Health workers in Cross River State are working under conditions that are not fit for health services. This report reveals that some operate from life-threatening infrastructures, lack manpower, electricity, drugs, and WASH facilities, and deal with insecurity to save lives.
One morning in January 2025, Mr Effiong Bassey, Head of Ikot Inwang Primary Healthcare Centre, Bakassi local government area of Cross River State, came to work and noticed his office laboratory had been burgled and a digital blood pressure monitor had been stolen. The burglar, aided with a long stick, moved the plastic table where it was close to the window, removed the digital blood pressure monitor from its casing and replaced it with stones.
This is not the first time the facility has been burgled. During the #EndSARS protest across Nigeria in October 2020, which led to the vandalisation of public and private properties, Ikot Inwang PHC was one. It was stripped naked of beds, chairs, tables, drugs, electrical appliances, wires, borehole pumping machines, overhead tanks, thermometers, toilet seats, washing hand basins, burglary proofs, among others.
It has only gotten new chairs and tables; its wards remain closed; the roof leaks; they have no functional toilets or bathrooms, and depend on stream water.
In Ekureku 2, Abi local government area, Agbara Health Centre operates from a life-threatening infrastructure. The facility’s main building looks good on the outside because it was recently painted, but the foundation is sinking and has begun to separate itself from the rest of the building. The waiting area, labour and general ward bear physical marks of this life-threatening situation. Their land has been encroached on.
In Akpabuyo, the Esuk Idebe Health Post in Ikot Nakanda operates from a rented one-room mud house. It has just a staff, a bed which is not in good shape, poorly ventilated, no toilet, no bathroom, depends on water from the river, no electricity, and drugs.
Ikot Anasua Health Post in Akpabuyo shares the same similarities with the Esuk Idebe Health Post, only that it doesn’t pay rent and operates from a modern building.
These challenges are shared by 11 other facilities visited by TheInvestigator in Abi, Biase, AKpabuyo and Bakassi. The 14 facilities visited within three weeks all lack a functional ambulance, laboratory, oxygen, and stretcher. They also have no visiting doctors, pharmacists, or health record staff.
These conditions have led to unsatisfactory working conditions and poor service delivery.
‘Only Our Passion Keeps Us Going’
Worried about their safety, some of the health workers spoke to TheInvestigator anonymously. They expressed frustration over their challenging working conditions.
*Mr Stanley Uche, a Senior Community Health Worker (CHEW), described his working conditions as “terrible”. He said, “There’s no motivation other than our passion to save lives.”
Lamenting further, he maintained that “the job is tedious and if you don’t get creative, you may not save a life because sometimes we lack basic items like spirit, disposable gloves, infusion pump, neonatal resuscitation equipment”.
*Mrs Ndem Virginia recalled, “I must tell you we are trying despite the difficult conditions we work in. The biggest problem is terrain and transportation. Imagine the distance from the junction to my facility? If there’s an emergency, it’s 50-50 chances. If we can get good roads, electricity, and routine doctor’s visits, healthcare services at the grassroots will greatly improve.”
*Mr Sabastine Eno, who was employed over 20 years ago, said, “The challenges we go through are not easy. My labour ward is leaking; I don’t have a pharmacy, I have just a few medications, no toilet, no source of water, no light, and no beds. These things scare patients; only those who know and trust us come to the facility.”
*Miss Juliet Abang blamed corruption for their condition. “If not corruption, I don’t know what is responsible. When you have politicians who are blind to the importance of health centres as the first place to call for any primary health issues. As for as we have the crops of politicians who are after immediate or personal gains the health sector will not improve.”
Urgent Plea
Residents in various local government areas express urgent concerns about their health centres, highlighting the need for government intervention.
Mrs Deborah Edet, a native of Ikot Nakanda Akpabuyo, said, despite the unpleasant appearance of their health centre, “it works. People here prefer native treatments, but when it doesn’t work at the dying minute, they’ll rush to the health centre.”
What sealed her convictions was a personal experience. “We were going to the farm with my dad, we met a woman who was in labour on the road. My dad and 2 other men were confused; before you knew it, a woman took her to a nearby compound, and she delivered. The woman whose house they took her to is a health worker. Till today, the baby boy is over 5 years old. The Health workers are well-trained but lack things to work with, and the poor are the problem.”
Mr Richard Enang, Ekureku 2 in Abi local government area, recalled how his late father, a senior CHEW, was so committed to his work, but when a stroke came, “all his sweat couldn’t take care of him. There was no source to even get a loan; we managed it the best we could. He had worked for over 20 years; the job is time-consuming because you also need to train yourself if you want to grow. After all, it is very rare that training opportunities come to them in health posts.”
