Health
How poverty affects childhood development in Nigerian capital
Eight-year-old Marvellous gripped a worn pencil tightly as she wrote on a single sheet of paper, kneeling on the bare concrete floor of an unfinished compound in Karshi, a satellite community on the outskirts of Abuja, Nigeria’s capital city.
Around her, four younger siblings sat barefoot, watching every movement of the pencil. Among them was a two-year-old toddler with mucus running from her nose.
The children barely noticed the visitor.
Because she is a minor, this reporter did not interview Marvellous directly. When asked if her parents were around, she quietly disappeared into the unfinished building behind her and returned moments later with her mother, Joy Kelvin.
Mrs Kelvin offered this reporter a wooden chair before settling on a stone beside the children. Behind her stood the family’s home, an unfinished three-bedroom building with exposed concrete walls and sections of roofing already beginning to deteriorate.
The structure does not belong to the family.
The owner allowed them to stay temporarily after they could no longer afford rent at their previous residence. The arrangement, however, comes with uncertainty.
“If the man decides to sell this house, we have no choice but to move again,” Mrs Kelvin told PREMIUM TIMES.
For many families, relocation is largely a housing challenge. For young children, particularly during their formative years, it can also disrupt the stability that underpins healthy development.
Frequent moves disrupt routines, friendships, schooling, and a child’s sense of security, all factors that child development experts say are essential during the early years of life.
Mrs Kelvin and her husband are raising five children on irregular incomes. She works as a domestic help while her husband is a tailor. Together, they navigate fluctuating earnings that force difficult choices about what can be paid for immediately and what must wait.
Food is often one of those choices. On some days, the family manages two meals. On other days, everyone eats only once.
Their meals consist largely of corn-based staples served with soup and whatever other food they can afford. Like many low-income households, they base their diet less on nutritional planning than on household income.
Despite these challenges, Mrs Kelvin remains determined to keep her children in school.
They attend a nearby private school, largely because the proprietor allows flexible payment arrangements.
“The owner of the school understands our condition, so she allows us to pay whatever we have, whenever we have it,” she said.
Without that flexibility, keeping the children in school would be difficult.
The family’s circumstances reflect a broader reality confronting many Nigerian households, where poverty shapes not only living conditions but also children’s opportunities to learn, play and thrive during the years experts describe as the most important period of development.
The years that shape a child’s future
Early childhood development refers to the period during which children experience rapid physical, cognitive, emotional and social growth.
Although the World Health Organisation (WHO) defines early childhood as the period from birth to age eight, child development specialists consistently identify the first five years as the most critical.
During this period, the brain develops at an extraordinary pace.
According to the United Nations Children’s Fund (UNICEF), more than one million new neural connections form every second during a child’s early years. These connections are shaped not only by genetics but also by the environments in which children grow, including the quality of nutrition they receive, the care they experience, opportunities for play and learning, housing conditions, exposure to stress and access to healthcare.
In practical terms, the environments children grow up in help shape how they learn, interact, communicate and adapt to the world around them.
For children like Marvellous and her siblings, those formative years are unfolding amid unstable housing, financial hardship and persistent uncertainty.
Inyang Ekan, a family physician working with Nigeria’s Sector-Wide Approach (SWAp) programme, said stability is especially important during early childhood because young children depend heavily on predictable environments to build emotional security and healthy social relationships.
Mr Ekan noted that stability extends beyond having a roof over a child’s head. It includes consistent relationships, familiar surroundings and routines that help children feel secure as they grow.
For families already struggling to meet basic needs, however, achieving such stability can be difficult.
When survival takes priority over stimulation
Inside Mrs Kelvin’s home, poverty influences more than where the family lives. It also shapes how every available naira is spent.
Feeding the children comes first. Other needs are considered only if money remains.
That reality became clear when Mrs Kelvin was asked whether she bought toys for her children.
“Toys?” she repeated, pausing briefly before responding.
“I can’t remember when last I got them toys. It is someone who has eaten that can buy toys.”
The response was neither dismissive nor indifferent. Rather, it reflected the practical calculations common in low-income households where every available naira is directed towards immediate necessities.
