By Victoria Ogechukwu Ujam
On a humid afternoon in Makoko, Lagos’s sprawling waterside settlement, 28-year-old Sandra balanced carefully on a wooden plank bridge before ducking into a shack built on stilts. Outside, the lagoon rippled with the sounds of paddling boats, children shouting from canoes, and women hawking food. Inside, the air smelled faintly of herbs and disinfectant. This is where Sandra delivered her fourth child just yesterday, not in a government hospital miles away on the mainland, but in a small, community-run clinic operated by her neighbors.
“All my children were born here,” Sandra said, adjusting her wrapper as she cradled her newborn. “The nurses know me, and they treat me well. It doesn’t cost what the big hospitals ask. Why would I go anywhere else?”
For women like Sandra, the choice is one of necessity. The nearest government facility is an hour away by boat and road, with child delivery fees starting at ₦50,000, beyond the reach of families surviving on fishing and petty trade.
Nigeria remains one of the most dangerous places in the world to give birth. According to the United Nations Maternal Mortality Estimation Inter-Agency Group (MMEIG), Nigeria accounted for nearly 29 percent of all maternal deaths worldwide in 2023, with about 75,000 women. Sub-Saharan Africa records a maternal mortality ratio (MMR) of 454 per 100,000 live births, more than double the global average of 197.
Even in Lagos, Nigeria’s wealthiest state, the crisis persists. A 2022 study found an MMR of 430 per 100,000 live births, with a woman’s lifetime risk of dying in childbirth at 1 in 51. For women in informal communities like Makoko, these national statistics are daily realities. With high costs, weak infrastructure, and long distances to government hospitals, families rely on community-run facilities.
Traditional birth attendants remain trusted, but without equipment or training, emergencies can turn fatal.
The Economics of Childbirth
Makoko, home to an estimated 100,000 residents, faces unique challenges. Built largely on water and lacking paved roads, the community is nearly invisible in official Lagos planning. Government hospitals charge ₦25,000–₦50,000 per delivery, a sum beyond many families’ reach. Local clinics, however, ask ₦5,000–₦10,000 and allow payment in installments, enough to save lives close to home.
“Even if I sell all the fish I catch in a week, I cannot raise hospital money,” said Mr. Ben, a fisherman whose wife recently gave birth at a waterfront clinic. “But here, they told me to bring what I have first, then complete later.”
Each month, some clinics record 10–20 safe deliveries, providing antenatal checkups, basic treatment, and referrals when complications arise.
On Google Earth, the Ayetoro Primary Health Centre appears to be just 0.73 kilometers from Makoko less than a ten-minute walk in ordinary conditions. But for women in labor, that ‘short’ distance can stretch into a long journey. They must first paddle across the lagoon, navigate narrow wooden bridges, and then find road transport before reaching the clinic. In emergencies, those extra minutes can mean the difference between life and death.
Community Clinics: Lifelines on the Water
To fill the gap, Makoko residents created their own alternative: privately owned clinics along the waterfront. These facilities blend herbal remedies with biomedical drugs under the guidance of trained nurses and doctors, offering mothers care they can afford and trust, close to home. It is an improvised solution where state health services fail to reach.
Inside the labor room where Sandra delivered, a wooden shelf stood beside the bed, stacked with paracetamol tablets, syringes in reused cartons, and bottles of herbal concoctions steeped in recycled soda bottles, labeled with blue and black marker.
The clinic owner, Dr Ave Bernard, a medical doctor trained at the University of Lagos, explained why his facility, licensed and operating since 2006, has thrived for nearly two decades.
“Women here believe in herbs,” he said. “If I ignore that, they won’t come. So I blend both herbal and biomedical. That’s how they trust me.”
He added that the clinic handles at least ten deliveries every month, all successful so far. Complicated cases are referred to doctors at Subbar Hospital, a private facility across the bridge. For essential services like scans, women are sent to partner hospitals, and results are explained back at the clinic. Primary health workers also visit occasionally to administer immunizations such as tetanus.
