How corruption hinders healthcare in conflict-torn Plateau communities
In Bokkos Local Government Area of Plateau State, grief is no longer a visitor, it has become a resident. Waves of armed attacks have left villages deserted, homes razed and families forced into makeshift camps. For survivors, the struggle does not end with escaping bullets and machetes alone, it continues in their daily fight to […]
In Bokkos Local Government Area of Plateau State, grief is no longer a visitor, it has become a resident. Waves of armed attacks have left villages deserted, homes razed and families forced into makeshift camps. For survivors, the struggle does not end with escaping bullets and machetes alone, it continues in their daily fight to find health care.
It has also been revealed that budget irregularities in primary health care in Bokko have deepened the suffering of the already traumatised communities. Despite huge allocations running into millions of naira in the past three years, documents and interviews show that most health centres remain underfunded, understaffed and in ruins.
A mother’s struggle at IDP camp
At the internally displaced persons (IDP) camp in St Thomas Catholic Church, Bokkos town, sitting quietly on a plastic chair and strapping her week-old baby on her back, wrapped in a faded multi-coloured cloth, a 30-year-old Monica Jonah recalled how she flee her home in Kadim village – 15 kilometres away while eight months pregnant.
“I ran so fast that I even forgot I was pregnant. It was life and death,” she said, softly.
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Monica delivered her baby at Bokkos Cottage Hospital but has not been able to return for postnatal checks or immunisation because: “The hospital is far from here and I don’t have transport money. Even when you get there, you still pay for services. I just thank God that I am alive.”
Her story is not unique. Across Bokkos, residents displaced by violence face a collapsing health system – one crippled not just by conflict but also by corruption and neglect.
Sharp Practices
This crisis reflects a broader national reality: A 2025 analysis by Chatham House ranks Nigeria among the 40 most corrupt countries globally, with corruption deeply embedded in public administration and service delivery.
The chairman of Bokkos Local Government, Amalau Samuel, hinted at such corruption at primary health centres within the local government area when he said, “Members of staff in some primary health care centres deliberately conceal government-supplied drugs, choosing instead to sell privately purchased medications to patients for personal profit. Only after exhausting their own stock do they release the government-provided drugs. This trend often leads to essential medicines expiring unused.”
A 2020 study published in the International Journal of Health Policy and Management identified absenteeism, procurement-related corruption, under-the-counter payments and employment-related corruption as the most damaging practices in Nigeria’s health sector. Practices that continue to undermine care for millions are already pushed to the margins.
Meanwhile, according to the United Nations High Commission for Refugees (UNHCR’s) Nigeria’s dashboard as at August 2025, the country hosts 3.57 million internally displaced persons – millions navigating broken systems in search of survival.
Budgets on paper, nothing in practice
According to the Director of Primary Health Care in Bokkos, Mr Joseph Lar Dashe, the local government has 106 primary health care centres, out of which 97 are functional, with 225 health workers serving a population of about 200,000 people.
A budget document obtained from Dashe through a Freedom of Information (FoI) request in June 2025 paints a grim picture of the funding and service delivery of these primary health facilities.
The document covered three years: 2023, 2024 and 2025. Approved budgets rose from N192 million in 2023, remained the same in 2024 and increased to N246 million in 2025.
But under the column: “Funds Used by Facilities,” the entry was a simple word: NIL,
In other words, none of the 97 functional primary health care centres in Bokkos received direct funding in any of the three years, although Dashe told this reporter that the budgeted sums were 100 per cent dispensed.
According to him, allocations from the local government “only go for salaries and other allowances or logistics for special programmes; that is all.”
This explained why personnel and overhead costs gulped a larger chunk of the budget. In 2025, salaries consumed N177.2 million or 72 per cent of the total budget. Allowances gulped another N80.8 million, bringing personnel expenses to over N258 million, an amount (N12 million) higher than the entire budget approved for that year.
The same pattern appeared in 2024 when personnel costs of N224.8 million were charged against an approved budget of N192 million. That year alone, staff expenses jumped by 158 per cent compared to 2023.