Beyond the paper in Marvellous’s hands, little suggested the kind of environment often associated with early childhood learning. Mrs Kelvin explained that the children often entertained themselves with sticks, improvised games and what she described as “children’s drama”, creating their own forms of play within the limits of what was available.
Mr Ekan says that childhood development depends on more than just food and schooling.
He noted that play, interaction, storytelling and exploration are all important components of early learning. Through play, children develop language, problem-solving abilities, creativity and social skills.
He added that developmental opportunities do not necessarily require expensive toys, but they do require stimulation and interaction.
Mr Ekan noted that siblings often play an important role in supporting early learning.
“Children can learn through teaching, guiding and playing with siblings. Simple games, storytelling, drawing and everyday objects can also support development.”
In many ways, Marvellous appeared to be performing that role. As she worked with her pencil and paper, her younger siblings watched closely, learning through observation and imitation.
However, developmental opportunities are also shaped by health and access to care.
Mrs Kelvin said she often relies on herbal remedies popularly known as “agbo” whenever her children fall ill. Formal healthcare is usually considered only when home treatment fails.
The nearest health facility, Karshi General Hospital, is geographically accessible. Financially, however, accessing healthcare is often more complicated.
Food insecurity and its developmental consequences
For Mrs Kelvin’s family, food insecurity is not simply about whether there is something to eat. It is also about whether the children consistently receive the variety of nutrients they need during the most important years of their development.
Orewole Fisayo, a paediatric nursing specialist at Mercy University Teaching Hospital in Osun State, described the first five years of life as a critical “window of opportunity” for child development.
“By age three, a child’s brain has already reached about 80 per cent of its adult size. Every nutrient a child takes in during this period is helping to build the architecture of the brain, immune system and physical body,” she said.
Ms Fisayo explained that inadequate nutrition affects far more than physical growth.
“These children do not underperform because they are less intelligent. Their brains are simply underfuelled.”
Research supports these concerns.
According to a World Bank report on Nigeria’s early childhood development outcomes, only 24.1 per cent of children aged four to six can write a simple word beyond their own name.
Just 39 per cent can correctly identify the larger of two single-digit numbers, while only 20.4 per cent demonstrate basic planning skills.
Broader indicators also reveal significant disparities in children’s access to adequate nutrition.
Data from the Nigeria Multidimensional Poverty Index show that food insecurity affects 24.1 per cent of children in Lagos, 34 per cent in Abuja, 49.5 per cent in Enugu, and 38.1 per cent in Kebbi.
Nutrition deprivation presents an equally troubling picture. While 11 per cent of children in Lagos experience nutrition deprivation, the figure rises to 12.1 per cent in Enugu, 31.5 per cent in Abuja and 54.4 per cent in Kebbi.
For households such as Mrs Kelvin’s, these statistics are reflected in everyday decisions about what food to purchase and how meals are distributed among family members.
According to Ms Fisayo, dietary diversity remains essential because no single food contains all the nutrients children require for healthy development.
Another childhood shaped by housing conditions
A few kilometres away, another family was confronting a different kind of hardship.
The first time this reporter passed through the area in Karshi, it was already evening.
Beneath a streetlight beside a row of shop compartments sat a small figure, motionless in the fading light.
From a distance, it was difficult to tell exactly what it was—a child, a shadow or simply another passing scene in a busy neighbourhood.
There was little reason to stop.
But on another evening, the figure appeared again in exactly the same place. Still beneath the same streetlight. Still alone.
Days later, on a Sunday morning, the mystery finally gave way to an answer.
People were coming out of the same row of shop compartments, moving in and out as if it were a lived-in space rather than a commercial structure. Among them were children.
The shops were not merely shops; people were living inside them.
That discovery raised a question this reporter could no longer ignore: What is it like for children to spend their earliest years growing up in a place never designed to be a home?
Living in two of the shop’s compartments was Loryoosu Ignatius, a farmer, occasional construction worker, and father of five.
When this reporter arrived, two of his sons were playing barefoot on a heap of stones beside a small corn farm behind the shops.
The older boy had just returned after calling his father from inside one of the compartments. He is eight years old. His younger brother is six.
Their three sisters, Mr Ignatius said, are in senior secondary school.
