INVESTIGATION: Inside Kano community where women face death due to crumbling health facility

Kano has one of the highest maternal mortality rates in Nigeria, and despite significant resources allocated to tackle this issue, the problem persists, affecting many rural communities.

Uzair Adam reports on the alarming state of maternal care in Mazan Gudu community, in Gabasawa Local Government Area, where inadequate healthcare services continue to pose severe risks to mothers and their newborns.

Nafisa Faisal’s story of labour and childbirth teeters on the edge of life and death. During the birth of her third child, Nafisa, a resident of Mazan Gudu in Gabasawa Local Government Area (LGA), Kano state, endured hours of excruciating pain without adequate medical assistance. The Mazan Gudu health facility was closed at the time, as it shuts down at 4:00 pm daily. Additionally, the facility lacks essential equipment, leaving her in a dangerous situation.

“I was in labour for more than twelve hours,” she recalled with her voice trembling.

“There was no doctor and the facility was even locked. They didn’t have the necessary tools or even enough clean water. At one point, I thought I was going to die. It was by God’s grace that my child and I survived.”

Sadly, Nafisa’s story is not unique. Countless women in Mazan Gudu have faced similar, if not worse, experiences. The lack of reliable healthcare has resulted in preventable maternal deaths, with many cases going unreported.

Mubarak Ibrahim’s painful story of losing his sister to childbirth shows the severe impact of this crisis. Ibrahim, whose sister died after prolonged labour, said, “The death of my sister was untimely. None of us ever thought we would lose her so quickly. She started her labour at night, and by morning, she was gone. We tried everything to save her, but it was in vain. The pain of her loss is something we carry every day.”

Nigeria grapples with one of the world’s highest maternal mortality rates, with Kano State recording a staggering 1,025 deaths per 100,000 live births. The challenge of inadequate infrastructure, particularly in rural areas, disproportionately impacts women, often forcing them to choose between a crumbling local clinic and a perilous journey to a distant, overburdened facility.

Lack of care in Mazan Gudu community threatens lives

Community sources said the Mazan Gudu healthcare outpost was established in 1991. But now, it is a shadow of its original intended purpose due to years of neglect by the Kano State government.  The current state of the facility puts lives at risk, particularly for expectant mothers and their babies.

Dahiru Isma’il shared the story of how his wife suffered during labor before they could find a vehicle to convey her to the Gabasawa PHC at the local government headquarters. Sadly, one of the twin babies she gave birth to died.

“When she started labor, we took her to the Gabasawa PHC because the Mazan Gudu facility was in such bad shape. She suffered a lot before we got to the hospital. She delivered one baby on the way and the other at the hospital. But the first baby died before we arrived. Only God saved the other baby and my wife from death,” he said.

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A visit to the healthcare facility by SolaceBase revealed the disheartening conditions of the facility which makes it practically impossible for it to provide quality healthcare services to members of the community. The facility’s only water source which is a hand pump borehole stands dry. A significant portion of the roof, including the doctor’s office, is missing, exposing patients and staff to harsh weather conditions. Visible cracks were also seen on the walls with overgrown grasses competing for space within the facility’s premises.

Even more, the facility is grossly understaffed with only two staff including volunteers. This severe understaffing compromises the quality of care, particularly for pregnant women. With a monthly patient volume exceeding 40 individuals, the facility is grossly overwhelmed.

National standards set by the NPHCDA stipulate a minimum of 24 staff members for a primary healthcare center, including medical officers, nurses, midwives, pharmacists, and support staff. The Mazan Gudu facility falls far short of this benchmark.

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“It’s impossible to properly care for patients, especially women in labour, with such limited manpower,” Malam Murtala, a staff of the facility said.

The poor state of the healthcare facility also creates a double jeopardy for residents seeking medical attention.  According to findings, the lack of basic infrastructure forces them to travel long distances, often on bad roads, to reach facilities in neighbouring communities.  These neighbouring facilities, already strained by their own populations, become further overburdened, leading to longer wait times and decreased quality of care. Another alternative they have is to patronize private hospitals which are often highly prohibitive and out of reach to the largely agrarian community.

Maryam Haruna, a mother of four, shared her difficult experience during childbirth. “I didn’t think I would live again because of the complications,” she said.

Maryam started labour late at night and had to wait until morning to be taken to the Gabasawa PHC for medical help. “I suffered a lot; the situation was so traumatic that I thought I would not survive it. I had excessive bleeding as a result of prolonged labour. The situation started at night. However, we had to wait until morning before I was rushed to the Gabasawa PHC.”

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Maryam’s trouble continued even at the hospital.

“Because of the amount of blood I had lost and the persistent headache, the doctor explained that I needed blood urgently. However, there was not enough space to fully admit me. I had to manage somewhere and was given a pint of blood before I was told to return home. The following day, I was taken back for another pint of blood. This went on for three days. It was God that saved my life and that of my baby.”

She also shared a sad story about her friend, who lost her baby in a similar situation. “My friend bled excessively before they could find a vehicle to take her to the hospital. In the end, the doctors were only able to save her life. But her baby suffered from the blood entering into the lungs and died instantly.”

