This report by Archibong Jeremiah examines the findings of the MyPHC Report by Orodata Science alongside the Cross River State 2024 Budget Performance Reports (BPRs). It highlights the alarming connection between structural healthcare deficits and significant budget execution failures.
In Cross River State, health workers are grappling with dire conditions that threaten not only their well-being but also the lives of the communities they serve. Many healthcare facilities are crumbling and under-resourced, forcing dedicated staff to operate in environments that are often life-threatening. “The job is tedious, and if you don’t get creative, you may not save a life,” shares *Mr Stanley Uche, a Senior Community Health Worker, highlighting the formidable challenges they face daily. The stark reality is that health personnel are often left without basic medical supplies, such as gloves and vital equipment, making their efforts to save lives precarious at best.
Take, for example, the Ikot Inwang Primary Healthcare Centre in the Bakassi local government area, where a recent burglary stripped the facility of essential medical equipment, including a digital blood pressure monitor. The ongoing insecurity compounds the problem, as staff navigate thefts and vandalism on top of the already crumbling infrastructure. “It has only got new chairs and tables; its wards remain closed; the roof leaks,” lamented one worker who pleaded anonymity. Such deteriorating conditions are not isolated; they reflect a broader trend affecting numerous facilities in the region.
Ward and other areas of Ikot Inwang Primary Healthcare Centre were vandalised during the #EndSARS protest.
At Agbara Health Centre in Abi Local Government Area, the facade of a recently painted building belies a sinking foundation, posing a significant risk to both patients and staff. The waiting area and general ward bear the physical scars of neglect, creating an environment that even the most hardened professionals find alarming. Here, as in many other facilities, the encroachment on land and lack of basic amenities heighten the risks associated with seeking care.
The building of the facility shows the sinking foundation.
The frustrations of the health workers resonate with the communities they serve, revealing a profound disconnect between political leaders and the realities of healthcare on the ground.
According to the MyPHC Report 2024 by Orodata Science, 22 deaths were recorded across 62 Primary Health Centres (PHCs) in Cross River State. Prolonged labour and lack of infrastructure were cited as major causes of patient mortality or required referral. The research was also carried out in five other states, Taraba, Benue, Anambra, Osun and Sokoto.
Investigation by TheInvestigator reveals a catastrophic failure where structural deficits transform routine childbirth into lethal emergencies. And this crisis is demonstrably fueled by the State Government’s underperformance of its budget for the health sector. Against an annual approved budget of over N42 billion for the health function, the State expended only 15.3% by the end of the fourth quarter of 2024, leaving billions of Naira unspent while preventable deaths occur in its primary healthcare facilities.
Structural Deficits And Mortality
The 22 documented patient deaths across 62 PHCs in one year underscore a deeply fractured primary healthcare system in Cross River State. The data confirms that the necessities for emergency obstetrics care are absent, creating a death trap for patients with complications.
Despite being under-staffed, security issues, no electricity, no source of water, bad roads, functional toilets, and high cost of transportation are other critical factors that fractured the state’s primary healthcare system, further review of the data revealed.
TheInvestigator’s analysis of the MyPHC data reveals a critical situation: only 9% of these facilities have functional ambulances. This glaring deficiency in the primary healthcare system has led to 694 essential referrals in just one year, frequently resulting in fatal delays.
Furthermore, there are alarming shortages of essential life-saving equipment, especially in the labour room, including delivery beds, bed pans, neonatal resuscitation equipment and fetal heart rate monitors. The lack of these vital tools severely compromises the ability to monitor maternal and fetal health while providing clean and properly equipped delivery spaces, contributing to disastrous outcomes like prolonged labour.
Additionally, there are shortages in crucial medical supplies, with the most pressing needs being oxygen, stretchers, blood pressure apparatus, personal protective equipment, and disinfectants. The unavailability of a blood pressure apparatus endangers the timely diagnosis of life-threatening conditions such as pre-eclampsia.
At the same time, the lack of oxygen and stretchers jeopardises care for critically ill patients. The high referral rate, driven by complications and inadequate infrastructure within these PHCs, underscores their inability to manage such cases effectively. The absence of functional ambulances further exacerbates this dire situation, making these referrals not just impractical but potentially lethal.