Mr Ignatius explained that his family previously lived in a rented three-bedroom apartment. Their circumstances changed after repeated thefts at his employer’s property. To protect the site, someone needed to remain there permanently.
He volunteered.
The arrangement eliminated rent but required that he relocate his family into the shop structures, where they have remained for the past three years.
“The man said he was going to come and build a standard space for my family and me, but to date, he has not come,” he said.
Inside, the family occupies two compartments. One serves as a sleeping space for the parents, while the other houses the children.
Neither room has windows.
At night, pieces of cloth are spread directly across the floor to create makeshift sleeping areas. During periods of intense heat, the family often sleeps outdoors.
“Sometimes the heat is too much, so we come outside to sleep,” he said.
For Mr Ignatius’ six-year-old son, these conditions have shaped much of his early childhood. Having spent three of his six years living in the shop compartments, he has grown up in a space never intended for family life.
His daily routine revolves around Government Primary School, Karshi, the surrounding open spaces and improvised forms of play.
Behind the shop structures, he and his brother use stones, sand, and discarded objects to create their own games, transforming the surrounding environment into makeshift playgrounds.
Despite these challenges, the family has developed ways of adapting.
Unlike Mrs Kelvin’s household, food insecurity is not their primary concern.
As a farmer, Mr Ignatius grows rice, beans, yams, and other crops. Much of what the family eats comes directly from the farm.
“We eat fruits very well. The children eat what we harvest.”
The health risks hidden within inadequate housing
The shop compartments present challenges that extend beyond overcrowding.
Poor ventilation, exposure to mosquitoes and environmental hazards all shape the children’s daily experiences.
“I have killed many snakes here,” Mr Ignatius said.
The same open spaces where the children play during the day become sources of concern at night.
Health issues have also emerged within the household. Mr Ignatius described recurring skin conditions affecting some of the children. Although he could not identify the condition by name, he demonstrated its appearance by drawing circles on his arm. He explained that he treats it at home using Ampiclox mixed with water.
While Mr Ignatius spoke about these conditions matter-of-factly, child development experts say the implications extend beyond day-to-day discomfort.
During the first five years of life, repeated exposure to illness, poor housing and environmental stressors can shape children’s physical, cognitive and emotional development in ways that may persist into later childhood.
Princess Olatubosun, a psychiatrist with the Ifedoyin and Friends Charity Organisation, said such living conditions can affect children’s health and development in multiple ways, often extending beyond the immediate risks that families notice.
Ms Olatubosun explained that poor ventilation and overcrowded living spaces can increase the risk of respiratory infections, including pneumonia and other illnesses that spread in poorly ventilated environments.
Sleeping outdoors, she added, exposes children to mosquito bites, increasing the risk of malaria and other vector-borne diseases.
According to her, prolonged exposure to excessive heat and inadequate shelter can also lead to dehydration, sleep disruption, heat stress and physical discomfort. While these conditions may appear temporary, they can affect children’s overall well-being and their ability to learn and concentrate.
She further noted that environmental conditions surrounding daily activities can create additional health risks. Children who spend significant time in outdoor environments may be exposed to smoke, environmental pollutants, contaminated water and poor hygiene conditions that can contribute to infections and other illnesses.
Frequent illness, she said, can have broader developmental consequences.
Children who are repeatedly unwell may experience reduced appetite, poor nutrient absorption and interruptions to normal growth and development.
Beyond physical health, she noted that inadequate sleeping conditions can affect sleep quality, concentration, learning ability and emotional regulation.
“Inadequate housing and lack of privacy can cause stress, anxiety and emotional insecurity in children,” she said.
She added that repeated exposure to unstable living conditions may also contribute to feelings of insecurity and social stigma, affecting children’s mental health, confidence and social development.
Learning beneath a streetlight
Each evening, the streetlight outside the shop compartments takes on a purpose beyond lighting the neighbourhood.
It becomes a classroom.
It was beneath that same light that this reporter repeatedly noticed the small figure sitting quietly in the evenings, long before discovering that families were living inside the shop structures.
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Mr Ignatius explained that his employer installed the light outside the property. With limited electricity in the shop’s compartments, his children move outdoors after sunset, setting up a small table beneath the streetlight to complete their homework.