Trust is a crucial currency in Makoko. Pregnant women say they feel safer there than making the uncertain trip to the mainland.
“If something happens at night, we can run here in ten minutes,” said Mr. Joseph, a fisherman whose wife gave birth to their third child in the clinic. “At the general hospital, the money they ask for is too much, and we don’t have it. Here, I paid only ₦7,000.”
The Bale of Makoko, Chief Orioye Jefta, calls these small facilities “lifelines.” He admits they lack equipment but insists they are saving lives in the absence of a government hospital.
“When my boss was alive, some people came to help us build a proper hospital,” he recalled. “But we had no land to give them. They told us instead to use the government hospital at Ayetoro, near the Third Mainland Bridge. For those living on land, it is easier to get there within 10 to 15 minutes by maruwa (tricycle).”
The community has long depended on midwives and traditional medical practices to fill the gap.
“All our midwives assist women during delivery, and here in Makoko, we trust God has given us the strength to care for ourselves with trado-medicals.”
Even in his household, all his children were delivered by midwives, a testament to how deeply the community trusts its informal maternal care system.
Blending Tradition with Medicine
Makoko’s clinics illustrate a unique hybrid approach: combining traditional herbal remedies with biomedical drugs under professional guidance. This allows providers to earn trust while giving mothers access to basic medical care. More than 60 percent of Nigerians first seek care from informal providers, according to the Federal Ministry of Health, a reflection of national reliance on hybrid systems.
Nurse Sarah Ogor, whose clinic has operated since 2014 on Apollo’s waterside, explained:
“In our hospital, we handle 15–20 deliveries per month successfully. The delivery fee is between ₦4,000–₦6,000 because some women cannot afford the full amount upfront. After delivery, they return home to complete ₦10,000–₦15,000, which we use to provide herbal medicine, injections, and drugs. We do our best, but our hospital is not fully equipped. We need more beds, mosquito nets, and even a boat to move patients in emergencies.”
Challenges Amid Success
Despite their successes, life-saving care in Makoko comes with daily hurdles. Inside Nurse Sarah Ogor’s waterside hospital, space is extremely limited. The delivery room has only a single table, and the clinic’s two beds are placed directly on the floor. Yet life-saving work continues: a woman gave birth to a healthy baby boy just the night before.
Sarah also runs a small chemist inside the hospital, selling essential medicines she learned about during her time in Benin Republic. She combines this knowledge with her nursing skills to provide both herbal and biomedical treatments to mothers in Makoko.
“Sometimes we get complicated cases at night,” Sarah explained. “We have to manage with what we have, and when emergencies arise, we rely on partner hospitals. It’s not ideal, but we do our best to keep mothers and babies safe.”
Finances and resources strain operations. Many families pay in installments, and while the clinics remain affordable, maintaining a steady supply of medicines, keeping beds ready, and ensuring essential equipment is functional is a constant challenge. Even with dedication, the clinics cannot replace a fully staffed hospital, but for Makoko’s mothers, these lifelines are the best option available.
What’s at Stake
Across Nigeria, informal providers like those in Makoko handle first-line care for millions. In maternal health, this reliance reflects both resilience and desperation: families innovate where the state does not deliver.
Experts suggest that with structured training, supervision, and support, clinics like Makoko’s could become a formal lifeline for underserved communities, showing how local solutions can save lives where hospitals cannot reach.
For Makoko’s residents, the debate feels distant. What matters is proximity, affordability, and trust.
“Our women cannot be left to die because hospitals are far,” the Bale said. “These clinics are not perfect, but they are here.”
As Sandra cradled her newborn, the morning sun shimmered on the water outside. She smiled faintly, relieved that both she and her child had survived the night. Her story, like Makoko’s, reflects both the ingenuity and the risks of communities forced to fill their own health gaps. Until policies catch up, communities like Makoko will continue to blend tradition and medicine, keeping mothers and newborns alive where formal systems fall short.
This story was made possible by Nigeria Health Watch with support from the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems.