In July 2024, Nigeria signed a new minimum wage of N70,000 into law, which revised the previous N30,000 set in 2019.
This new wage, effective from May 2024, might not be unconnected to the significant increase in salaries and wages as reflected in the budget.
Speaking about the implications of poor funding of primary health care centres by local governments, Alhassan Yahaya, the chairman of Maternal-Neonatal Child Health Care (MSCH) in Gombe State said, “Ninety-nine per cent of PHCs in Nigeria channel their budgets to salaries and wages, as well as personnel. This is to tell you that local governments don’t fund primary health care centres.
“Thank God that the federal government came up with initiatives of revitalising health care, like the basic health care provision fund, but if for any reason that funding stops, primary health care will suffer, which means that more women and children are going to die.”
Drugs and supplies reduced to crumbs
While salaries swelled, money for medicines shrank. In 2025, just N5 million was set aside for “drugs/lab/medical supplies.” Spread across 97 facilities, that amounts to an average of N4,292 per centre in a month.
For context, Kim Jerry Bot, a pharmacist and the director-general of the Plateau State Drugs and Medical Commodities Management Agency, said such amount could not be enough to treat malaria for an individual.
“Treating malaria now is more than N7,400 on average, including investigations, let alone stock a community health facility,” he said.
Christiana Ajawa, a 60-year-old resident of Daffo, confirmed this reality thus: “Most of the medicines we need are not available. They mostly give us Paracetamol for everything.”
Another resident, Eli John, who has delivered seven children at Daffo Primary Health Centre, however, acknowledged improvement in antenatal and postnatal care, but lamented lack of drugs, saying, “That is our biggest setback.”
Responding to the issue of corrupt practices in primary health care centres that hinder patients from accessing drugs in facilities, the chairman of Bokkos Local Government said there were mechanisms in place to ensure that citizens benefit from government’s interventions on medicines.
This, according to him, involves community leaders and village heads reporting such corruption.
According to a 2022 United Nations Development Programme (UNDP) review of Nigerian primary health care centres, fewer than half of such public facilities nationwide had consistent medicine stocks.
However, in Bokkos, “miscellaneous” spending in the budget ballooned from N3 million in 2023 to N22.5 million in 2025, with no breakdown provided. Travel and transportation gulped N6 million, more than the drug budget, while printing alone consumed N2 million.
Health centres in ruin
The challenges are not just financial. Months of violent attacks in Bokkos communities have destroyed or shut down several primary health care centres.
According to Dashe, five facilities were burnt: Hokk, Kopmur, Hurti, Shorom and Suwa.
In Kaban village, this reporter found the primary health care centre locked and deserted.
Two women working on a nearby farm, who pleaded that their identities be concealed, explained that the facility had been locked for weeks as health workers had fled.
In Horop, the primary health care centre had been moved to a small shop-like structure by the roadside while renovation of its permanent site stalled.
Dabit Clement Joseph, the youth leader of Horop, who lamented that the temporary site was too small and could not admit patients, pleaded that something be done.
He said, “Although our community has not been attacked, affected persons from nearby communities who came in need of medical assistance could not access the primary health care centre because it is mostly locked. Even when some do, the size of the current facility is so small that patients who come for treatment cannot be admitted because it only operates from a small room.”
A man who identified himself as a security staff member living close to Horop Primary Health Care Centre, which is under renovation said, “The workers came once, dropped materials for the new building and never returned.”
With this development, residents of Horop face a critical health care gap as the abandoned renovation and inadequate temporary clinic leave them without reliable access to medical treatment in sight.
Sources who spoke to this reporter in communities that were attacked said health facilities were targeted during attacks. Equipment was stolen or destroyed in Kopmur, Hurti, Hokk, Shorom, Marshi, Horop and Kaban.
“One of our staff lost his life. Normal services have been paralysed because health workers closed facilities out of fear,” Dashe said.
Two primary health care workers from different facilities admitted that the crisis worsened the already dire shortage of staff. Volunteers fill critical gaps but without pay or official recognition.