What appears to be resilience is also evidence of deprivation.
The children are learning, but under circumstances few would choose for them.
A different beginning
Within the same community, another household presents a contrasting picture.
When this reporter visited the home of Goodness Adaoyiche, signs of childhood were immediately visible.
Teddy bears rested on a chair inside the sitting room. Children’s books and educational materials were kept in designated spaces. The environment was organised, well-ventilated and clearly structured around the needs of young children.
Mrs Adaoyiche and her husband are raising two children aged six and four.
Unlike the previous households, concerns about housing insecurity and food scarcity were absent from the conversation.
Instead, discussions centred on learning, growth and development.
Mrs Adaoyiche explained that educational activities are intentionally encouraged at home. Her younger child, currently in Nursery One, can already read simple words. To demonstrate this, she produced certificates recognising academic performance and classroom participation.
Nutrition also receives deliberate attention.
“My children eat as much as they want, sometimes five times a day,” she said.
Although food is readily available, she explained that meals are carefully balanced and regularly include fruits and other nutritious foods.
The family also provides educational toys and learning materials, replacing them whenever necessary.
The children were not at home during this reporter’s visit, but the environment itself spoke volumes.
Unlike the uncertainty that surrounded Marvellous’ family or the cramped shop compartments where the Ignatius children were growing up, this home offered predictability, stability and space to learn and play.
The contrast was about more than material possessions.
It reflected the vastly different developmental opportunities available to children growing up within the same community.
Books, toys, balanced nutrition, structured learning and stable housing combine to create an environment that nurtures healthy development during the earliest years of life.
What the data reveals
The differences observed across the three households mirror broader national patterns.
According to the Nigeria General Household Survey-Panel (GHS-Panel) Wave 5 (2023/2024), approximately 74 per cent of children in urban areas are able to complete most developmental tasks assessed in the survey, compared with only 42 per cent of children in rural areas.
The gap is particularly evident in literacy-related skills, where urban children outperform rural children across reading, writing, and letter recognition indicators.
Researchers attribute these disparities to differences in access to educational resources, household learning environments, caregiver support and broader socio-economic conditions.
The contrast between Mrs Kelvin’s unfinished home, the Ignatius family’s shop compartments and Mrs Adaoyiche’s household demonstrates how these national disparities are experienced in everyday life.
While one child grows up amid housing uncertainty and food insecurity, another navigates environmental hazards and overcrowded living conditions, while others benefit from stable homes, learning materials and consistent nutrition.
Together, their experiences show how living conditions shape developmental opportunities long before formal schooling begins.
The findings suggest that childhood development is shaped not only by individual ability but also by the environments in which children grow.
Editor’s note: The names of the children used in this report have been changed to protect their identities.
Under the harsh April sun, the heat was oppressive in Fagge Local Government Area of Kano State. But 56-year-old Uma Usman kept walking from one compound to another, calling out familiar names, knocking gently on half-open doors and asking after children she had come to know over the years.
She is not an employee of the local Galadima Primary Health Centre. Her name does not appear on any government payroll. Yet, she has become one of the most important links in the community’s immunisation system.
Her job is to find children who missed their routine immunisation appointments.
“I know the community very well, so I follow them house by house,” Mrs Usman told PREMIUM TIMES. “If the parents don’t come, we check the register and trace the households.”
For Mrs Usman, behind every missed appointment, there is a story.
Sometimes a child is ill. Sometimes a mother cannot raise money for transport. Sometimes parents are occupied with work or family responsibilities.
“When you reach a house, you find it is not that they don’t want to come,” she said. “Something just stood in the way.”
Mrs Usman’s daily routine illustrates a broader reality observed in a PREMIUM TIMES investigation in Kano and Gombe states.
Contrary to the widespread assumption that vaccine shortages are the biggest obstacle to routine immunisation, frontline workers in the two states described a different problem. Vaccines are usually available. The challenge is ensuring children complete the immunisation schedule.
However, for many families who spoke with PREMIUM TIMES, the barrier is not acceptance but access. Long distances to health facilities, transport costs, delayed outreach activities and the daily struggle to earn a living often interrupt follow-up visits. As a result, many children receive their first vaccine but never complete the doses needed for full protection.
