Why Nigerian women still die giving birth despite 30,000 Primary Healthcare Centres

In Nigeria, too many women still face serious challenges when trying to access safe and timely care during childbirth. For many families, concerns about whether the nearest Primary Healthcare Centre (PHC) is functional, staffed, or properly equipped remain part of the reality of seeking maternal care.

According to the World Health Organization, Nigeria accounts for nearly 28.5% of global maternal deaths. A Nigerian woman’s lifetime risk of dying from pregnancy or childbirth is estimated at 1 in 19, compared to 1 in 4,900 in developed countries. These numbers reflect more than medical complications alone. In many cases, the problem begins long before an emergency occurs. Across several communities, PHCs still struggle with inadequate staffing, unreliable electricity, limited medical supplies, and weak referral systems.

Maternal mortality is therefore not just a medical adversity; it is reflective of the condition of the healthcare system. Expanding access to functional and well-supported Primary Healthcare Centres is essential to improving maternal health outcomes, reducing preventable deaths, and advancing Universal Health Coverage in Nigeria.

Distance is not the only gap

Nigeria’s Primary Health Centres were designed to solve the distance problem to bring basic obstetric care within reach of every community. Today, over 30,000 PHCs are spread across the national landscape. However, physical presence alone does not equate functional access.

The 2021 National Health Facility Survey revealed that fewer than one in four PHCs met minimum standards for basic service readiness. For maternal health specifically, the gaps are stark: non-functional delivery rooms, lack of access to clean water, broken autoclaves for instrument sterilisation, and unreliable power supply for night-time deliveries.

What this means in practice is a two-tier failure. First, a woman may arrive a PHC only to be turned away or receive substandard care because the facility cannot support a safe delivery. Second, and perhaps more damaging over time, communities lose trust in their local PHC entirely. Utilisation rates drop; women revert to home deliveries without skilled attendance, and the facility becomes merely a building, not a functioning health system.

Infrastructure is clinical, not administrative

Healthcare infrastructure is often treated as separate from care delivery, but it directly affects patient outcomes. Through PSHAN’s Adopt-A-Healthcare Facility Programme (ADHFP), we have seen how poor facility conditions undermine safe maternal care. The state of a Primary Healthcare Centre influences the quality-of-care patients receive.

Reliable electricity, clean water, proper ventilation, functional labour wards, and equipped emergency units are all essential to safe healthcare delivery. A leaking roof that disrupts a delivery room during heavy rains is not just a maintenance issue; it can delay emergency care. A non-functional borehole is not simply an operational gap; it affects hygiene, infection prevention, and patient safety.

When PHCs are revitalized, the impact goes beyond infrastructure. It improves the ability of healthcare workers to provide timely, safe, and quality care, particularly for women and children who rely heavily on these facilities.

Targeted investment, measurable results

The encouraging reality is that many of the infrastructure challenges facing Nigeria’s Primary Healthcare Centres (PHCs) can be addressed through targeted and accountable investment. Through PSHAN’s Adopt-A-Healthcare Facility Programme (ADHFP), private sector organizations, philanthropists, and corporate partners support the revitalization of PHCs under structured implementation and monitoring frameworks.

The goal is not simply to renovate buildings, but to restore functional healthcare services in communities where the need is greatest, particularly in areas with high maternal and child health risks.

With proper planning, transparent implementation, and sustained investment, Nigeria’s network of over 30,000 PHCs can become a stronger and more reliable foundation for maternal healthcare, disease prevention, and Universal Health Coverage.

The reform agenda must go to the facility level

Nigeria’s Health Sector Renewal Investment Initiative has set the right priorities for primary healthcare and maternal health, but real progress depends on whether Primary Healthcare Centres function when they are needed most. Every maternal death linked to a non-functional PHC is more than a tragedy; it is a preventable system failure with a physical address.

The issue is no longer whether PHCs exist or whether more are being built, but whether they work when a woman arrives at 2 a.m. in labour. Because at 2 a.m., survival is determined by functionality – not just policy or structure.

Olisa Wilson Nkollo is a Project Associate and Quantity Surveyor at the Private Sector Health Alliance of Nigeria (PSHAN)