How Erratic Power Remains Major Obstacle To World Bank-Backed PHC Upgrades

The revitalisation of Primary Healthcare Centres (PHCs) under the World Bank-supported IMPACT project has improved access to healthcare and restored confidence in many communities across Kaduna State. But despite these gains, poor power supply and emergency response challenges continue to hinder service delivery. In this report, BABAJI USMAN BABAJI examines the impact of the intervention at Ikara Primary Healthcare Centre and the obstacles that remain.

Despite ongoing efforts to strengthen primary healthcare delivery in Kaduna State, inadequate infrastructure and unreliable electricity supply continue to undermine service provision in many rural communities. For years, residents in several local government areas have struggled with limited access to quality healthcare due to poorly equipped facilities, erratic power supply, and shortages of essential services, forcing many patients to seek treatment in distant towns or private clinics.

To address these challenges, the Kaduna State Government, with support from the World Bank-funded IMPACT project, embarked on the revitalisation of selected Primary Healthcare Centres (PHCs) across the state. The intervention focused on upgrading infrastructure, improving access to essential medical equipment, expanding service delivery, and creating a more conducive environment for both healthcare workers and patients. The initiative has contributed to increased utilisation of healthcare services and renewed public confidence in several facilities.

However, while the revitalisation programme has recorded notable successes, persistent electricity challenges continue to threaten its sustainability. In many facilities, unstable power supply affects the storage of vaccines, operation of medical equipment, lighting during night-time emergencies, and the overall quality of care.

Healthcare workers in the state told LEADERSHIP Weekend that without reliable electricity, gains recorded through infrastructure upgrades may not fully translate into improved health outcomes, particularly during emergencies when timely response can mean the difference between life and death.

For many patients, the upgraded facility represents a significant improvement from the past. However, some residents say recurring power outages continue to pose challenges, particularly during emergencies and night-time visits. They expressed concern that without a reliable electricity supply, the facility may struggle to deliver services effectively despite the investments made in infrastructure and equipment.

When our correspondent who visited the facility, Mrs Hajara Amadu arrived at the Ikara Primary Healthcare Centre (PHC) in Kaduna State with her eight-month-old daughter strapped to her back told LEADERSHIP Weekend that a few years ago, she would have had to travel several kilometres to access medical care because the facility lacked the capacity to provide adequate services.

Today, however, she is among many residents benefiting from improvements brought about by the revitalisation of the centre under the World Bank-supported IMPACT project.

Like several residents of rural communities, her confidence in public PHC facilities was slim. Her reason was that they were only dilapidated buildings with a shortage of health workers and inadequate medical equipment. “Today, within minutes of arriving at the facility, my baby was attended to by healthcare workers. Medicines are available. The wards are functional. So the difference is clear,” she said.

Corroborating her, Nafisa Abdullahi, another patient admitted at the facility, said there are several visible changes in the centre compared to its previous condition.

The Kaduna State Government is implementing the ongoing PHC revitalisation programme under the World Bank-supported Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services (IMPACT) project, aimed at improving healthcare delivery. The facility also receives drugs from the Kaduna State Contributory Health Management Authority (KADCHMA).

Yet, the question of whether the intervention has truly transformed healthcare delivery at the grassroots level still remains. For health experts like Dr Isa Bala Ahmad, the Health secretary at Ikara PHC, these facilities are meant to serve as the first point of contact for millions of citizens seeking medical care.

He said that for decades, many rural centres have struggled with neglect, broken infrastructure, staff shortages, inadequate equipment, and poor maintenance, which pushed many residents to bypass local health centres.

Dr Bala, who is also one of the professionals familiar with the revitalisation project, said Ikara PHC was not immune to these challenges. “Before now, some centres were almost collapsing. Some were in very poor condition, and we were even afraid to admit patients,” he recalled.

For health experts, it is often difficult to provide quality care in facilities that lack basic infrastructure, and patients often notice these deficiencies. As confidence declines, attendance drops, and many residents seek alternatives elsewhere.

Beneficiaries and health workers like Dr Bala believe the revitalisation programme has reversed that trend. “Since the facilities were renovated, they have come back to life,” he said.

According to the officer-in-Charge of the facility, Dr Rufai Garba, attendance has increased to over 100 per cent as confidence in the facility continues to grow. He said new buildings now stand alongside renovated structures, while medical equipment has also been provided for improved service delivery.

