Primary health care in crisis: Healthcare access barriers and zero-dose burden among conflict-affected populations in northwest Nigeria
1
Program, Society for Family Health Nigeria, Kano, Nigeria
2
Program, Kano Youths Champion Development Initiative, Sabuwa gandu Kano State, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A3444
ABSTRACT
BACKGROUND:
The SOKEZA region of Northwest Nigeria faces escalating rural, politically induced, and grazing-related banditry that has destabilized communities and severely weakened primary health care (PHC) systems. Women, children, and adolescents carry the highest burden of disrupted access. As of 2023, only 200 of 700 PHCs in Zamfara remained functional, while repeated attacks have driven a mass exodus of healthcare workers and restricted humanitarian access. This study assessed access to essential PHC services among conflict-affected populations across SOKEZA.
METHODS:
A mixed-methods design was applied between January –August 2025. The study engaged 100 internally displaced persons (IDPs), 50 exodus healthcare workers, and 80 religious/traditional leaders. Snowball sampling was used for IDPs across camps in Batsari (Katsina), Tsafe (Zamfara), and Isa (Sokoto). Data collection involved structured key-informant interviews. Quantitative data were analysed using descriptive statistics, while qualitative interviews underwent inductive thematic analysis to explore PHC system disruptions, workforce displacement, and community health-seeking constraints.
RESULTS:
Among mothers interviewed, 99.9% had zero-dose children, and 89.7% had not accessed PHC services in the previous six months. 98% of exodus health workers were unable to reach their duty posts; the remaining 2% required armed escorts. With 99% of pregnant women reporting no ANC visits due to insecurity and lack of providers. Thematic analysis revealed four dominant disruptions: widespread facility closure, healthcare worker displacement, collapsed supply chains, and restricted humanitarian operations.
CONCLUSIONS:
Persistent insecurity has resulted in severe PHC service paralysis, extreme immunization gaps, and widespread unmet health needs in SOKEZA. Strengthening security protection for health workers and facilities, deploying mobile clinics and telemedicine, expanding humanitarian corridors, and improving coordination between government, security agencies, NGOs, and traditional leaders are essential to restoring PHC access and reducing avoidable morbidity.
The SOKEZA region of Northwest Nigeria faces escalating rural, politically induced, and grazing-related banditry that has destabilized communities and severely weakened primary health care (PHC) systems. Women, children, and adolescents carry the highest burden of disrupted access. As of 2023, only 200 of 700 PHCs in Zamfara remained functional, while repeated attacks have driven a mass exodus of healthcare workers and restricted humanitarian access. This study assessed access to essential PHC services among conflict-affected populations across SOKEZA.
METHODS:
A mixed-methods design was applied between January –August 2025. The study engaged 100 internally displaced persons (IDPs), 50 exodus healthcare workers, and 80 religious/traditional leaders. Snowball sampling was used for IDPs across camps in Batsari (Katsina), Tsafe (Zamfara), and Isa (Sokoto). Data collection involved structured key-informant interviews. Quantitative data were analysed using descriptive statistics, while qualitative interviews underwent inductive thematic analysis to explore PHC system disruptions, workforce displacement, and community health-seeking constraints.
RESULTS:
Among mothers interviewed, 99.9% had zero-dose children, and 89.7% had not accessed PHC services in the previous six months. 98% of exodus health workers were unable to reach their duty posts; the remaining 2% required armed escorts. With 99% of pregnant women reporting no ANC visits due to insecurity and lack of providers. Thematic analysis revealed four dominant disruptions: widespread facility closure, healthcare worker displacement, collapsed supply chains, and restricted humanitarian operations.
CONCLUSIONS:
Persistent insecurity has resulted in severe PHC service paralysis, extreme immunization gaps, and widespread unmet health needs in SOKEZA. Strengthening security protection for health workers and facilities, deploying mobile clinics and telemedicine, expanding humanitarian corridors, and improving coordination between government, security agencies, NGOs, and traditional leaders are essential to restoring PHC access and reducing avoidable morbidity.
| eISSN: | 2654-1459 |
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