By Dr. Usman Muhammad Shanawa

For decades, Nigeria’s healthcare system has faced a familiar set of challenges: inadequate infrastructure, limited access to specialised medical services, weak primary healthcare facilities, shortages of healthcare personnel and the rising financial burden of treatment on ordinary Nigerians.

Against this backdrop, the Federal Government under President Bola Ahmed Tinubu has pursued interventions across different levels of the healthcare system, ranging from primary healthcare and general hospitals to specialised tertiary facilities, digital health, emergency care and healthcare financing.

For Dr. Usman Muhammad Shanawa, a Consultant Obstetrician and Gynaecologist and specialist in Gynaecological Oncology with more than two decades of experience in clinical practice and healthcare management, the interventions deserve to be examined as part of a broader attempt to strengthen Nigeria’s healthcare architecture.

Dr. Shanawa’s assessment moves across the three levels of healthcare delivery, ranging from primary, secondary and tertiary, while drawing particular attention to diagnostics, maternal healthcare, hospital infrastructure, health insurance and the growing role of technology.

For him, the real significance of healthcare reform lies not simply in the announcement of new projects, but in whether the changes improve access to quality medical care for Nigerians.

*Zamfara: A local window into the reforms*
Dr. Shanawa’s assessment begins from Zamfara State, where he says federal support and collaboration with state authorities have provided a local perspective on the changing healthcare landscape.

He recalled that financial constraints had historically affected the implementation of several healthcare projects at the state level.

According to him, increased federal financial support and policy interventions under the Tinubu administration created room for renewed investment, with 2025 emerging as a particularly significant period for healthcare development in the state.

He views the experience as an illustration of how government intervention can translate into improved access to healthcare when funding, policy and implementation converge.

*At the top: Expanding tertiary healthcare*
At the apex of Nigeria’s healthcare system are tertiary institutions, where patients with complex medical conditions are expected to receive specialised treatment and advanced diagnostic services.

Yet these institutions have historically faced technological and infrastructural gaps.

Dr. Shanawa identifies improved diagnostic capacity as one of the areas requiring sustained attention.

He points to technologies such as Computerised Tomography (CT) scanners and Magnetic Resonance Imaging (MRI) as critical tools for modern medical practice.

For a specialist in gynaecological oncology, the issue carries particular weight.

Cancer care, he explains, depends heavily on timely and accurate diagnosis. The availability of sophisticated diagnostic and oncology services closer to patients can reduce the need for long-distance travel in search of specialised treatment.

He also points to the development of oncology facilities in states such as Katsina, Enugu and Edo as examples of efforts to expand specialised cancer services beyond traditional medical centres.

The broader implication, in his assessment, is that advanced healthcare should not remain concentrated in only a few locations.

*The missing link: Strengthening secondary healthcare*
Between the primary healthcare centre and the highly specialised tertiary hospital lies another crucial layer, that is the secondary healthcare.

For Dr. Shanawa, general and state hospitals remain an indispensable part of the healthcare chain.

These facilities often receive patients referred from primary healthcare centres and provide services beyond the capacity of frontline facilities, while also serving as important points for emergency treatment.

He particularly highlights emergency obstetric care.

For women experiencing complications during pregnancy or childbirth, he argues, the availability of properly equipped secondary hospitals and effective referral systems can be critical.

This makes the strengthening of general hospitals more than an infrastructure issue. It is also a question of how quickly the healthcare system can respond when lives are at risk.

*Primary healthcare: Rebuilding from the foundation*
If tertiary healthcare represents the peak of the system, primary healthcare is its foundation.

And this, according to Dr. Shanawa, is where one of the most important aspects of the current reforms lies.

Nigeria’s healthcare system has historically been characterised by patients bypassing weak or poorly equipped primary healthcare centres and seeking treatment directly at secondary and tertiary institutions.

The result has been pressure on higher-level hospitals, with facilities already handling complicated cases also having to deal with conditions that could have been managed closer to patients’ communities.

Dr. Shanawa sees the renewed emphasis on primary healthcare as an attempt to reverse this pattern.

He argues that strengthening the base of the healthcare pyramid while maintaining improvements at the tertiary level is essential to creating a more functional system.

