Challenges Faced by Katsina Primary Health Centres: Staffing and Power Issues Lead to Service Gaps

As night falls over Dansarai village in the Malumfashi Local Government Area of Katsina State, the activity within the local primary health centre diminishes significantly. Inside the women's ward, two patients rest on metal beds while their relatives wait for the night shift procedures to conclude. As darkness sets in, it is customary for most non-urgent cases to head home until the following day.

The Dansarai primary healthcare centre, along with its counterpart in Dayi, is officially tasked with offering around-the-clock basic health services for the rural populace. However, field observations reveal significant discrepancies between established protocols and the realities of nighttime healthcare delivery.

While the Dayi PHC manages a limited overnight service bolstered by on-site security and minimal staffing, Dansarai’s services predominantly occur during the day, driven by reported staff shortages and issues with water and electricity supply, according to both patients and health workers. State officials have indicated that corrective steps are being formulated to resolve these deficiencies.

Facility personnel noted that these two health centres cater to numerous adjacent rural communities, making it essential to have reliable after-hours service for urgent maternal and child health scenarios.

When a reporter visited the Dansarai PHC around 2:30 p.m. on February 13, the compound appeared orderly, with freshly painted buildings. Within the female ward, two admitted patients were accompanied by their family members, while the male ward also housed two patients. Around five volunteer health workers, led by Hafiz Haruna, were present.

Health staff underscored the reliance on volunteers for consistent service delivery. Haruna, a volunteer since 2016, detailed that the facility typically operates from the morning until early evening, closing officially between 4 p.m. and 5 p.m. He mentioned that extended hours could occur until 8 p.m. but rarely beyond that point due to staffing constraints.

A patient, Rabiatu Abdulrasheed, shared that she usually heads home following her treatment and returns the next day for further assistance. "We return home," she disclosed.

The water situation at the facility remains rudimentary, as noted during the visit. It primarily relies on a manually operated well on-site, with staff and management confirming the absence of a piped water system, placing additional strain on regular operations.

Electricity supply is another critical issue for the facility. Officials stated that Dansarai PHC is not connected to the national grid and lacks a comprehensive solar power system. A small generator is utilized primarily for laboratory services, compelling the facility to function largely during daytime hours due to insufficient electricity at night.

According to staffing data reviewed, the facility is operated by a limited number of permanent staff, while casual workers and volunteers make up a substantial portion of the workforce. Health workers indicated that the centre's sustainability is heavily dependent on these volunteer efforts.

A visit to the Dayi Primary Health Centre painted a more complex picture. Arriving at approximately 5:30 p.m. on February 13, it was noticeable that some health workers remained present along with security personnel in converted staff quarters.

Mani Ahmad, the officer in charge, stated that the facility is designed for almost 24-hour service, although maternity services become less frequent at night unless there are patients in active labour. Patients in other wards are typically monitored through the night, and cases exceeding the centre's capabilities are redirected to higher-tier hospitals.

Health workers credited the availability of local security personnel for encouraging staff retention during overnight hours, although security issues in the nearby rural regions continue to affect overall staff confidence.

Officials have acknowledged ongoing challenges related to infrastructure. Ahmad revealed that the facility has been grappling with water supply challenges for over ten years, currently relying on daily deliveries from vendors, and solar lighting is insufficient, with parts of the hospital remaining poorly illuminated at night.

In communication with PREMIUM TIMES, the Katsina State Primary Health Care Board conceded that some rural establishments face persistent infrastructure shortcomings and outlined efforts to address them. The Executive Secretary, Shamsuddeen Yahaya, noted that the Dayi PHC has encountered ongoing water scarcity, despite the existence of a borehole and an overhead tank, as the necessary piping systems have deteriorated. Conversely, the Dansarai facility is without an on-site water source due to a malfunctioning borehole.

The board clarified that Dayi is connected to the national grid and supplemented by a solar system and generators, albeit these do not power the entirety of the facility. Dansarai lacks grid connection altogether, primarily relying on a small generator focused on laboratory operations.

Further images confirm that essential infrastructure improvements are needed at both healthcare centres. Staff affirmed that additional health workers, as appointed by the state, are slated to be deployed in Malumfashi Local Government Area, with assurances for next-level enhancements to more health facilities soon.

As per Nigeria's primary healthcare standards, facilities designated for 24-hour care are expected to maintain skilled staffing continuously, especially for emergency services and maternal health. Experts express concern that inconsistent night-time services expose rural populations, particularly pregnant women and children, to harmful delays in treatment and essential referrals.

For many community members, the effects of these service gaps translate into significant distances, time, and costs. Patients and caregivers relayed to PREMIUM TIMES that evening referrals or repeat visits during the day frequently incur additional transport expenses, especially affecting families from surrounding areas.

At Dansarai PHC, health workers recognized the operational challenges but asserted the centre continues to function within its available resources. For individuals in more remote settlements, the journey to healthcare facilities means that nighttime decisions are often made in observation of transportation availability alongside security concerns and clinical urgency.

The Katsina State Government emphasizes that staff recruitment and facility upgrades will enhance primary healthcare delivery. However, visits to both Dayi and Dansarai indicate that, despite some progress, notable disparities in infrastructure, staffing distribution, and nighttime service availability persist. Efforts to upgrade at least one health centre per ward are underway, with promises of ongoing investments necessary in staffing, water supply, and dependable energy to facilitate effective, round-the-clock services in rural jurisdictions.

Ultimately, a reliable shift in the healthcare delivery in Katsina's rural areas hinges on addressing the discrepancies between policy promises and the realities on the ground. Ensuring consistent night security, availability of staff, water, and lighting are vital to providing adequate care when patients arrive after dark.