sitting area directly obstructs ramp access, making wheelchair navigation difficult. At PHC Anvambe, only one building has a ramp, despite the facility consisting of multiple structures. These seemingly minor design oversights effectively exclude persons with disabilities from full and dignified access to care.
Communication Barriers for the Visually and Hearing Impaired
Accessibility challenges extend beyond physical structures. All reviewed PHCs lack clear signage, visual markers, adequate lighting, or guiding cues, making navigation difficult for people with visual impairments. Similarly, persons with hearing impairments receive little to no communication support, as none of the facilities provide sign language interpreters, visual communication aids, or staff trained in alternative communication methods.
These local realities mirror national trends identified in the World Bank’s “Disability Inclusion in Nigeria: A Rapid Assessment” (2018), which highlights inaccessible environments, limited disability-focused training for health workers, and poor access to information as major systemic barriers. Persistent negative attitudes, weak institutional frameworks, and underfunded inclusive policies further shape exclusion at the PHC level.
Staffing Shortages and Service Inconsistency
Beyond infrastructure, staffing levels and service reliability play a crucial role in healthcare accessibility. While staff shortages affect all patients, their consequences are especially severe for persons with disabilities who may require assistance, predictable service schedules, or continuity of care. Emergencies further expose these weaknesses, as understaffed facilities struggle to respond promptly, leading to referrals that demand additional travel, time, and financial resources.
In effect, access to healthcare in Buruku depends not only on proximity to a PHC but also on a patient’s physical ability, financial capacity, and resilience in navigating an inconsistent system.
From Operational Gaps to Equity Failures
The conditions in Buruku’s PHCs reveal more than operational shortcomings—they expose systemic equity failures. Inadequate infrastructure, insufficient staffing, and inaccessible facility design undermine maternal and child health outcomes while systematically excluding persons with disabilities from services intended for entire communities.
These realities contradict Nigeria’s commitments under Sustainable Development Goal 3, which prioritises equitable access to quality healthcare for all. Addressing them will require targeted funding, inclusive facility design, adequate staffing, routine maintenance, and stronger accountability mechanisms at both local and state levels.
Strengthening primary healthcare in Buruku—and across Benue State—means recognising that PHCs must be not only functional, but truly accessible to everyone who depends on them.
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