The consequences extend far beyond individual families.
This investigation examined routine immunisation efforts and challenges in Kano and Gombe between 2023 and 2026, drawing on field visits, interviews, official records and data from health authorities and development partners.
The period captures the continuing struggle to reach children who have never received a vaccine, as well as those who start their vaccination schedule but fail to complete it.
According to UNICEF, Nigeria has one of the world’s largest populations of zero-dose children, those who never received a routine vaccine. Its latest data shows that only about 67 per cent of surviving infants receive the third dose of the diphtheria, tetanus and pertussis (DTP3) vaccine, while coverage for the second dose of the measles vaccine is about 35 per cent.
Although routine immunisation coverage has improved in recent years, many children still receive no vaccines at all or fail to complete the schedule.
Behind those national figures are thousands of individual stories like the ones Mrs Usman encounters every week.
But the investigation found another, less visible reality.
Across communities in Kano and Gombe, routine immunisation continues largely because health workers, volunteers and community mobilisers bridge gaps created by delayed funding, difficult terrain and overstretched primary healthcare systems.
Many spend their own money to reach remote settlements. Volunteers without formal employment trace children from house to house. Outreach activities continue even when operational funds arrive months late.
Different communities, same struggle
The pattern seen in Fagge extends far beyond one community.
In Takai LGA of Kano State, reaching children who miss vaccination appointments often means travelling long distances across scattered settlements. Health workers say routine clinic sessions alone are not enough; repeated outreach visits are essential to find children who fail to return.
“There is never a time when people come and we do not have vaccines,” said Muhammad Ali, the officer-in-charge at Gamawa Health Post in neighbouring Gombe State.
Field records reviewed by PREMIUM TIMES and interviews with frontline workers showed that children scheduled for follow-up are not always reached as planned.
Health workers explained that outreach teams frequently face transport constraints, limited time, and difficult terrain, making it impossible to visit every household listed for follow-up during a single outreach exercise.
“We don’t refuse to go,” one health worker said. “But sometimes the list is longer than what we can physically cover in one outreach.”
Many children miss vaccine doses because follow-up visits could not be completed.
In Billiri LGA of Gombe State, the pattern is the same.
Health workers and volunteer mobilisers spend almost as much time searching for children who missed appointments as they do on administering vaccines.
Across these locations, one pattern persists: children often begin immunisation but fail to complete the schedule because of family challenges.
A system sustained by people
For Ignatius Essien, general manager of eHealth Systems Africa, the difficulty families face getting to health facilities helps explain the introduction of the Zero Dose Support Programme.
Mr Essien said the programme gives transport support to caregivers who bring their children for immunisation. It applies to children coming for either their first dose or subsequent doses.
“The funds are not tied to routine immunisation outcomes,” he stated.
He explained that the idea grew from what health workers repeatedly saw in the field: families who wanted to vaccinate their children but lived too far from health facilities or could not afford the fare to get there.
“Some say they cannot even afford transport fare to the clinic,” he said. “That is what stimulated the stipend.”
The support started at N500 but has since increased from N1000 to N2500 depending on the vaccine type as transport fares and the cost of living rose.
At Sansani PHC in Billiri LGA, routine immunisation sessions typically attract between 30 and 45 caregivers.
Behind those clinic days, however, lies another routine that is rarely captured in official reports —tracing children who do not return.
The facility’s Head of Immunisation, Elias Ezekiel, said health workers use immunisation registers to identify children who miss appointments from the catchment seven communities.
“From the register, if anyone misses, we follow up,” Mr Ezekiel told PREMIUM TIMES.
That work depends on outreach funding.
The health centre receives about N35,000 monthly for outreach activities, but the money is released quarterly by the State Primary Health Care Development Agency.
When PREMIUM TIMES visited, more than three months had passed without any release.
Mr Ezekiel said the delays are routinely reported through local government health authorities.
“If we stop outreach, the children will miss their vaccines,” he said.
So, staff members buy fuel and pay transport costs from their own pockets while waiting for the fund.
His account echoed those of several frontline workers interviewed across Kano and Gombe.
