Despite the presence of primary health centres across Cross River, most lack the basic tools, staffing, and power required for safe childbirth, making a woman’s address a major determinant of survival. Evidence from national and state datasets shows a collapse in facility readiness. Without urgent investment in functionality and accountability, maternal deaths will remain unacceptably high. Anne Agbi, Ntakobong Otongaran and Udeh Onyebuchi report.
At a small health centre in Biase, the light goes out just as a woman begins to push. The nurse steadies her hands and reaches for a phone to brighten the room. It is the third delivery of the night. The only light comes from a flickering rechargeable lamp.
Across Cross River State, hundreds of primary health centres promise safe motherhood, but for many women, whether they survive childbirth depends less on care than on where they happen to live. In this state, a mother’s address can mean the difference between life and death. Cross River records an estimated eight hundred maternal deaths for every one hundred thousand live births, far above the national average and nearly twelve times the global target, revealing a stark reality: proximity to a facility does not guarantee safety when basic services fail.
Scenes like this are common across the state, where primary health centres exist in every local government area but their ability to save lives is in doubt. An examination of data from CheckMyPHC, the MyPHC 2024 national report, and Nigeria’s most recent Demographic and Health Survey reveals a quiet collapse in basic readiness. Most centres are not equipped to provide skilled care, maintain steady electricity, or stock the supplies that turn ordinary deliveries into safe ones.
From the hills of Obudu to the forest communities of Akamkpa, most residents live within a short distance of a primary health centre. But closeness does not mean safety. CheckMyPHC’s field data from 2024 show that fewer than four in ten facilities have a functional labour ward. Only twenty nine percent have delivery beds in usable condition. Barely one in five have a working suction machine to clear a newborn’s airway. In some districts, midwives deliver babies under torchlight. Only twenty two percent of centres have generators that function, and many solar installations funded by past donor projects have failed. A nurse in Biase said her clinic had been without power for months. “We use a rechargeable lantern during delivery,” she said. “When it goes off, we close shop.”
One health worker in Calabar who declined being named for fear of retribution described the network of health centres as “a system of buildings without functionality.” Without power or water, even skilled professionals are powerless against bleeding, infection, or obstructed labour which are the three leading causes of maternal death in Nigeria.
The CheckMyPHC dataset offers the first real time view of labour ward readiness in Cross River. Each indicator represents the percentage of facilities that meet essential standards for safe delivery. Fewer than one in five centres have a functional delivery bed, running water, and consistent power supply combined. Only a third employs a trained birth attendant. Fewer than one in five operates twenty four hours a day.
The MyPHC 2024 report places Cross River below the national average on every readiness indicator. Across Nigeria, thirty eight percent of primary health centres provide round the clock services. In Cross River, only nineteen percent do. National coverage for electricity and clean water stands at forty seven and forty three percent respectively. Cross River meets barely half of those figures.
The shortage of skilled staff is another defining weakness. The latest Demographic and Health Survey shows that fifty four percent of births in Cross River are attended by trained health workers, compared with more than ninety percent in Lagos and Ekiti. The gap in survival rates follows the same pattern. Across Nigeria, skilled attendance at birth remains the single strongest predictor of maternal survival. Analysis of national data shows a direct link between professional care and death rates. Cross River falls in the lower half of this scale. Despite its relative peace and economic potential, the state’s maternal mortality ratio is higher than in some conflict affected northern regions.
Inside the Worst Performing Local Government Areas
Bakassi: Delivering under torchlights
In Bakassi, several primary health centres score below minimum safety standards. At Ifiang Nsung PHC, inspectors documented broken doors, leaking roofs, missing medical records, and absent staff. Women bring rechargeable lamps as part of their delivery kits.
Akpabuyo: Cold chain failure and emergency risks
Peer reviewed studies and readiness data show that no PHC in Akpabuyo has basic airway equipment. Several lack refrigerators, making vaccines unusable. One nurse told researchers, “We pray nothing serious happens at night because we have nothing to save a life.”
Ogoja: Long distances and no refrigeration
In Ogoja’s Bansara PHC, vaccines cannot be stored because refrigerators do not work. Families sometimes walk kilometres only to be turned back on immunisation days.
