By Abdulrasheed Hammad

Primary health care was established in Nigeria to provide essential health services that are accessible, affordable, and culturally appropriate to the local population. However, PHCs in Sokoto State have now become a danger zone that complicates diseases brought by patients seeking medical attention. This was as a result of environmental pollution caused by the PHCs in rural Sokoto communities through the burning and burying of waste in the health facilities.

Burnt and Buried Site in Sanyinna PHC in Tambuwal LGA. Credit: Abdulrasheed Hammad


All the 10 PHCs that this reporter visited in Wurno and Tambuwal LGA don’t have government waste bins, which forces them to burn and bury the refuse, thereby complicating the diseases of the patients seeking medical attention.

Dumpsite at Sanyinna PHC. Credit: Abdulrasheed Hammad


Fatima Aliyu, a 52-year-old resident of Sallah village and grandmother to a sick child in Sanyinna Primary Health Care, said her granddaughter is battling malaria fever, which she believes is a result of indiscriminate waste disposal in their community and open defecation. She also noted that the burning of refuse in the PHCs further complicates her granddaughter’s health.

Dumpsite at Sanyinna PHC. Credit: Abdulrasheed Hammad


“The child has no boundaries on where she plays, which was the cause of his malaria fever. The burning of refuse by the PHCs does more harm to our health as patients. There is no functioning toilet in the healthcare facility, which worsens the situation. We and our children usually defecate in the open space, and we dump our refuse in the backyard. The smoke from burning the refuse in the health facilities affects our health, but we have no option but to endure it as patients,” she said.

Dumpsite at Sanyinna PHC. Credit: Abdulrasheed Hammad


The indiscriminate waste disposal by primary health care is increasing mosquitoes, which is the cause of malaria, thereby affecting the patients seeking medical attention and causing environmental pollution for the residents of the community.

Burnt and Buried Site in Sanyinna PHC in Tambuwal LGA. Credit: Abdulrasheed Hammad


According to the 2021 World Malaria Report,, Nigeria had the highest number of global malaria cases (26.6%) and the highest number of deaths (31% of global malaria deaths) in 2021. The country accounted for an estimated 54% of malaria cases in West Africa in 2021.

Also, there is very dangerous waste from hospitals, labs, and healthcare that has the potential to contaminate the underground water in the area where it is located and that has a long-term effect on people living in those areas and the patients. Not only does this contribute to the creation of greenhouse gasses, but it also causes significant harm to aquatic life, living organisms in the soil, and wildlife. The value of property diminishes continually with the illegal dumping of refuse.

Burnt and Buried site for Marnona Health Post


According to the research organized by the six authors at Sokoto State University, open dumping with 53.05% is the major method of disposing and managing solid waste in the Sokoto metropolis. Waste burning accounted for 22.2%, storage in waste bins 5.32%, digging and burying 3.7%, land filling 6.6%, and others accounted for 9.12%. The implication of this is that most households dump their refuse on roads, streets, available open spaces, gutters, market areas, and other illegal dumpsites. This can cause health hazards for the people living in this area. Traffic congestion and the inaccessibility of roads also result from this act of dumping waste on some major roads in the area. The problem with this method is air pollution and its inability to treat inorganic items of solid waste such as bottles, glass, metals, etc.

State of Toilet in Dinawa Health Clinic in Wurno. Credit: Abdulrasheed Hammad


Environmental pollution and open defecation are spreading diseases such as malaria and fever caused by mosquitoes that breed on the waste and gutters occupied by solid waste. Other diseases include respiratory problems, typhoid, cholera, and meningitis. The solid waste may decompose to emit methane and carbon dioxide, which contribute to climate change.

It can also result in waterborne diseases, vector-borne diseases, respiratory infections, skin infections, parasitic infections, and malnutrition.

Muazu Aliyu, the community health worker at Kwargaba PHC, recounted an outbreak of cholera in 2021, during which the community was overwhelmed. Lack of space forced them to accommodate over 40 patients per day on the floor outside the facility. The outbreak, suspected to have been triggered by a woman from Lokoja, Kogi State, claimed the lives of many in the communities, but despite this saddening incident that claimed the lives of many in the community, the Kwargaba PHC still resulted in burning and burying refuse in their PHCs.

“We later discovered it was an airborne disease, potentially spread through contaminated water sources. Unfortunately, we lacked the resources to conduct a thorough investigation into its root causes,” he said.

In Wurno Secondary School Clinic Facility, the toilet has run down, and the school and the health facility are also practicing burning and burying refuse due to a lack of government waste bins. Usman Aliyu, a community health worker, pointed this reporter to one big place where they are dumping and burning their refuse.

Wurno Secondary School Clinic Facility Dumpsite. Credit: Abdulrasheed Hammad


The community health worker in Marnona Health Post, Hassan Haruna, also confirmed that the PHC is practicing a burnt and buried approach in disposing of their waste, adding that the lack of government waste bins in the PHCs forced them to be burning and burying their refuse without looking at its negative effect.

Toilet in Wurno Secondary School Clinic Facility. Credit: Abdulrasheed Hammad


Alhaji Sanni, 48, and a representative of the community leader in Lahudo community, while explaining how the doctors used to dump the waste, said that the community health worker used to gather the waste from the hospital, put it in the dump site, and burn it.

Toilet in Wurno Secondary School Clinic Facility. Credit: Abdulrasheed Hammad


Alhaji Sanni, who saw this as a normal thing, said: “Even if we have a malaria outbreak due to this, it wouldn’t be worse because we used to receive vaccines, and if we have such issues, we will just inform the LG health work in charge, and they will immediately take proactive measures.”.

State of Toilet in Dinawa Health Clinic in Wurno


The community health workers in Dogon-Daji Primary Health Centre Facility, Jabo Primary Health Centre, Dimbiso Health Post, Dinawa Primary Health Centre, and Kwasare Health Post also confirmed that the PHCs are burning and burying refuse due to a lack of government waste bins in the PHCs. The patients continue to suffer from environmental pollution, which complicates their diseases due to the lack of waste bins in Sokoto PHCs.

Image of waste dumped in the front of Dogon Daji PHC. Credit: Abdulrasheed Hammad


Larai Aliyu Tambuwal, Executive Secretary of Sokoto State Primary Health Care, said this reporter should write a formal letter to the Sokoto State Primary Health Care Development Agency before giving this reporter an opportunity to interview her.

An acknowledgement copy of the letter written to Sokoto State Primary Health Care Development Agency. Credit: Abdulrasheed Hammad


After the letter was submitted to the agency, she said she recently assumed office and finds it challenging to provide a response regarding the steps they are taking to improve the state of primary health care in the state. She noted that all the directors from whom she could gather information have been dropped, and she does not want to provide inaccurate information to the reporter.

She added that she hasn’t fully taken over the office and is not familiar with the programs they are implementing, noting that she is from WHO and lacks complete information about the PHCs in the state.

She said, “With the absence of the directors I relied on for information, it’s difficult to give you a response. I hold a strategic position, and any information I provide will bind me. Therefore, I refrain from making statements to avoid any repercussions.

“I am accountable for all activities within the agency, and I am cautious not to make statements that will come back to me. I am currently gathering this information, as I have not been actively involved in the system. Previously, I worked at the WHO, focusing on surveillance and immunization. I have just arrived at the office, and it is empty. Please give us time to gather the necessary information.”  

This story was produced for the Frontline Investigative Program and supported by the Africa Data Hub and Orodata Science.

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