Vaccines are generally available, they said, but getting them to children in remote communities often depends on health workers absorbing the cost whenever operational funding is delayed.
That challenge is more difficult for facilities serving scattered settlements.
A quiet crisis in the North
The challenges confronting health workers in Kano and Gombe reflect a much wider crisis across northern Nigeria, where hundreds of thousands of children remain unreached by routine immunisation.
In April 2025, UNICEF estimated that about 53,000 children in Gombe State had never received a routine vaccine. More than half of them were in five high-risk LGAs, including Akko, where health authorities were contending with poor access to healthcare, low awareness and vaccine hesitancy.
To address the problem, the Gombe State Primary Health Care Development Agency, with support from UNICEF, launched the Fathers’ Response Team in 2024 to encourage greater male involvement in decisions about child health and immunisation.
Even so, many children continue to miss life-saving vaccines.
The challenge is even greater in Kano.
UNICEF estimates that more than 300,000 children are zero-dose, accounting for half of the burden across Kano, Katsina and Jigawa states.
UNICEF’s Chief Field Officer in Kano, Rahama Farah, said more than 600,000 children across the three states have yet to receive their first routine vaccine dose.
Many of these children live in remote or underserved communities where access to healthcare remains inconsistent.
“This is a basic fundamental child right,” Ms Farah noted.
She also warned that missed vaccinations increase vulnerability to outbreaks of preventable diseases and urged caregivers to complete immunisation schedules.
Why Kano and Gombe tell different stories
Although Kano and Gombe face similar immunisation challenges, the underlying pressures are different.
In Kano, the greatest obstacle is scale. With a population of more than 17 million people and over 600,000 births every year, health facilities operate under constant pressure.
The 2021 Multiple Indicator Cluster Survey (MICS) found that about 30.2 per cent of children in Kano are zero-dose, while only about 48 per cent complete the full routine immunisation schedule by their first birthday. National estimates indicate dropout rates of up to 31 per cent between the first and third doses of routine vaccines.
In Gombe, where the population is less than a third of Kano’s, geography plays a larger role. Communities are more dispersed, distances are longer, and access to health facilities often requires significant time and effort.
Estimates place Gombe’s zero-dose prevalence between 18 and 22 per cent, with only about 36 per cent completing full immunisation in some datasets.
Where the system weakens
The investigation found that the biggest weakness in routine immunisation is not getting children into the system.
It is keeping them in it.
Across health facilities in Kano and Gombe visited by PREMIUM TIMES, workers consistently described a system that performs relatively well at administering first doses but struggles to retain children through the full vaccination schedule.
Nationally, dropout rates between early and later vaccine doses range from about 12 to 30 per cent, depending on location.
At the Galadima PHC in Kano, Hauwa Isa, the assistant head of the facility, pointed to a solar-powered vaccine refrigerator stocked with vaccines.
“We have complete vaccines in the fridge,” she said. “We conduct immunisation three times a week and spend other days on outreach.”
“The real issue is not availability. It is continuity.”
That continuity depends on a governance system in which responsibility is shared but accountability is often blurred.
Primary health centres are under local governments, while state Primary Health Care Development Agencies oversee much of their staffing and operations. The federal government sets national policy and supports key immunisation programmes through partnerships with development agencies.
Health workers told PREMIUM TIMES that when outreach funding is delayed or operational gaps emerge, it is often difficult to determine where responsibility lies.
Money, priorities and the field reality
Over the past five years, both Kano and Gombe have recorded sharp increases in their budgets.
Official budget documents show Kano State’s spending plan rose from N221.24 billion in 2022 to N1.47 trillion in 2026, while Gombe’s grew from roughly N154.96 billion to N617.95 billion over the same period.
Those figures suggest governments have greater financial capacity to deliver public services, including primary healthcare.
Yet interviews with frontline workers across both states tell a more complicated story.
For them, the size of the budget does not matter when operational funds do not arrive when they are needed.
Outreach funding illustrates that gap.
It is the money that helps vaccines to reach children in remote communities. Health workers say when those funds are delayed, outreach activities depend on staff members improvising.
