By Adamu Lawal Toro
A health system is only as strong as its weakest link. For years in Kaduna State, that link was the place most people go first when they fall ill: the primary health care centre.
When the administration took office in 2023, most of the state’s primary health care centres were dilapidated. Equipment did not work. Staff were too few and poorly motivated. In many communities, a clinic existed in name only.
That mattered more than it might seem. Primary health care centres are meant to be the backbone of any health system, designed to handle about 80 per cent of the population’s needs. General hospitals are expected to take about 12 per cent and teaching hospitals the remaining 8 per cent. When the base of that pyramid collapses, everything above it buckles. Patients with malaria, pneumonia or diarrhoea, the three most common illnesses seen at Kaduna’s PHCs, end up in crowded general hospitals or travel long distances for care that should have been available down the road.
Three years on, Kaduna is attempting something many states only talk about: fixing the whole system at once, from the village clinic to the specialist hospital.
Start at the base. According to Prof. Bello Jamoh, commissioner for health Kaduna State,255 primary health care centres have been revitalised and upgraded to Level 2 status. In each of the state’s 23 local government areas, one PHC has been developed into a Centre of Excellence, and each of these centres has received standard and tricycle ambulances. The tricycle ambulance may look modest, but on rural roads it can mean the difference between a mother reaching help in time and not reaching it at all.
Then the middle tier. Fourteen general hospitals across the state have been renovated and re-equipped. These receive the patients the PHCs cannot manage, and their decay had long frustrated doctors and patients alike.
At the top sits the new 320-bed Bola Ahmed Tinubu Specialist Hospital, now completed and commissioned. It is designed to manage complex medical conditions and to serve as a major referral centre. For many Kaduna residents, that could mean treatment at home instead of an expensive trip to Abuja or abroad.
That is what makes the approach holistic. A specialist hospital without functional clinics below it becomes overwhelmed with cases that should have been treated earlier. Clinics without a referral system above them become dead ends. Kaduna is building all three tiers together and linking them with ambulances.
Buildings, however, do not heal people. Health workers do.
This is where the state’s most consequential decisions may lie. The government has committed to recruiting 1,800 health workers every year for five consecutive years to close the staffing gap, and has already done so in 2025 and 2026. It has approved and paid the 2024 CONMESS and CONHESS salary scales, paid the Medical Residency Training Fund to doctors in training, and enhanced the hazard allowance for health workers.
Two incentives deserve particular attention. A rural posting allowance now rewards staff who serve in remote communities, where vacancies have always been hardest to fill. And the bonding scheme for medical students has been revived, giving the state a claim on the doctors it helps to train. At a time when Nigerian doctors are leaving the country in large numbers, these are practical tools for keeping talent at home.
The reforms also reach the less visible parts of the system. A pharmaceutical-grade warehouse has been built at the state’s Drug Management Agency, which should improve the storage and distribution of medicines.
Financing completes the picture. The state has approved the enrolment of 100,000 vulnerable people in its health insurance scheme, among them pregnant women, children under five, people with disabilities and people over 65. For poor households, the cost of treatment is often the barrier that keeps them away from clinics until it is too late.
Are the reforms working? There are early signs. Prof. Jamoh says the state has recorded a 27 per cent decline in maternal mortality over the last three years. Maternal deaths are among the most sensitive measures of a health system’s performance, because saving a mother in labour requires everything to work together: a trained midwife, a functioning clinic, a working ambulance and a hospital ready to receive her.
He is candid that more needs to be done. Malnutrition persists in parts of the state. Health officials are working with community stakeholders and have taught many households to prepare nutritious meals for children and pregnant women from locally available foods. It is a sensible, low-cost approach, though it will need sustained resources.
Questions remain, as they should. How many of the upgraded centres are fully staffed and running every day? How many of the 100,000 people approved for health insurance have actually been enrolled? Will the gains in maternal health hold. Above all, will the reforms survive beyond one administration?
Nigeria is littered with commissioned hospitals that later fell silent for lack of staff, drugs or maintenance. The real test for Kaduna will not be the ribbon-cutting. It will be whether the clinics are open, staffed and stocked five years from now.
For now, the direction is right. Kaduna is treating health care as a system, not a collection of projects.
For the pregnant woman in a village in Birnin Gwari or Kauru, the measure of all this is simple. When labour begins at night, will there be a nurse at the clinic, a vehicle at the door and a hospital ready at the end of the road?
If the answer becomes yes, Kaduna will have achieved something worth copying across the North.