The Financial Disconnect: Budget Vs Performance
The structural deficiencies detailed above are not due to a lack of appropriation but a systemic failure to execute the allocated budget. Budget Performance Reports (BPR) for 2024 demonstrate that the funds necessary for infrastructural upgrades, equipment procurement, and supply replenishment were largely withheld or unspent by the responsible government agencies.
The annual approved budget for the health function (which encompasses the Ministry of Health and the Primary Healthcare Development Agency) in Cross River State for 2024 was N42,002,748,015.
Analysing the 2024 health budget performance (actual expenditure vs annual budget), the performance over the year reveals a consistent pattern of budget execution failure:
By the end of the 2024 fiscal year, only N6.45 billion of the over N42 billion budgeted for the health sector had been actually spent, representing a staggering under-expenditure of approximately N35.55 billion.
This withheld funding could have addressed the critical infrastructure and equipment gaps documented in the PHC report, which caused 22 preventable deaths.
The 15.3% was not released directly to the Primary Healthcare Development Agency but through health programmes and counterpart funding. TheInvestigator’s probe of the 2024 budget and the BQR, from the first, second, to third quarters, no release was made to the agency from the regional section (economic expenditure), but administrative costs were running.
Stakeholders Chestise Government
Amidst the alarming statistics revealing that only 15.3% of the 42 billion Naira budget allocated for health in 2024 was utilised, leaders from various advocacy groups who spoke with TheInvestigator are raising urgent concerns about the dire state of primary healthcare in Cross River.
Mr Kingsley Eworo, State Coordinator of the Budget Transparency and Accountability Initiative (BTAN), expressed concern over the fact that only 15.3% of the approved 42 billion Naira budget for health in 2024 has been utilised. This significant underfunding is severely impacting the functionality of primary healthcare centres, raising concerns over public health outcomes across the region.
Eworo emphasised the criticality of health in fostering overall productivity, stating, “If only 15% of an entire budget is spent, then there is no magic, no prayer that can save such a community.”
He noted that the poor allocation and release of funds foster a cycle of decline that not only affects health but also trickles down to impact other sectors of the economy.
Echoing these sentiments, Comrade Ogar Emmanuel Oko, Secretary of the Niger Delta Activists Forum (NDAF), highlighted the repercussions of inadequate funding.
“Underfunding or non-release of funds is a well-documented cause of primary health care failure in Nigeria,” Oko stated.
He pointed out that the state has recorded 22 avoidable deaths, attributing this tragedy to poorly equipped and understaffed health facilities. He described the situation as “suicidal,” stressing the need for immediate action to address these shortcomings.
In a related viewpoint, Comrade Richard Inoyo, a public health and human rights advocate, also weighed in on the crisis, highlighting the pressing need for a comprehensive approach to healthcare funding.
He emphasised that sustainable solutions require not just financial investment but also strategic planning and consistent oversight. “We must be deliberate in our efforts to ensure that health budgets are not only allocated but released in full and utilised effectively,” Inoyo stated.
Inoyo warned that without substantial investments in healthcare infrastructure, human resources, and essential medical supplies, communities risk continuing down a path of deterioration in health services.
The collective voices of Eworo, Oko, and Inoyo call for urgent reform and prioritisation of healthcare funding within the state budget.
“The Report Was Unfounded” – SA Budget
The Director-General of the Cross River State Primary Health Care Development Agency (CRSPHCDA), Dr Vivien Mesembe Otu, was contacted by TheInvestigator to know what really happened that her Agency was not directly funded on the budget line.
On the 18th of November, 2025, she was contacted, but no response has been received despite repeated reminders.
Mr Otu Otu Ita, the Special Adviser on Budget to the State Governor, was contacted after no response was received from the DG. He said, “The report was unfounded.”
He added that “I am aware that in the last two years, so many PHCs have been renovated. I doubt there’s any political ward in the state that did not benefit from the exodus of facelift PHCs.”
Note: The name asterisked is to conceal the person’s identity because she requested it.
This story was produced by TheInvestigator Health Desk, supported by the Africa Data Hub and Orodata Science.