In Fagge and Takai LGAs of Kano State, workers told PREMIUM TIMES that each PHC is allocated about N7,000 a month for outreach transport.
Several months’ allocations are often paid together in arrears at the end of a quarter, long after many of the outreach visits.
In Gombe State, PHCs receive N35,000 a month for outreach transport, but the money is likewise paid quarterly.
The situation is even more difficult at health posts.
Unlike PHCs, they receive no dedicated transport allocation, according to workers interviewed by PREMIUM TIMES. Yet they are responsible for tracing children who miss appointments and carrying vaccination services to remote settlements.
When priorities compete
Funding pressures extend beyond the health sector.
Budget documents reviewed by PREMIUM TIMES show that both Kano and Gombe have made substantial allocations to debt servicing in recent years.
In the 2026 fiscal year, Kano budgeted about N69.84 billion for debt repayment, while Gombe allocated roughly N37.23 billion.
Those obligations are met before many operational funds are released to sectors such as PHCs, reducing the fiscal space available for routine service delivery.
Health workers say they experience those pressures in delayed outreach, postponed field visits and reduced operational flexibility.
Government spending priorities are also visible elsewhere.
In Kano, the state approved the purchase of 41 sport utility vehicles (SUVs) for members of the House of Assembly in 2024 at a cost of about N2.6 billion, alongside other vehicle purchases for the executive and security agencies.
In Gombe, similar procurements included 41 SUVs for lawmakers and commissioners in 2023, while more than N2 billion was allocated for vehicles for the judiciary in 2025.
Government officials have defended such purchases as necessary for governance and movement across challenging terrains.
For health workers travelling across the same terrains, however, the contrast is difficult to ignore. Many outreach teams continue to rely on motorcycles, commercial transport, or long walks to reach remote communities.
Where the system holds
Despite its weaknesses, northern Nigeria’s routine immunisation system continues to function because thousands of frontline health workers, volunteers and community mobilisers return to the same communities, often with limited resources, determined to find children who have missed their vaccines.
But sustaining that effort requires more than commitment, according to public health expert Abdulhameed Adediran, who warned that children who miss subsequent vaccine doses remain vulnerable to preventable diseases.
“A child is supposed to have three doses but has only the first dose. That child is not 33 per cent protected. That child is not protected because the first dose is supposed to last for a particular period before the next one is administered to have a complete effect,” he told PREMIUM TIMES via phone interview.
Mr Adediran said inadequate financing for PHC undermines the entire immunisation system. According to him, when outreach activities are poorly funded, children in distant communities are more likely to miss vaccinations, leaving dangerous gaps in disease prevention.
He traced many of the problems to systemic weaknesses, including poor funding, shortages of health workers, weak accountability, and inadequate infrastructure. In many facilities, he noted, community health extension workers shoulder responsibilities beyond their intended roles because of years of limited recruitment.
Mr Adeniran said immunisation programmes must be designed around the realities of the communities they serve rather than through one-size-fits-all approaches.
“People sit in Abuja and take decisions for people in those villages, and those decisions don’t necessarily work for them or are not necessarily applicable to them,” he explained, adding, “We need to start looking at a tailored, people-centred approach to our health institutions.”
Government responds
Responding to the findings, the Gombe State Primary Health Care Development Agency acknowledged that delays in releasing outreach funds sometimes occur, attributing them to administrative procedures, financial reconciliation processes and the timing of support from development partners.
The State Immunisation Officer, Abdulkarim Aliyu, said routine immunisation outreach is funded through a combination of government resources and donor support, with disbursements passing through several approval and accountability processes before reaching health facilities.
While acknowledging the effect of delayed releases, Mr Aliyu praised frontline workers who continue to provide outreach services despite funding constraints.
“We also recognise and appreciate the dedication of frontline health workers who often go the extra mile to ensure that vaccination services continue even when resources are delayed,” he said.
He said the agency has strengthened defaulter-tracking systems, expanded community mobilisation through Ward Development Committees, Community Health Influencers, Promoters and Services (CHIPS) agents and the Mama-to-Mama initiative, while holding regular review meetings to identify communities with high dropout rates and deploy targeted interventions.