‘No enough hands to work’
Even before the attacks, Bokkos was struggling with manpower crisis. With only 225 health workers for about 200,000 residents, according to local government estimates and population projections based on the 2006 census, the ratio is one health worker to every 800 people. Meanwhile, the World Health Organisation recommends one to 225 people.
Three primary health workers who spoke anonymously for fear of losing their jobs, said they were overwhelmed.
“In our facility, we are expected to run three shifts, but we are just two employed staff, one community health extension worker and a volunteer. It is impossible to cope. What happens when we break down?” one of them asked.
The Federal Ministry of Health and Social Welfare, in a 2024 report revealed that Nigeria had only 1.83 health workers per 1,000 people, which falls far below the WHO benchmark of 4.45 per 1,000.
Bigger picture of systemic neglect
The problems in Bokkos mirror national challenges. The Basic Health Care Provision Fund (BHCPF), created in 2014 to strengthen primary health care centres using one per cent of federal revenue, supports 14 facilities in Bokkos.
While confirming support for drugs to the facilities, benefiting from the BHCP fund, Mr Dashe acknowledged that the project gives “them (the 14 PHCs) money for drugs from the Drug Revolving Funds. “But besides buying the drugs, when the primary health centre realises that they still have drug supplies, they could use the funds for minor repairs of the facilities like windows, cracks on walls or wells.”
Mr Dashe’s remarks, while seemingly supportive of the flexibility granted to PHCs under the Basic Health Care Provision Fund (BHCPF), inadvertently expose a deeper issue of systemic mismanagement and lack of oversight.
A retired director of primary health centres in Bokkos, Mrs Mildred Gokum, said the neglect had been long-standing, adding, “There is a yearly budget from the local government area, but nothing is released for projects. Proposals for drugs are ignored. Staff strength has always been poor.”
The World Bank, in its health financing reports, also links weak primary health centre performance to poor governance at the facility level. It notes that only 30 to 40 per cent of Nigeria’s public primary health centres are functional and about 40 per cent of them lack electricity. Many facilities average just six to 10 hours of power daily, undermining vaccine storage and emergency services.
The human cost
As centres remain shut, residents are forced to travel long distances or rely on private chemists. Women risk childbirth without skilled care. Children miss vital immunisations, and common illnesses become deadly.
The World Health Organisation and United Nations Children’s Fund (UNICEF) both use the completion of the third dose of the DTP (diphtheria, tetanus toxoid, and pertussis) vaccine (DTP3) as a measure of primary health strength.
Nigeria’s DTP3 coverage remains around 62 per cent, far below the universal coverage goal of 90 per cent. In Bokkos, where drug budgets are crumbs and primary health centres lie in ruins, that figure is even lower.
At the IDP camp in St Thomas Catholic Church, Monica is nursing her newborn gently, not having an idea of when he would receive his first vaccination.
Bokkos communities are not only battling the trauma of violent conflict, they are also victims of a silent war waged through corruption and neglect in their health system.
Budgets exist on paper but facilities see nothing. Salaries balloon, but medicines vanish. Buildings are burnt or abandoned. Health workers are too few, and those who remain are overworked and afraid.
The result is a health system paralysed by irregularities, leaving families at the mercy of both insecurity and disease. Unless accountability returns to primary health financing, Bokkos and many communities like it across Nigeria will continue to pay the ultimate price.
This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its Report Women Female Reporters Leadership Programme (FRLP) Fellowship, with support from the Bill & Melinda Gates Foundation.
Government reacts
The plateau state commissioner for health, Dr Nicholas Ba’amlong during a telephone interview with the reporter, noted that, “when you see one local government budget and what they do, it does not translate to the others.”
Adding that the findings in Bokkos might not be the same as other local governments in the state, Ba’amlong noted that the issue was not about corruption.
He said that the government is making out mechanisms to see that the Drug and Medical Commodities Management agency takes responsibility for the supply of drugs in all the primary healthcare centers. “For now, what they are doing is supplying the basic healthcare provision fund facilities, which are present in all the local governments, because not all PHCs are under the basic healthcare. Before now, the facilities themselves buy drugs and continue to sell the way they want without control.”