The Federal Government has reported the deployment of National Health Fellows and Public Financial Management Officers across all 774 local government areas under the health-sector renewal programme, alongside the revitalisation of primary healthcare facilities in priority areas.

For Dr. Shanawa, the importance of such interventions lies in bringing healthcare closer to the people before illnesses become more complicated.

*Maternal mortality: The doctor’s particular concern*
For an obstetrician, the discussion inevitably returns to maternal health.

Dr. Shanawa describes maternal mortality as one of Nigeria’s most persistent public-health challenges, one that has affected generations of Nigerian women.

He argues that strengthening primary healthcare, improving referral systems, expanding the frontline health workforce and ensuring access to emergency obstetric care are essential to addressing pregnancy-related complications.

The Federal Ministry of Health has reported improvements in maternal and newborn health indicators in areas targeted under its intervention programmes.

For Dr. Shanawa, however, the importance of such interventions ultimately comes down to whether a pregnant woman can obtain appropriate care at the time she needs it.

The journey from pregnancy to safe delivery, he suggests, depends on the strength of the entire healthcare chain, from community-level services to emergency and specialist hospitals.

Healthcare needs people, not just buildings
Infrastructure may be the visible face of healthcare investment, but Dr. Shanawa stresses that facilities cannot function without the professionals who operate them.

Doctors, nurses, midwives, community health workers, laboratory scientists, pharmacists and other healthcare professionals are central to translating infrastructure and equipment into actual medical services.

The Federal Government has reported recruitment and retraining initiatives for frontline and community-based health workers as part of its health-sector renewal efforts.

But recruitment is only one part of the challenge.

For the reforms to be sustained, healthcare workers must also be retained, properly deployed and supported with the equipment and working environment required to provide quality care.

*The cost of getting sick*
Another dimension of Nigeria’s healthcare challenge is affordability.

For many families, the question is not only whether a hospital exists, but whether they can afford the treatment available there.

Dr. Shanawa therefore places health insurance and healthcare financing alongside infrastructure and medical technology in his assessment of the reforms.

He points to the Basic Health Care Provision Fund and broader efforts to expand health insurance coverage as mechanisms that could reduce the financial burden on patients.

The Federal Ministry of Health has reported significant increases in health insurance enrolment, while also acknowledging that out-of-pocket expenditure remains high.

This presents one of the central tests for healthcare reform: expanding services while ensuring that the people who need those services are not priced out of the system.

Healthcare goes digital
The transformation is also taking place beyond hospital walls.

Digital health and electronic medical records are increasingly becoming part of the effort to modernise Nigeria’s healthcare system.

Dr. Shanawa highlights electronic medical records and health-information exchange systems as important tools for improving the management and continuity of patient care.

The Federal Government’s Nigeria Digital in Health Initiative is intended to improve interoperability between healthcare facilities and facilitate the secure sharing of health information.

For a healthcare system spread across a vast country, better digital connectivity could help bridge some of the gaps between facilities and levels of care.

Measuring the Tinubu health reset
For Dr. Shanawa, the ultimate measure of healthcare reform is not the number of projects announced or facilities commissioned.

It is what happens to the patient.

Can a woman access skilled care when she needs it?

Can a patient obtain an accurate diagnosis without travelling hundreds of kilometres?

Can an emergency case receive timely treatment?

Can a family afford the cost of care?

Can healthcare professionals work with the equipment, personnel and systems they require?

These questions bring the debate back to the heart of healthcare delivery.

The Federal Government has reported progress across areas including infrastructure, digital health, primary healthcare, workforce development and maternal-health interventions.

But sustaining such gains will require continued financing, effective implementation, maintenance of infrastructure, retention of skilled professionals and stronger coordination among federal, state and local authorities.

For Dr. Shanawa, Nigeria’s healthcare system cannot be transformed by focusing on only one level.

The primary healthcare centre, the general hospital and the specialist tertiary institution must function as parts of the same system.

That, ultimately, is the test of the health reset, and whether the reforms can move beyond policy and infrastructure to create a healthcare system in which quality, affordable and accessible medical care is closer to the Nigerian who needs it most.

