Health
A generation at risk: The inside story of how Benue’s PHCs are failing children
Benue’s primary health centres are failing children, with empty clinics, absent staff, dead equipment and no essential drugs. Though billions are budgeted for PHC services, funds rarely reach facilities, leaving them powerless to treat basic, preventable illnesses.
Across 121 clinics, most lack doctors, functioning vaccine fridges, oxygen or reliable power, leading to hundreds of avoidable child deaths.
The gap between budgets and reality is a governance failure—one that demands transparency, sustained investment and urgent operational reforms to save lives. Anne Agbi, Udeh ONYEBUCHI and Ntakobong Otongaran report.
It was past nine on a Thursday night when Blessing Igbudu carried her 18-month old son, Terver, through the gate of Yelewata Primary Health Centre in Guma Local Government Area. The moon was bright enough to see the clinic’s cracked walls, but inside there was no light, no nurse and no sound at all.
“I called and called,” she says, sitting on the same plastic chair where she waited that night in August. “Only the dogs answered.”
Terver had been burning with fever for two days. His breathing had turned fast and shallow. By the time a neighbour borrowed a motorcycle to take them toward Makurdi on the broken road, the boy had already gone limp. At the teaching hospital, doctors fought for six hours. At 4:17 that morning, they stopped.
He became one of the roughly 120,000 Nigerian children who die every year before their fifth birthday, most from illnesses that have been treatable for decades: pneumonia, malaria, diarrhoea and newborn sepsis.
The global context sharpens this picture. UNICEF and WHO estimate that 4.8 million children under five died in 2023, with Nigeria contributing one of the largest national burdens. Most of these deaths come from familiar causes.
In Benue State, the tragedy is not simply distance or poverty. It is the stark truth that many primary health centres are clinics in name only.
The first thing visitors notice in these places is the quiet. Not the calm quiet of a clinic prepared for emergencies, but the uneasy silence of a place that has stopped expecting help. Mothers arrive with sick children but sometimes the nurse on duty is away. Pharmacy shelves may have paracetamol but lack antibiotics or oral rehydration salts. Vaccine fridges rest unplugged or broken. Once darkness falls, many centres close in all but name.
These failings are repeated so often that they might seem ordinary. But they are not inevitable. They are the result of a system that receives money on paper but delivers very little at the frontline.
When budgets say one thing and clinics show another
The Nation examined records from 121 state run clinics using the Check My PHC dataset, the Nigeria Primary Health Centre Energy Assessment and the 2024 Benue State budget along with federal projects data for the state. The pattern that emerges is consistent and troubling.
On paper, Benue appears to be investing heavily in primary health care. The 2024 budget allocated more than 7.6 billion naira (N7,604,527,454) to the Benue State Primary Health Care Board alone. When all federal and state PHC specific spending is combined, the total directed to primary care reaches at least 8.7 billion naira (N8,718,398,061). When compared to total visible health spending, roughly 36 percent of the health budget is intended for PHC level work.
These funds include new health centres in Agatu, Apa, Obi, Adoka and Okpokwu, a programme to upgrade selected PHCs to provide emergency obstetric and newborn care, a ward health package under the Basic Health Care Provision Fund and a state programme for free maternal and child health services. Federal programmes such as the Expanded Midwives Service Scheme also operate in the state.
On paper, this should mean PHCs stocked with essential drugs. PHCs with working cold chain systems for vaccines. PHCs with reliable power. PHCs with midwives on shift. PHCs capable of saving the lives of children like Terver.
But the facility data tells a completely different story.
Across the 121 clinics surveyed, most reported no pharmacy or pharmacies that have not been restocked in months. Many lack any source of water. More than half cannot power a vaccine fridge or oxygen concentrator. Immunisation services range from very good in a few locations to poor in many others. 96 percent of the clinics have not had a doctor on site at any time in the past year.
The contrast is sharp. Benue allocates billions to primary care but the clinics that should give life remain unable to function. The budget and the reality do not meet.
The empty chair
In the courtyard of Naka Primary Health Centre in Gwer West, a wooden sign still reads Doctor’s Office. The door behind it is padlocked. Through a dusty window sits a desk and a chair thick with dust. Staff say the last doctor sat there in 2017.
It is the same story repeated across Benue: of the 121 clinics surveyed, 116 recorded no doctor presence at all. Only 5 facilities near the capital reported any weekly doctor visits.
Dr Moses Agaku (not his real name), a paediatrician at the teaching hospital in Makurdi, describes the consequence.
“We get children who have been bouncing from clinic to clinic,” he says. “By the time they reach us they are already in coma or cardiac arrest. Many could have been saved with a simple injection of artesunate or a few hours of oxygen at the primary level.”