One of the significant changes at Ikara PHC was its elevation to a Centre of Excellence. The facility, popularly known by residents as Malam Sambo Hospital, has become a referral hub serving multiple communities across Ikara local government arrea.

Dr Garba said the centre now receives referrals from nine other primary healthcare centres and 45 smaller health facilities across the local government.

Cases that once required immediate referral to higher-level hospitals can now be managed within the facility. “Previously, even minor emergencies had to be referred because we lacked equipment and personnel. Today, we have two medical doctors, modern equipment, and trained staff capable of handling complicated deliveries and emergencies,” Garba explained.

He said the development has significantly reduced delays in residents’ access to care. Instead of travelling long distances to general hospitals, many patients can now receive treatment closer to home.

Dr Garba added that the facility currently serves more than 54,000 residents directly, while also attending to patients from neighbouring communities and even parts of Kano State.

The impact of the revitalisation programme is expected to be most visible in maternal and child healthcare. Nigeria continues to grapple with some of the highest rates of maternal and infant mortality, with rural communities bearing a disproportionate share of the burden.

Recent health estimates place Nigeria’s maternal mortality ratio at 1,047 deaths per 100,000 live births and the infant mortality rate at about 55 deaths per 1,000 live births.

At Ikara PHC, healthcare workers say the situation has improved considerably. One of the notable additions is specialised equipment for newborn care, including devices capable of supporting premature babies born before full term.

The officer-in-Charge of the centre, Dr Garba, recalled that in the past, babies born prematurely often required urgent referral to distant hospitals. He noted that such referrals frequently involved delays that could prove fatal. He added that the centre now has modern equipment and trained personnel capable of supporting newborns requiring specialised care.

Experts and analysts argue that infrastructure alone does not save lives, stressing that doctors, nurses, midwives and community health workers remain the backbone of any healthcare system.

Recognising this, the Kaduna State Government said it has invested heavily in workforce expansion under the revitalisation programme. At Ikara PHC, staffing levels have improved considerably compared to previous years, Dr Garba said. He noted that the facility now has two medical doctors and a strengthened workforce, with visible impact extending beyond numbers.

The health worker added that improved working conditions and availability of equipment have boosted staff morale and productivity. “Before, some staff came late because there was little motivation. Now they know they can work efficiently because the necessary equipment is available,” he said.

Dr Garba disclosed that the facility operates with a relatively modest solar system despite serving a large population and functioning as a referral centre. He stressed that as more equipment is added and patient numbers increase, energy demand continues to rise. The facility is therefore seeking an upgrade to ensure uninterrupted service delivery.

For patients, the improvement may seem simple, but for health sector experts, it reflects the reality that investments in healthcare infrastructure often succeed only when matched with investments in human resources.

Despite the gains, a closer look at the facility by LEADERSHIP Weekend reveals issues that still require attention. While there is solar-powered electricity, staff say the current capacity may no longer be sufficient for its expanding responsibilities as a Centre of Excellence.

Healthcare workers also raised concerns about emergency transportation. Although the centre currently has one functional ambulance, they say it is inadequate for a referral facility serving such a wide catchment area. Dr Garba noted that there are times when the ambulance is already deployed on referral duties while another emergency arises elsewhere.

Similarly, Dr Isa Bala Ahmad, the Health secretary for the council, identified additional gaps still affecting the full success of the project. He said the intervention should be extended to smaller rural facilities that remain dilapidated, to improve grassroots healthcare delivery and ease pressure on upgraded centres.

The IMPACT Project has upgraded hundreds of facilities, expanded workforce capacity and improved access to healthcare services for thousands of residents. At Ikara PHC, the gains are visible in renovated buildings, increased patient attendance and improved maternal healthcare services.

Yet health officials stress that the true measure of success lies in whether these facilities remain functional and able to meet the needs of the communities they serve.

For beneficiaries like Hajara Amadu and others, the transformation is already making a difference. But sustaining that confidence will depend on maintaining these gains. As experts argue, in healthcare, success is not only about what has been delivered, but whether it continues to deliver when patients need it most.

In conclusion, the improvements at Ikara PHC reflect clear progress in strengthening primary healthcare delivery under the IMPACT project, with better infrastructure, equipment and expanded services bringing care closer to the people.

However, LEADERSHIP Weekend writes that sustaining these gains will require continued investment in reliable power supply, emergency response systems and rural facilities to ensure that no community is left behind. If these gaps are addressed, the transformation seen in Ikara could serve as a model for improving healthcare outcomes across Kaduna State and beyond.