Wukari Traditional Council
Aku Uka’s Palace, Wukari, Taraba State

RE:WE ARE UNDER SIEGE: TARABA MONARCH BREAKS SILENCE AS FULANI BANDITS OVERRUN THE ANCIENT KWARARAFA KINGDOM:

The attention of the Aku Uka’s Palace has been drawn to a piece in the Social Media titled, “‘We Are Under Siege ‘: Taraba Monarch Breaks Silence as Fulani Bandits Overrun the Ancient Kwararafa Kingdom.”

The piece being referred to is credited to the Aku Uka, Dr. Ishaku Adda Ali, Matakhitswen, said to be contained in the speech he read at the recent Assembly of the ethnic nationalities of the old Kwararafa Confederacy organised by the Kwararafa Development Forum (KDF) in Abuja on Saturday, 19th September, 2026.
Below is the full text of the anonymous writer/commentator’s piece as it appeared in the Social Media, on Tuesday, 22nd September, 2026:

“The Aku-Uka of Wukari, HRM, Dr Ishaku Adda Ali, has raised a desperate alarm over the escalating security crisis engulfing the historic Kwararafa kingdom in Taraba State, declaring that the situation has reached a point where silence is no longer an option. Speaking at the 2026 Kwararafa People’s Assembly in Abuja, the monarch revealed that the old Kwararafa Confederacy—one of the oldest and most culturally significant traditional institutions in Nigeria—has come under sustained Fulani bandit siege, with communities living in constant fear. His intervention is significant because traditional rulers rarely speak this bluntly in public; when they do, it usually means the violence has overwhelmed local capacity and the state has failed to protect its people.

“The deeper implication is what this says about Nigeria’s widening security vacuum. Taraba sits at the crossroads of the North-East and North-Central, a corridor where Fulani bandits, kidnappers, and separatist militias operate with frightening impunity. If an ancient kingdom with deep historical roots and a sitting monarch can be “under siege” in 2026, then the federal government’s claims of progress against insecurity ring hollow. For the Tinubu administration, this is another embarrassing data point ahead of 2027: the violence is not confined to a few flashpoints—it is spreading into communities that once considered themselves safe. The Aku-Uka’s alarm is not just a Taraba problem; it is a warning that Nigeria’s security architecture is failing across multiple regions at once. And when kings begin to cry out, it is usually because the people have already been abandoned.”

Our observations on the above piece are as follows:
1. The piece in question is not only mischievous, false and blatant lies but cowardly, as the writer has not the courage to disclose his or her identity. The speech read by the Aku Uka never mentioned any ethnic group, as the perpetrators of insecurity or violence as mentioned by the anonymous writer.

Let me quote exactly what the Aku Uka read in his speech on security:
“Our people have contributed immensely to Nigerian development in such areas as agriculture, the armed forces, natural resources, and culture, among others. Yet, many of our communities continue to suffer deprivation in areas such as infrastructure, economic opportunities, and general marginalization and discrimination in the nation’s political set up. Our appeal and clarion call is therefore simple: we seek for fairness, equity, justice, security and inclusion in all spheres of our national life.”
Why the writer made this blatant assertion by putting words into the mouth of the Aku Uka for something he (Aku) never said can not be fathomed to any sane person, except this mischief maker. The intention is to clearly create communal disharmony. The Aku Uka is a peace maker and would never be a party to anything that will bring about conflict among various groups in the country.

2. Aku Uka’s speech was not about Taraba State, but concerning the whole old Kwararafa Confederacy in modern Nigeria and the challenge of security generally, being experienced in a number of States in the country.

3. It is clear that the Federal Government under leadership of President Bola Ahmed Tinubu, has been making strenuous effort to address the various security issues across the whole country. The Aku Uka deeply appreciates such efforts and will continue to pledge his support in tackling and bringing to an end the security challenge.

4. Let me emphatically state that the Aku Uka’s speech he read was not about politics or the 2027 election. The Aku Uka is a traditional ruler who does not dabble into politics. It is therefore the height of irresponsibility and mischief to drag His Majesty into political matters. Furthermore, nowhere did Aku Uka make any reference to 2027 election in the speech he read or politics generally for that matter.
It is possible that the anonymous hack writer is fronting for his or her political masters agenda and so believe that by dragging the revered monarch into the political issues, they would reap political mileage out of this falsehood. If this is the intention of the mischievous writer, no doubt he or she has failed in this regard woefully. His Majesty, Dr Ishaku Adda Ali, Aku Uka’s sole concern is about fairness, justice, equity and progress of the descendants of the old Kwararafa Confederacy and indeed, the country as a whole.