Mr Aliyu added that the agency was pursuing workforce training, supportive supervision, and strategic staff deployment to address staffing shortages, while routine data validation and quality assessments are used to monitor immunisation records and identify children who miss scheduled vaccinations.
Looking ahead, he said the agency would focus on strengthening outreach services, improving community engagement, and expanding efforts to identify and vaccinate zero-dose and under-immunised children.
In Kano, the Director-General of the State Primary Health Care Management Board, Salisu Ibrahim, said outreach stipends are paid through a performance-tracking system supported by Acasus, a routine immunisation partner that monitors outreach sessions conducted by service providers.
Mr Ibrahim explained that payment delays sometimes occur because service-delivery records must first be verified before payments are processed.
He said the state has adopted several measures to reduce vaccine dropout rates, including ensuring that planned immunisation sessions are conducted, expanding public awareness campaigns, and addressing practices that contribute to missed vaccination opportunities.
While acknowledging financial pressures, he said the current administration of Governor Abba Yusuf increased outreach stipends from N1,000 to N4,000 per session to help health workers cope with rising transportation and operational costs.
He added that the board also conducts monthly data validation exercises, review meetings and independent surveys to identify service gaps and strengthen routine immunisation in underserved communities.
Whether those efforts will be enough to reduce the number of children missing vaccines remains uncertain.
What is clear, however, is that across communities in Kano and Gombe, routine immunisation continues to depend heavily on the persistence of health workers, volunteers and caregivers who keep showing up despite funding delays, staffing shortages and the difficulties of reaching remote settlements.
For many children, completing vaccination depends on that fragile chain.
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The National Agency for Food and Drug Administration and Control (NAFDAC) has alerted Nigerians to the circulation of a suspected counterfeit asthma medicine, warning that its use could lead to treatment failure and other serious health risks.
The agency made this known on Friday in a public alert shared on its official X account, saying the suspected falsified product, Ulmicort 0.5 mg/ml Inhalation Suspension, was detected during market surveillance conducted by pharmaceutical company AstraZeneca.
According to NAFDAC, AstraZeneca informed the agency that the product closely resembles its registered asthma medicine, Pulmicort (Budesonide) Nebulising Suspension, and could mislead healthcare professionals and patients.
Pulmicort is an inhaled corticosteroid prescribed to prevent asthma symptoms such as wheezing and shortness of breath, and is used as a maintenance treatment for people living with asthma.
Health risks
NAFDAC warned that counterfeit medicines may not meet the required standards of quality, safety and efficacy.
It explained that such products could contain incorrect ingredients, the wrong quantity of active ingredients, harmful contaminants, or no active ingredient at all.
“The use of such products can result in treatment failure, worsening of respiratory conditions, unexpected adverse effects and other serious health consequences,” the agency said.
Asthma is a chronic disease that affects the airways in the lungs, causing them to become inflamed and narrowed. It can lead to symptoms such as wheezing, coughing, chest tightness and difficulty breathing, and requires regular treatment to keep symptoms under control.
Product traced to Anambra
Providing details of the suspected counterfeit product, NAFDAC said it bears the batch number 25770416E, with a manufacturing date of June 2025 and an expiry date of May 2027.
It was reportedly found in Eastern Nigeria and traced to a distributor’s address at 15 Chizzon, Awada, Obosi North, Anambra State.
The agency added that the suspected counterfeit product is labelled as being manufactured by Legency Remedies PVT Ltd, located in Himachal Pradesh, India.
NAFDAC said it has commenced an investigation to determine the source and distribution network of the suspected counterfeit medicine.
The agency added that all its zonal directors and state coordinators have been directed to intensify surveillance and conduct mop-up operations to remove the product from circulation nationwide.
READ ALSO: NAFDAC blacklists Onifam Laboratories over regulatory violations
Advice to consumers
NAFDAC urged consumers and healthcare professionals to buy medicines only from licensed pharmacies and authorised distributors, and to examine product labels and packaging before use carefully.
The agency also encouraged the public to report suspected cases of counterfeit or substandard medicines to the nearest NAFDAC office via its toll-free line, email, or online reporting platforms.
It advised healthcare professionals and patients to promptly report any adverse reactions linked to medicinal products through its pharmacovigilance reporting channels.
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