Residents also face a huge financial burden.  While the journey to overburdened public facilities adds transportation costs, patronizing private hospitals presents a different kind of barrier.  Residents of Mazan Gudu are unable to pay as the fees are simply out of reach for the community’s predominantly agrarian population. Many residents rely on subsistence farming, leaving them with little to no disposable income for healthcare expenses.

Malam Aliyu, a primary school teacher in the community, lamented how transport fare adds to the burden of seeking healthcare, leading to many complications during pregnancy and childbirth in the community.

“We have our facility, but it has been in ruin for several years. Even the transport to Gabasawa PHC is another burden on us, especially with the current economic hardship. Most people cannot afford the cost of drugs and when you add transport fees, seeking medical intervention becomes less of an option,” he said.

Rural communities faced with desperate choices

This situation forces residents into a difficult choice.  They can risk travelling long distances to potentially overstretched public facilities, or they can forgo proper medical care altogether.  The consequences of this situation are awful.  Many women, particularly in the face of the deplorable conditions at the Mazan Gudu and congestion at Gabasawa PHC, have turned to alternative, often unsafe, traditional methods of childbirth.

Bilkisu Sunusi, a resident, sheds light on this worrying trend.  She said: “The deplorable state of healthcare at Mazan Gudu and the congestion at Gabasawa PHC have made some women to resort to traditional birthing methods, which often lack proper hygiene and can be dangerous.”

Another resident, Hadiza Yakubu, provided more context.

“Because we don’t receive the attention we deserve at the hospital, some women follow some nurses, like Malama Aisha, Malama Sadiya, and Malama Ummi, to their homes for childbirth. Sometimes, the nurses aren’t available or are even asleep, leaving us waiting in vain. I had to give birth to my only child at Malama Sadiya’s house. This is not how it should be. We need our healthcare facility rehabilitated.”

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Kano’s healthcare expenditure

Despite significant budget allocations by the Kano State Government for health improvements, the condition of healthcare facilities in these communities remains poor. From 2020 to date, the state government has allocated N118.1bn to revitalize the health sector. However, infrastructural decay and staff shortages still persist especially in rural communities leading to numerous health challenges.  Pregnant women, in particular, face severe complications like eclampsia, high blood pressure, excessive bleeding, and even untimely death.

“This shouldn’t be the reality for Kano residents,” said Sulaiman Ahmad Dandago, a healthcare finance expert.  “Considering the supposed budgetary allocations aimed at improving healthcare in the state, such a situation is unacceptable.”

Dandago stated that the lack of standard domesticated health policy in the state is what has contributed to the menace. He added that: “However, corruption deteriorates everything. Government should concentrate more on preventive measures to curb corruption and its impacts.”

A recent analysis by SolaceBase revealed a disturbing trend in Kano State’s health expenditure. Despite substantial health budgets, the government has consistently underperformed in delivering essential healthcare services. Between 2021 and the first quarter of 2024, Kano State executed a mere 18 percent of its health budget. In 2021, N5.3bn was spent out of the budgeted N16.4bn. The following year, an abysmal N1.18bn was spent from a N18.9bn allocation. Even in 2023, only half of the budgeted N26.7bn was utilized. The trend continued into 2024, with a paltry N98m spent from the N42.5bn capital expenditure budget for the first quarter (Q1).

Dandago expressed his frustration with the government’s handling of healthcare funds. “The government is just lying because everything now has been politicized, and corruption has ruined almost everything in Nigeria, especially in Kano,” he said.

“The main reason this isn’t being felt in rural communities like Mazan Gudu is corruption, especially considering the money budgeted and what is actually spent at the end of the day. To address this issue, government needs to understand the value of the lives of the people they are leading. They should not be so heartless, stealing and mismanaging money at the expense of the masses’ lives.”

‘Our Women Deserve to Live’ – Village Head

Meanwhile, the village head, Alhaji Yusuf Abdullahi, called on the government to come to the aid of women and rehabilitate the Mazan Gudu Health Post to reduce the number of pregnancy and childbirth complications and deaths in the community.

A resident, Shamsu Anas, said it is unfortunate that despite the dense population of the community, they are still grappling with health issues, especially related to women during pregnancy and childbirth.

He stated, “There was a time when a woman died at this hospital before she was taken to the Gabasawa PHC. Women sometimes bleed, and before they can reach the hospital, they lose their lives.”

Anas added that it is sad to see their women suffering before their eyes, adding that the situation sometimes leads to eclampsia, paralysis, or worse, untimely death.

He said: “We do our best to see that we rehabilitate the hospital; it was scarier before. We gathered money and changed the roof. However, the government needs to intervene because we cannot do it alone. We won’t be tired of calling until our voices are heard.”

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Daha Abubakar Chiroma decried the way women lose their lives untimely as a result of the deplorable condition of the hospital. He said: “The situation of women always get complicated whenever they are taken to the facility. To me, the facility is useless and has been condemned.”

Kano Govt reacts

Contacted about the sufferings in Mazan Gudu Community, the Commissioner, Kano State Ministry of Health, Dr. Labaran Abubakar, acknowledged the issues with rural healthcare facilities.

Dr. Abubakar emphasized that the government is making unwavering efforts to address the issue, adding that, “Over one thousand hospitals are planned to be rehabilitated by the Kano State Government this year.”

This SolaceBase report 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.