DANJUMA A. ADAMU, Esq.
The NENE of the Jukun People

By Abba Anwar

A triple alliance of faith and state could have been the best caption for this piece. When I talk of triple alliance, I am referring to the genuine support Barrister Muhiyi Magaji Rimingado’s assigned responsibility in the Kano State Task Force Against Drug Abuse and other Related Crimes is getting from our moral bases, the Ulama, Imams and Hisbah.

The fight against drug abuse and other related crimes is now gaining more support in the state and beyond the state. At first, few people started coloring the effort with political sentiment. But now, even at the level of comments sections of the Task Force social media handles, you begin to understand that, more and more people are supporting the move, without any recourse to political party affiliation or other human sentiments.

In the last two to four days, I observed that, over 98% of those making comments in the comments sections of the Task Force social media handles are supporting, praying, engaging and canvassing more support for the state government in this all-important effort. Governor Abba Kabir Yusuf’s genuine political will is appreciated. While Barrister Rimingado’s is applauded and encouraged.

It is very safe and logical to say that, when you have the Council of Ulama of Nigeria, the Association of Kano State Friday Mosques Imams, and the Hisbah Board all speaking with one voice in support of a government committee, you are no longer looking at ordinary politics. You are looking at a moral consensus that is translating into political capital. A tripartite moral support with strong link to state.

That is exactly what is happening today in Kano around the Kano State Task Force Against Drug Abuse and Other Related Crimes, what many on the streets now simply call “Muhuyi’s Assignment.”

And from mosque pulpits to market stalls to social media comment sections, the verdict is blunt and the same. That is with this patriotic effort, Governor Yusuf is gaining more ground, winning more hearts, and inching ever closer to a second term in 2027. Morality overtakes politics. In this calculation, the chances for the Governor’s reelection for a second tenure, is tilted more to the moral side than political engagement.

Under this analogy, the Governor’s achievements in the infrastructural development, the feats he achieved in the health sector, the visible results in the education sector, the good outcomes in the agricultural sector, improved beautification of the urban areas, roads networks in the rural areas, unwavering commitment towards a united APC the ruling party, and encouraging budget implementation, among others, are not the watch words here. The watch word is one, that is MORALITY.

Which eventually led to what I call A Triple Alliance of Faith and State. Meaning the support from the religious institutions. Which is not accidental; it is structured. That is when the Council of Ulama of Nigeria, Kano State Branch, under its Chairman Sheikh Ibrahim Khalil, provided the theological seal. Drug abuse, in Islam, is not just a crime. We are told by scholars that it is indeed the mother of all evils. It destroys hankali (intellect), which Shari’ah came to protect. When the Ulama publicly commend the Task Force, they are telling the faithful that fighting drugs is ibadah. And it is by all standard. In their part the Association of Kano State Friday Mosques Imams, under Sheikh Muhammad Nasir Adam, took it directly to the people. With over 2,000 Friday Mosques under its umbrella, reaching millions of worshippers every Friday, the Imams use the Minbar into a platform for advocacy. In the last few Fridays, Sermons (Khutbahs) across Kano Municipal, Gwale, Dala, Tarauni and other LGAs have focused on the dangers of drug abuse (shaye-shaye) and the parental responsibility to protect children.

They are not only praying for the Task Force — they are naming and shaming the act, and calling on parents to report dealers hiding in their neighbourhoods. That is grassroots mobilization no police van can achieve.

While the Hisbah Board provides the street-level muscle. Hisbah operatives know every black spot, every uncompleted building where substances are abused. Their collaboration with the Task Force means that enforcement is no longer a game of hide-and-seek. It is coordinated, intelligence-driven, and faith-inspired. It is very clear for all to understand that when faith and state align like this, criminals lose their hideout.

This piece is only concern with these religions groups, faith-based platforms, that is why there isn’t any mention of other primary and other relevant agencies. The relevant agencies are equally important as these bodies. And sometimes above faith-based platforms. Because they are empowered by Law to enforce law and use force where necessary. My intention with this piece is only religious bodies and comments sections.

