How a Village Head built Primary Healthcare Centre to curb infant and maternal mortality in Kano

After retiring from civil service in 2003, Alhaji Kabiru Yahaya would return to his community in Kano to witness a deteriorating health situation thousands of people, especially pregnant women are going through. And he would, eventually, be saddled with the responsibility to head the community as “Dakaci,” Village Head. But the appointment would come after the once Executive Director of FBN Merchant Bank took the bull by the horn to single-handedly plant the seed to solving the health challenges in the community, by building a Primary Healthcare Centre to meet the needs of the community. He named it “Hotoron Arewa Community Health Centre,” the second but community-owned PHC in Hotoro.

Hotoro is a fast-growing community in Nassarawa Local Government Area (LGA). It’s about a 9 kilometres drive to the Emir’s Palace in Kano city. The population of the town has been growing “geometrically,” according to Alhaji Kabiru, mainly due to the humanitarian crises in northeast Nigeria. Most of the people migrating settle around that axis.

This sudden increase in population, Alhaji Kabiru found out, has put a lot of pressure on the single existing primary healthcare centre (PHC) built by the government many years ago in the community, and is already in a bad shape. “And perhaps,” Alhaji Kabiru explained, “because of the economic situation in the country, many people in this community, especially women, find it rather difficult to travel 5-6 kilometres to get medical attention in secondary and tertiary-level health facilities.”

Addressing maternal mortality in Hotoro

A pregnant woman, Salma Alhassan, visited the facility for the first time to book an antenatal appointment because it’s closer to her than any other hospital. She learnt about the PHC from community women who have been recommending the facility for other women, and through the “friends of the hospital” who went to their house for an outreach.

Prior to building the Hotoron Arewa Community Health Centre, Lami Ibrahim, a pregnant resident of the community speaking, said they used traditional means of delivery because of distance to the government-owned healthcare facility in Hotoro and, also due to the cost of services in private hospitals in neighbouring communities.

But according to the facility’s health extension officer-in-charge of the Hotoron Arewa Community Health Centre, Aisha Muhammad Ahmad, things have now changed. Since April 2020 when she assumed duty, antenatal care services are now rendered to about 150 – 160 women of Hotoro and neighbouring communities. She said about 5 – 6 births are attended to in the facility, monthly.

Receiving antenatal care from skilled providers usually at a healthcare facility isn’t just important in monitoring pregnancy; it also reduces morbidity and mortality risks for both the mother and child during delivery and 42-days after delivery (postnatal period).

Data from the 2018 National Demographic Health Survey shows that 34.7% of women in Kano are still not receiving antenatal care from a skilled provider and only 23.2% receive postnatal care compared to the 13.8% and 72.8% in Lagos state respectively. The North-Western region – where Kano has the highest population – has the least number of women attending a healthcare facility for antenatal care in Nigeria.

“Friends of the hospital” and management

After the completion of the Hotoron Arewa Community Health Centre, Alhaji Kabiru handed over its management to the Nassarawa LG. To help in the management of the healthcare facility, they set up a committee the locals called “The Community Friends of the Hospital.” The 15-member committee consists of religious influencers and health workers who also organise awareness outreach in the community, educating people on prevailing health problems and the methods of preventing and controlling them. This, according to the committee chairman, Dahiru Adamu Hotoro, has helped reduce ‘self-help’ and the use of traditional means of treatment and has increased hospital attendance by pregnant women.

“I am truly happy with the establishment of this facility,” said a resident of Hotoro, Nura Ahmed Bello. “In the past, we must travel to other places for medical attention. But you can now see we’ve everything within our reach.”

The facility renders services under the GOPD, antenatal, immunization, family planning, and growth monitoring and evaluation units with no free services but considerable discount. Whenever there’s a malaria outbreak in Kano, treatment is rendered free of charge at the facility as the district head pays for everything.

Like other government-owned health facilities, all professionals in the Hotoron Arewa PHC are posted by either the State Primary Healthcare Management Board (SPHCMB) or the LG, and they are on their payroll. But support staff such as the securities and cleaners are ‘donated’ by the community which has developed a sense of ownership with the facility. 

“Not enough to lament, someone needs to do something”

In May 2013, while Alhaji Kabiru was flipping through the pages of The Economist magazine, he read an article on Sub-Saharan Africa titled “Where not to be a mother.” The article focused mainly on a non-governmental organisation (NGO)’s annual report, Save the Children, about the high rate of child and maternal mortality in the region.

In the report, Nigeria ranked 172 out of 176 countries on five indicators, including the risk of dying during pregnancy or childbirth and income level. This, Alhaji Kabiru believed was true about northern Nigeria where he said: “the poorest health facilities and the chances of women dying during childbirth are higher.” It’s especially true about his community where women die giving birth at home without having access to any healthcare facility “due to proximity and ignorance.”

Alhaji Kabiru feels “it’s not enough to read and lament, someone has to do something about it.”

Few months after reading the report, he used a portion of his land measuring 100 x 35 feet to single-handedly build – from foundation to roof – and equipped the Hotoron Arewa Community Health Centre. 

The need for more citizen participation

There are currently 2,100 PHCs in Kano State, including the one built by Alhaji Kabiru. While this number is still not enough, many of the PHCs are monumentally inefficient in rendering quality services, due to ineffective and explicit primary healthcare policies and especially citizen participation in the state.

Alhaji Yakubu collecting an award of recognition from KNSG

On July 27, the Kano State Governor, Abdullahi Umar Ganduje convened for the second time in 3-years, the PHC Investment Summit in the state. Stakeholders in attendance including development partners, government agencies, and philanthropists, traditional and religious leaders – including Alhaji Kabiru who was officially recognised by the Kano state government for his contribution towards a healthy Kano, and community members in attendance donated cash in millions to support healthcare delivery in the state.

But the philosophy, according to the governor, was to create and strengthen the synergy between the state and those in attendance that is critical for the overall improvement of the health of the Kano people. “Cash donation isn’t all the state needs,” said the executive secretary of the State Primary Healthcare Management Board (SPHCMB), “it needs intervention from all and sundry to build more PHCs, or improve the existing ones in providing quality services”.

Shortages of health personnel, as well as other socio-cultural and economic barriers, affect the quality of care and it increases the women’s use of alternative health care services.

Recounting on the report he read on The Economist, Alhaji Kabiru said “if people like me who are privileged to have gone to school, got a good job and even buy these papers to read such a report would do something, then a number of health problems would automatically be solved.”

Asked whether he faced any negative surprises during the project, Alhaji Kabir said “there were no serious challenges rather, pleasant surprises. From my experience, I will advise anyone willing to take this path to just go ahead.” He said the management of health in Kano State are very “proactive, friendly and business-like officials; they do not act with the usual lacklustre attitude of most public servants.”

He added that the health officials in the state are very passionate about seeing health facilities being built and developed in the state.

Hotoro itself needed more

As the population of Hotoro increases, this hospital has only solved a fraction of the community’s need for affordable healthcare services. There’s still not enough space for antenatal and immunization services as the women attending always come in increasing numbers. The hours of operation are also of concern as the facility operates on an 8 am – 4 pm basis. To make the facility do better, there’s more the local government should do as it’s donated to her in good faith.