Corruption's Impact on Healthcare in Conflict-Ravaged Plateau Communities

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The Crisis in Bokkos: A Systemic Collapse of Health Care

In the Bokkos Local Government Area of Plateau State, grief has become a permanent resident. Armed attacks have driven entire communities from their homes, leaving villages abandoned and families scattered into makeshift camps. Survivors face not only the immediate dangers of violence but also an ongoing struggle for access to basic health care. This crisis is compounded by systemic issues such as corruption, underfunding, and neglect, which have left primary health care facilities in disarray.

A Mother's Struggle at the IDP Camp

At an internally displaced persons (IDP) camp located at St Thomas Catholic Church in Bokkos town, Monica Jonah, a 30-year-old mother, cradles her newborn on her back while sitting on a plastic chair. She recalls fleeing her home in Kadim village, 15 kilometers away, during her eighth month of pregnancy. “I ran so fast that I even forgot I was pregnant. It was life and death,” she said softly.

Monica gave birth at Bokkos Cottage Hospital but has not returned for postnatal checks or immunizations. “The hospital is far from here, and I don’t have transport money. Even when you get there, you still pay for services. I just thank God that I am alive.”

Her story is repeated across Bokkos, where displaced residents face a crumbling health system. The collapse is not solely due to conflict but also to deep-seated corruption and mismanagement.

Sharp Practices in Health Care

Nigeria ranks among the 40 most corrupt countries globally, according to a 2025 analysis by Chatham House. In Bokkos, this corruption manifests in various ways. The chairman of Bokkos Local Government, Amalau Samuel, revealed that some staff members at primary health care centers deliberately hide government-supplied drugs, selling privately purchased medications instead for profit. Only after exhausting their own stock do they release the government-provided drugs, often leading to essential medicines expiring unused.

A 2020 study published in the International Journal of Health Policy and Management identified absenteeism, procurement-related corruption, under-the-counter payments, and employment-related corruption as key challenges in Nigeria’s health sector. These practices continue to undermine care for millions.

Budgets on Paper, Nothing in Practice

According to the Director of Primary Health Care in Bokkos, Mr Joseph Lar Dashe, the local government operates 106 primary health care centers, 97 of which are functional. However, a budget document obtained through a Freedom of Information request in June 2025 shows that none of these centers received direct funding between 2023 and 2025. Despite approved budgets rising from N192 million in 2023 to N246 million in 2025, the column labeled "Funds Used by Facilities" read "NIL."

Dashe claimed that the allocated funds were fully disbursed, but the breakdown reveals that salaries and allowances consumed the majority of the budget. In 2025, salaries alone accounted for N177.2 million, or 72% of the total budget. Allowances added another N80.8 million, surpassing the entire annual budget by N12 million.

This pattern persisted in 2024, with personnel costs reaching N224.8 million against an approved budget of N192 million. The rise in salaries coincided with the implementation of a new minimum wage of N70,000 in May 2024.

Drugs and Supplies Reduced to Crumbs

While salaries swelled, funding for medicines dwindled. In 2025, just N5 million was set aside for "drugs/lab/medical supplies," averaging about N4,292 per facility per month. Kim Jerry Bot, a pharmacist and director-general of the Plateau State Drugs and Medical Commodities Management Agency, noted that this amount could barely cover the cost of treating malaria for one individual.

Residents like Christiana Ajawa, a 60-year-old woman from Daffo, confirmed that essential medicines were rarely available. “They mostly give us Paracetamol for everything,” she said.

Eli John, who delivered seven children at Daffo Primary Health Centre, acknowledged improvements in antenatal and postnatal care but lamented the lack of drugs, calling it the biggest setback.

Health Centres in Ruin

Beyond financial mismanagement, physical damage has further crippled health care in Bokkos. Five primary health care centers—Hokk, Kopmur, Hurti, Shorom, and Suwa—were destroyed in violent attacks. In Kaban village, the center is locked and deserted, with health workers having fled. In Horop, the facility has been moved to a small shop-like structure, while renovations at the original site have stalled.

Dabit Clement Joseph, a youth leader in Horop, described the temporary site as too small to accommodate patients. “Even when some do come, the size of the current facility is so small that patients cannot be admitted because it only operates from a small room.”

Staff Shortages and Overwork

Before the attacks, Bokkos already faced a severe shortage of health workers. With only 225 workers serving about 200,000 residents, the ratio is one worker for every 800 people—far below the World Health Organization’s recommendation of one per 225 people. Three anonymous health workers described being overwhelmed, working three shifts with just two employed staff and a volunteer.

The Federal Ministry of Health and Social Welfare reported that Nigeria had only 1.83 health workers per 1,000 people in 2024, falling far below the WHO benchmark of 4.45 per 1,000.

A Broader Picture of Systemic Neglect

The challenges in Bokkos reflect national trends. The Basic Health Care Provision Fund (BHCPF), created in 2014, supports 14 facilities in Bokkos. While it provides funds for drugs, Mr Dashe noted that facilities can use leftover money for minor repairs. However, this flexibility highlights deeper issues of mismanagement and lack of oversight.

Retired director Mrs Mildred Gokum emphasized that neglect has been long-standing, with yearly budgets failing to translate into action. The World Bank links weak primary health center performance to poor governance, noting that only 30-40% of public centers are functional, and many lack electricity.

The Human Cost

As health centers remain closed, residents are forced to travel long distances or rely on private chemists. Women risk childbirth without skilled care, and children miss vital immunizations. Nigeria’s DTP3 coverage remains around 62%, far below the universal goal of 90%. In Bokkos, where drug budgets are minimal and facilities lie in ruins, the figure is even lower.

At the IDP camp, Monica nurses her newborn, unaware when he will receive his first vaccination. Bokkos communities are not only battling the trauma of conflict but also the silent war of corruption and neglect in their health system.

Budgets exist on paper, but facilities see nothing. Salaries balloon, but medicines vanish. Buildings are burnt or abandoned. Health workers are too few, and those who remain are overworked and afraid. The result is a health system paralyzed by irregularities, leaving families at the mercy of both insecurity and disease.

Unless accountability returns to primary health financing, Bokkos and many communities like it across Nigeria will continue to pay the ultimate price.