I observed and said that Governor is gaining ground. Let’s see how Muhuyi’s assignment becomes Gov Abba’s political advantage. In Kano politics, popularity is not built in Government House. It is built in homes where a mother is worried about her son coming home high. It is built in wards where fathers fear their daughters are being lured with codeine. It was an open secret that for decades, Kano was accused of being a transit route and a dumping ground. Dealers operated with impunity at notorious spots. Parents whispered, they prayed, but they saw no action.

The Task Force changed that narrative. Under Barrister Rimingado the committee adopted a model that is not just about arrest, it is about disruption, prevention, and justice. Then reformation also follows. That is why Kiru Reformatory Centre is extremely important and relevant. As more of such Centres are needed.

In recent weeks alone, we had a situation where the government was able to secure the conviction of notorious suppliers who were administering intoxicating substances to vulnerable underage children — sentenced to nine years without an option of fine by Magistrate Court No. 44, Gwammaja. That single judgment sent a message: Kano’s children are not for sale. When over 200 drug abusers were also convicted by the recently established mobile courts attached to the Task Force.

Drug marketers, abusers and their connivers are no longer at ease in the state. Let me say this to the hearing of all that, these are not abstract achievements. These are kitchen-table issues. And kitchen-table issues win elections. Go and make a research on political behaviors and public engagement.

That is the main reason why the comment sections of the Agency’s Facebook and TikTok handles are no longer toxic — they are full of “Allah ya taimaka,” “Allah ya saka da alheri,” “A cigaba da wannan aiki,” and crucially, “Abba ya yi kokari, sai second term.” Market leaders at Dangwaro Market themselves are now cooperating to track illegal drugs. This is leadership by example.

The people have connected the dots: clean hospitals plus clean streets equals a governor who cares. I was at an Agency’s engagement effort. What I witnessed was superb. The reform in Drugs and Medical Consumables Supply Agency (DMCSA) — from 30% drug availability to over 90%, clearance of N1.2 billion debt, elimination of fake drugs from public hospitals — and the crackdown on illicit drugs are now seen as two arms of one policy of Governor Yusuf to clean Kano’s health system. To me Governor Yusuf is Sarkin Tsaftace Kano.

Reason why a Task Force becomes a political movement. That is how Muhuyi’s assignment gives Abba more ground, more clearance for victory, more faith in his style of leadership, more loyalty from his people in the government, more courage in discharging responsibilities on the shoulders of the Task Force and more prayers and commitment for the Governor’s second coming.

We all believe and want it this way that, Continuity is the Real Issue.
The way I see it is this, that those calling for second tenure are not just being political. They understand a bitter truth about Kano, that good initiatives die after elections.

I suggest that our Governor should break the cycle. We need institutionalization of the process and the effort. For example when a committee seizes drugs, destroys N1.5 billion worth, then after May 29th, dealers return with N3 billion worth because there is no institutional memory. Your Excellency Sir you need to institutionalize this success in the following three ways:

1) Enact a Law: Transform the Ad-hoc Task Force into Kano State Drug Control Agency with statutory powers.

2) Fund It: Sir give it a budget line in the 2026-2027 budget, just as health now enjoys over 15% above the Abuja Declaration.

3) Kindly link it to DMCSA: Let the clean drug supply chain and the dirty drug blockade work as two arms of one policy.

As a Call to Action procedure let our people know that support is more than a comment. Report a dealer. Protect a child in your street. Your support today is what makes Kano safer tomorrow. Intel is very important and impactful.

To the Friday Imams and Ulama, please keep the khutbahs coming. The war against drugs is won in the home before it is won on the street.

To the Task Force please understand that this public love is a trust. Remain fair, remain transparent, publish every seizure and every conviction.

To the Governor, Your Excellency Sir you have found something rare — an intervention that unites Ulama, Imams, Hisbah, and the common man. It is giving you ground, it is giving you popularity, and it is giving you a strong moral case for 2027. Protect it Sir.

The fight against drugs is not ADC or NDC or PDP versus APC. It is whether the 12-year-old in Fagge today will become a pharmacist or a patient in a rehabilitation centre.

For the first time in a long time, Kano believes it will be the permanent former drug abuse have. And it credits Muhuyi’s assignment and Abba’s leadership for that hope.

Anwar writes from Kano
Sunday, 20th September, 2026