Odukpani and Akampa: Routine care collapsing
Facilities in these LGAs report long drug stockout periods, leaking roofs, and near empty staff rosters. Women delay antenatal visits knowing they are unlikely to receive help.
A report by Nigeria Health Watch found that more than seventy percent of maternal deaths nationwide result from preventable causes including postpartum bleeding, eclampsia, infection, and complications from unsafe delivery. These are the conditions that require trained personnel and functional tools. Yet CheckMyPHC’s data confirm that most Cross River facilities lack both.
Less than a quarter of centres employ a trained midwife. Many rely entirely on community health extension workers who handle deliveries without supervision. In several local government areas, traditional birth attendants are still the first choice for pregnant women. They are trusted and accessible but rarely trained to manage complications.
Distance adds another layer of danger. In the forested south and hilly north, many women travel ten to fifteen kilometres to reach a clinic. Bad roads and poor transport make the journey longer. National studies show that transport delays account for one quarter of maternal deaths in rural Nigeria. Without ambulances, families often use motorcycles or tricycles to carry women in labour. Some die on the way.
Even those who reach a facility may find it closed at night or short of staff and medicines. These obstacles represent what public health experts call the three fatal delays: the delay in deciding to seek care, the delay in reaching it, and the delay in receiving it.
Budget realities and systemic failures
On paper, Cross River made what appears to be a substantial commitment to primary health care in its 2024 budget. The state allocated about N3billion to PHC-related capital projects, including N1.1 billion for the construction and renovation of ten comprehensive health centres, N600 million to equip facilities in four LGAs, and N500 million for Basic Health Care Provision Fund activities, alongside additional votes to upgrade PHCs and build new development centres. But this capital-heavy investment sits against a longer pattern of chronic underfunding of the health system itself.
BudgIT’s fiscal review shows that in 2023, health received less than seven percent of total state spending, far below the Abuja Declaration target, with less than a third of that amount reaching primary care. Recurrent funding for drugs, power, water and maintenance remains extremely low. On average the state spends only about N2,500 per woman of reproductive age on supplies and operational needs each year. With most available resources absorbed by salaries, little is left to keep PHCs functional, stocked or safe. The result is a network of facilities that look supported on paper but remain unable to deliver care when women need it most.
According to health experts at the Frontiers in Public Health, “Government spending on primary health care in many Nigerian states remains far below what is required to deliver even the most basic service package. Capital allocations alone do not translate into functionality without consistent investment in staff, commodities, maintenance and power.”
Health workers at PHCs in Cross River report asking women to buy their own delivery kits before being admitted. For many families, that extra cost makes facility based delivery expensive. The Demographic and Health Survey notes that thirty eight percent of Nigerian women still give birth outside health facilities. In Cross River the number approaches half.
Nigeria’s Maternal and Perinatal Death Surveillance and Response system requires every health facility to report and review each maternal death within forty eight hours. In practice, only about half of Cross River’s primary centres submit such reports. Those that do rarely follow up on the findings. The MyPHC report calls this the country’s silent crisis. Without complete data, deaths remain invisible and accountability disappears.
A monitoring officer in Calabar admitted that many facilities keep the forms untouched. “We have the papers,” she said quietly, “but they stay in a drawer.”
In other states, evidence shows that progress is possible. In Ebonyi, a partnership between the government and a humanitarian group has produced model health centres that operate day and night with solar power, trained midwives, and stocked delivery rooms. Facility-based births there have increased by more than seventy percent. In Kebbi, local authorities now investigate every maternal death through a system called SEMCHIC, linking findings to immediate corrective action. The model has improved referral systems and emergency care within three years.
These examples prove that when data drive decisions and money follows evidence, maternal deaths can decline sharply.
For Cross River, the way forward is clear. The weakest centres must be rehabilitated and provided with reliable power and water. Every facility should have at least one trained midwife and a means of emergency transport. Community ward committees can monitor performance, track stock shortages, and hold local authorities accountable. Regular public reporting of maternal deaths and follow up actions would help sustain transparency and drive improvements.
The experience of Cross River mirrors that of much of Nigeria. Infrastructure exists, yet functionality does not. Without skilled staff, electricity, clean water, and accountability, the promise of safe motherhood will remain out of reach.
This story was produced by the Nation’s Health desk, supported by the Africa Data Hub and Orodata Science.