Miss Emem Archibong in Nsidung, Bakassi local government area and Sandra Unoh in Etono Central in Biase local government area, who spoke to TheInvestigator separately, called for urgent government intervention.
Stakeholders Demand Immediate Action
Critical stakeholders contacted by TheInvestigator frowned at the state of the facilities, cited an administrative gap and called for immediate attention to health centres and posts across the state.
Leader Ben Usang, Coordinator of Cross River State Civil Society Network, said the findings of TheInvestigator are “disturbing”.
Asserting that health is fundamental to our survival as a people, Usang said, “A lot of our people still reside in rural areas, and it is from these rural areas that we have our food security, and basic farming takes place there. What the urban cities depend on is from rural areas. If these people are not healthy, the food security problem we have in the urban areas would only be compounded.”
Calling for improved service delivery, he stated, “It is important that our government addresses these issues. A couple of health centres are quite dilapidated, barely staffed, and very distant from the location of those who are supposed to use them; they do not receive the necessary equipment and support required.
“Health care is about life, and if there is anything not available, it means the risk of losing a life is there. We can’t continue like this as a people, we have to fix our health system. If we can’t fix it all, let’s fix our primary health care centres. Let the people at the grassroots feel the government.”
Concluding, he said, “What I’m hearing is disheartening; the civil society community is desperately worried. The local government has to sit up.”
Mr Felix Ukam, Executive Director of Centre for Healthworks Development and Research Initiative (CHEDRES), said, “As someone working closely within the health development space, I deeply resonate with your findings.”
On the poor state of health infrastructures, he said, “Many of these facilities were built decades ago and have suffered neglect, with no structured maintenance or upgrades. Your observation on the lack of adequate manpower is sadly accurate. In some communities, there hasn’t been a doctor posted for years.”
As a solution, he stated, “We need to engage retired professionals on short-term contracts, strengthen the CHEW system, and ensure that the state fully draws down from federal programs like the Basic Health Care Provision Fund. More importantly, we must advocate for local training and deliberate deployment strategies to underserved LGAs.
“Equally concerning is the lack of motivation among the few health workers still holding the system together. Some go months without pay, yet they show up. We need to create an incentive structure that rewards performance, ensures prompt salaries, and gives room for professional development. Simple acts of recognition can go a long way in keeping morale up.”
Furthermore, Ukam suggested, “Finally, we must reintroduce NYSC doctors to those areas with added incentives and ensure that policies around rural postings are enforced fairly and attractively. Partnering with faith-based institutions and NGOs can also temporarily fill gaps while we press for longer-term solutions. However, I must emphasise that none of these solutions will take root without strong political will.”
Efio-Ita Nyok, a doctor of political philosophy, said he is surprised no effort has been made to fix the infrastructure destroyed during the #EndSARS incident.
His words, “I do not know why, after the #EndSARS incident, as unfortunate as it turned out to be in terms of infrastructure, infrastructural damage that came in the wake of that incident, the federal government and even the state government have not paid keen attention to rehabilitating infrastructure at the primary health care level.
“But as it stands, it’s surprising that, for instance, like the community you just mentioned in Bakassi, that even the property has even been touched twice, first with #EndSARS and then a burglary incident. It’s surprising that nothing has been done.”
Pinpointing the fact that with financial autonomy, the grassroots are still not feeling the impact of government, he said, “First, we are aware that there is financial autonomy of the local governments, at least the federal government has secured a Supreme Court judgment in that regard. There is no local government that has said the local government legislative assembly has passed, deliberated on a budget that was presented to them by the chairman.”
He added that “I am confused. There seems to be a gap where we have financial autonomy, money is going to the local government account coffers directly, but up till now, none of the local government chairmen in Cross River state has been able to come up with a budget of what they intend to do annually. So there’s an administrative vacuum. So it suggests to me that what is supposed to be done is not done. We don’t have priorities. We cannot tell what the priority of the local government is.”
Government Yet To Respond
TheInvestigator contacted the Cross River State Ministry of Health for comment on what it is doing to ameliorate the poor working conditions of health workers, when the last recruitment was done, and what Cross Riverians at the grassroots should expect.
Mr Kingsley Agim, the Information Officer of the Ministry, promised to gather all the facts and respond on Monday, May 5th 2025, but has not responded at press time.
Note: The name asterisked is to conceal the person’s identity because they requested it.
This story was produced for the Frontline Investigative Program and supported by the Africa Data Hub and Orodata Science.