Across communities in Girei LGA, health workers say they are routinely forced to perform multiple roles at once, moving between antenatal care, deliveries, outpatient consultations, immunisation services and emergency response, often within the same shift.
At Damare Primary Health Centre (PHC) in Girei LGA, Adamawa State, volunteer health worker Godiya Deborah Umaru was on duty alongside only one permanent staff member when several patients arrived.
They included a woman in labour and an accident victim. Outpatients crowded the waiting area, while admitted patients also required care.
“We could not attend to all of them,” Ms Umaru recalled.
The experience is familiar across rural PHCs in Adamawa State, where a shortage of health workers has left facilities unable to meet growing demand for services.
Across communities in Girei LGA, health workers say they routinely perform multiple roles simultaneously, moving between antenatal care, deliveries, outpatient consultations, immunisation services, and emergency response, often within the same shift.
Findings by this reporter show that PHCs in this LGA depend on volunteers to fill critical workforce gaps. In some facilities visited, volunteers assist with immunisation, antenatal care, labour and delivery, wound dressing and other essential services alongside permanent staff.
Interviews with facility managers, volunteers, health workers and government officials, as well as a review of state health sector documents, reveal a primary healthcare system under pressure from persistent staffing shortages, limited equipment and uneven distribution of health workers.
While the Adamawa State Government says it has recruited additional personnel and is improving service delivery, findings from rural facilities suggest many remain heavily reliant on volunteers to keep their doors open and maintain basic healthcare services for thousands of residents.
In Nigeria’s rural communities, PHCs serve as the first point of contact for medical care. Residents depend on them for immunisation, antenatal services, childbirth, treatment of common illnesses and emergency care.
But visits to health facilities in Girei LGA reveal a system operating under intense pressure, sustained by a small workforce and an increasing reliance on volunteers.
At Njobbore PHC, facility manager Pafinus Linus said staff shortages have long been one of the clinic’s biggest challenges.
The facility provides immunisation, antenatal care, family planning, outpatient services and delivery care for the surrounding communities. Yet the number of health workers available has often fallen short of the workload.
According to Mrs Linus, the facility currently operates with a mix of permanent staff and volunteers spread across different units. However, the staffing arrangement remains fragile because workers are frequently required to abandon their assigned duties to respond to emergencies elsewhere in the clinic.
She explained that a staff member assigned to antenatal care may be called into the labour ward. “During night shifts, a single health worker may simultaneously function as a nurse, midwife, records officer and emergency responder,” she said.
“As a staff, you cannot depend only on your unit,” Mrs Linus said. “You have to do everything.”
The result is a system built around constant task-shifting.
At Damare PHC, health workers described similar conditions.
The facility serves an estimated population of 6,596 people. According to its officer-in-charge, Aishat Musa, the clinic operates with a combination of permanent staff, hired workers and volunteers who are integrated into a 24-hour duty roster to ensure services remain available round the clock.
“The facility serves a population of 6,596, and the staffing structure includes 10 permanent staff, eight hired staff and 15 volunteers,” she said.
On paper, it might sound like a crowded workforce, but in practice, it is a workforce that depends on a delicate mix of permanent workers, contractual staff and volunteers to keep the clinic open round the clock.
“We mix the permanent staff and the hired staff in the roster,” Mrs Musa said.
While the arrangement helps keep the facility running, it also reflects a reality faced by many rural clinics: maintaining services often depends on workers stretching beyond their formal responsibilities and volunteers filling critical gaps in the workforce.
Nigeria’s PHC system is guided by minimum staffing standards set by the National Primary Health Care Development Agency (NPHCDA), which outlines the basic human resource requirements for functional facilities.
Under the framework, a standard PHC is expected to have a mix of skilled personnel, including at least one Community Health Extension Worker (CHEW) or Junior CHEW, a midwife or nurse, a pharmacy technician, and a laboratory assistant, alongside environmental and support staff. Larger or upgraded facilities are expected to have additional staff depending on population size and service demand.
These benchmarks are intended to ensure that even the most basic rural clinic can provide essential services such as antenatal care, safe delivery, immunisation, disease surveillance and emergency response without over-reliance on a single cadre of workers.
However, field findings from these PHCs suggest that many rural facilities fail to meet these minimum requirements.
Ms Umaru, the volunteer at Damare PHC, represents a growing group of health workers who now form an informal but essential part of Adamawa’s rural healthcare system.
Unable to secure immediate employment after graduation in 2024, she turned to volunteering at Damare PHC in April 2025, where she was attached after submitting her application and credentials.
Since then, she has been integrated into the facility’s daily operations, working under supervision across immunisation, antenatal care, labour and delivery support, and wound dressing services.
In practice, her role goes beyond observation or assistance. On many days, she works alongside a single permanent staff member to manage multiple incoming patients.
More details here...
