Stakeholders in Lagos State have called for urgent action to address the deepening crisis in the delivery of Primary Health Care (PHC), accusing local councils of failing to perform their statutory duties.
They stated that the neglect has left many communities without access to basic health services, forcing the state government and development partners to assume responsibilities that should be managed at the local council level.
The concerns were raised during a PHC Accountability Framework Review Workshop organised by the Lagos State Primary Health Care Board (PHCB), in collaboration with the International Society of Media in Public Health (ISMPH), the Legislative Advocacy Initiative for Sustainable Development (LISDEL), and other partners. The forum sought to advance access to healthcare, strengthen accountability, and review progress in the state’s PHC system.
The Director of Planning, Research, and Statistics at PHCB, Dr. Temitope Balogun-Alo, disclosed that more than 100 wards in Lagos have no PHC facilities, despite 20 new centres currently under construction.
She also said the state is grappling with a shortage of nearly 5,000 health workers, a situation she attributed to the continuous exit of staff, brain drain, and the difficulty of attracting doctors and nurses to work in underserved areas.
Balogun-Alo explained that discrepancies in ward classifications complicate planning and distribution of health facilities. According to her, Lagos has 376 wards administratively, but federal programmes often rely on political ward structures, which create confusion and inequity. “In some cases, one ward may have several Primary Health Centres (PHCs) while another has none. This is a major challenge to equitable distribution,” she said.
She further highlighted the challenges of land availability for building new facilities in urban areas. “Right now, urban areas are fully built up, and there is no farmland lying around. Many of the new facilities were only possible because communities graciously gave us land. But if land size is not appropriate for our prototype design of comprehensive health centres, ordinary PHCs, or clinics, we cannot build,” she said.
Beyond infrastructure, staffing remains a critical concern. The director noted that continuous replacement of staff leaves the system not keeping pace with demand. To address these challenges, she said the board is exploring outreach models and health posts, where mobile teams would visit underserved communities a few times weekly to deliver services.
She also revealed that the state is advocating for pooled funding for PHCs, to be shared based on equity rather than equality, ensuring rural and underserved areas receive fair support.
On referral services, Balogun-Alo said Lagos is working with the Ministry of Health to improve emergency response, including the revival of water ambulances for riverine communities and the introduction of telemedicine to extend access.
However, she lamented that the state still depends on ambulances procured in 2009, of which only 30 remain functional. She urged renewed investment in standard ambulances to strengthen linkages between primary and secondary health centres.
She further disclosed that PHCB prioritises continuous training for PHC staff, much of which is supported by development partners. “If there is one thing we are doing well, it is training. Our workforce is constantly trained and retrained, especially in preventive care, which is the foundation of primary health,” she said.
In his remarks, the Chairman, House Committee on Health and Primary Healthcare, Apapa Constituency, Hon. Lawal Musibau, said the Assembly has observed major lapses during oversight visits to PHCs. According to him, while facilities belong to local governments, the personnel are managed by the PHCB, yet councils often neglect their duty to maintain infrastructure or support workers’ welfare.
“We saw PHCs without proper call rooms for doctors and nurses. Councils think that because personnel come from the board, they should not take responsibility for their welfare. This is unacceptable,” he said, promising further oversight to hold councils accountable.
Also, Chairman of the Lagos State Community Development Advisory Council (LSCDAC), Amusat Azeez, commended the forum for involving communities in health sector accountability. He said the programme provided an opportunity to understand how funds are allocated and how effectively they are utilized at the grassroots level.
The Director of Programmes at LISDEL, Ademuyiwa Damilola, emphasised the importance of accountability in health financing. He said efficient use of limited resources requires strong transparency mechanisms, noting that LISDEL has worked closely with the state health sector to strengthen accountability systems.