Recent academic findings reinforce this link between human-resource scarcity and preventable child deaths. A national study by Professor Ekanem N. Ekure and colleagues at the University of Lagos, published in the Nigerian Journal of Paediatrics, found a strong positive correlation between the child-to-paediatrician ratio and under-five mortality across Nigerian states. The researchers reported that areas with few or no trained paediatric personnel recorded significantly higher death rates, showing how the shortage of skilled hands at the first point of care directly translates into lost lives.
When light fails, lives fade
The PHC Energy Assessment shows that fewer than one in four clinics in Benue have any connection to the national grid. Even those that do, experience long outages and unstable voltage. Donor installed solar systems have failed in many places because batteries and inverters were never replaced when they aged.
In several centres, staff stopped offering services at night because they cannot power lights. “Sometimes we deliver babies with phone torchlight,” a nurse in Otukpo said. “We just pray the battery lasts.”
At Aliade General Hospital, one of the few facilities with doctors, the lights often go out between seven and eight in the evening. The generator is used only for the most severe emergencies because fuel is scarce. The solar system installed in 2019 runs low because the batteries are weak.
Across the dataset, 82 percent of Benue’s PHCs cannot run an oxygen concentrator. 60 percent have no functional vaccine fridge. Nighttime in Benue is a dangerous place for a sick child.
Mercy, Moses and Little Doose
In the village of Anvambe, 27-year old Doose Mzungve keeps a notebook. In it are three names.
Mercy. Eleven months. Died of diarrhoea. No oral rehydration salts at the clinic.
Moses. Three years. Died of malaria. No injectable artesunate. Referral arrived too late.
Little Doose. Forty days. Died after breathing problems. No oxygen. No ambulance.
The clinic in Anvambe has a cheerful mural of babies painted by UNICEF in 2020. It has never had a doctor. The vaccine fridge has been dead since 2022. Drug supply came four months ago, a single carton that ran out in one week.
The conditions in Anvambe are not an exception. They are the rule.
Where the money goes to disappear
The fragility of these clinics mirrors the fragility of the state’s spending structure.
A detailed review of the 2024 budget shows that while the PHC Board received a sizeable allocation, much of it went to capital items such as vehicles and administrative equipment. The budget contains no clear recurring line that guarantees a stable supply of essential drugs, oxygen equipment, cold chain maintenance or community health outreach.
In LGAs where federal and state records show PHC projects, the clinics still recorded the same failures seen elsewhere: no water, no power, no medicines.
Interviews and local budget tracing found repeated leak points. In Apa Local Government Area, officials say N8 million was approved for PHC drugs in 2024 but only N1.1 million naira arrived after transport claims, facilitation fees and other deductions. That tiny remainder bought only a few essentials.
These routine erosions of allocated funds convert the promise of a budget into the reality of a single carton of medicines that runs out in one week. A senior Ministry of Health official, speaking anonymously, said, “Primary health care is where budgets go to disappear.”
The nurses who stay
Despite everything some still come to work every day. Jennifer Agaigbe (not her real name), 41, works at Ortese Mbaatsua Primary Health Centre. She has not had an official leave in three years. She has delivered more than one hundred babies using a phone torch and a plastic apron.
When asked why she puts in the extra work, given very little at her disposal, she pointed to a photograph on the wall. A little girl who survived severe malaria in 2023 because Jennifer walked several kilometres to buy amoxicillin from a private pharmacy and paid for it herself.
“That one life,” she says, “is why the rest of us have not walked away.”
In the past year, she has lost four children, she believes could have survived if the clinic had oxygen and if the solar batteries still worked.
When governance fails, children pay
BudgIT’s State of States 2025 report, which tracks how effectively states convert budgets into services, provides a clearer picture of why the money on paper never becomes medicine, oxygen, or power at the primary health centre level in Benue.
While the state allocated more than N7.6 billion to the PHC Board and billions more were directed at PHC-specific federal projects, the same report shows Benue ranks low on capital budget performance and consistently fails to channel health spending into the operational items that save children’s lives.
These governance failures explain why Mercy died of diarrhoea without oral rehydration salts, why Moses died of malaria without artesunate, and why Little Doose died gasping for oxygen. The contrast with states like Gombe, Rivers, Kano, and Kwara is stark. Those states prioritised PHC operations, ensured solar power and functioning cold chain, strengthened drug supply systems, and maintained visible midwife rotation.
Gombe, in particular, has cut under-five mortality by more than 40 percent in eight years through consistent political will and facility readiness. Benue can do the same.
To prevent more needless deaths, the state must publish per LGA PHC expenditure, ring-fence funds for essential medicines, oxygen, and cold chain maintenance, enforce transparent drug delivery to facilities, repair or replace broken solar and grid systems, and make PHC staffing and supervision a priority. Without these deliberate steps, the budgets will remain impressive on paper while children continue to die in clinics that cannot save them.
This story was produced by the Nation’s Health desk, supported by the Africa Data Hub and Orodata Science.
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