The waiting room at Tudun Wada Primary Health Center in Warji was already full before sunrise. The building, painted in yellow and light green, stands out against the dusty courtyard outside. Inside, the heat presses in as pregnant women sit shoulder to shoulder on woven mats, balancing baby cards on their laps while waiting for their turn. Some squeeze onto a long wooden bench; others sit cross-legged on the floor. There are no chairs, just the rhythmic hum of chatter and the rustle of wrappers, and in the middle of it all, Fauziya Mustapha, the only Skilled Birth Attendant (SBA) in the facility, moves briskly between patients.
Since her posting in May 2025 under Bauchi State’s Impact Project, Fauziya has handled more than 50 deliveries in three months. The load is heavy, but her voice carries a calm confidence that reassures mothers. “We have challenges, yes,” she tells WikkiTimes, “but the women are now coming. Even those who give birth at home bring their babies here afterward.”
The Bauchi State government launched the Impact Project earlier this year, deploying 100 Skilled Birth Attendants across 20 Local Government Areas—five per LGA to improve maternal health outcomes. The initiative aims to reduce maternal and newborn deaths by increasing access to skilled care, strengthening primary health facilities, and providing free delivery kits to ease the financial burden on families.
Bauchi State records one of the highest maternal mortality rates in the country. With only about 2 in 10 births attended by a health professional, most women rely on traditional birth attendants. The Impact Project represents a bold effort to reverse that trend.
Warji: One Midwife, Many Mothers
Tudun Wada Primary center provides antenatal care (ANC), labour, immunization, family planning, and monitoring and evaluation services, but with only four staff members, including Fauziya, it remains overstretched.
Officer-in-Charge Nathaniel M. Shuka tells WikkiTimes that the SBA’s arrival has “brought life” to the facility. “Before, women were afraid to come here,” he recalls. “Now ANC days are full. But one SBA cannot handle all the work.”
On Tuesdays, the busiest ANC day, women sit on mats because the chairs are not enough. The center’s renovation has improved its look, but poor roads, grounded ambulances, and limited equipment still affect service delivery. “When there’s an emergency, we rely on motorcycle riders to move patients to the sister hospital,” Shuka says.
Still, community trust is growing. Mai Unguwa Idi Hamidu, a local leader, says, “Families now encourage pregnant women to deliver in hospitals. The SBA has helped change our attitude.”
For mothers, the change is noticeable. Nusaiba Aliyu, who gave birth to her first child at home with a traditional birth attendant, said she now prefers the hospital since the SBA’s arrival. “We feel safer here,” she said.
But traditional birth attendants (TBAs) remain deeply trusted and express a strong desire for training and partnership with the formally trained SBAs. Traditional Birth Attendants (TBAs) have been part of Nigeria’s maternal-care fabric for generations, especially in rural communities across Bauchi State where hospitals and clinics arrived far later than in cities.
In many communities, TBAs apprenticed their skills informally from elder women in the community, handling pregnancies, births and postnatal care long before skilled midwives became available. Their presence reflects both enduring trust and the reality that modern maternal-health systems remain out of reach for thousands of women in remote areas.
Dije Hassan, a long-practicing TBA who handles more than 20 deliveries each month, said, “Households still call me during labor. Sometimes I refer women to the hospital, but I have never been invited to health talks with SBAs.”
Baima: Between Tradition and Transition
About 15 kilometers from Tudun Wada lies Baima, a farming community where tradition still shapes childbirth choices. Here, Salamatu Auwal, a traditional birth attendant with over 20 years of experience, remains a trusted figure. Sitting on a wooden stool outside her mud-brick house, she recalls her long years of assisting women during childbirth.
“I attend to more than 20 deliveries each month,” she says, her hands busy grinding herbs. “The women in this community trust me to handle their labour and care for their babies. When I notice complications, I refer them to the hospital.”
Salamatu, who often gives women sugar and hot water during labor to “ease delivery,” insists she has never lost a mother. Yet, she admits she has never been invited to any joint meeting or health talk with the new Skilled Birth Attendants (SBAs) posted to the area. “I want to learn,” she adds quietly. “If I get training, I can help them.”
Since the Impact Project deployed SBAs to Bauchi’s primary health centers in May 2025, local attitudes toward hospital deliveries are slowly shifting.
At the Baima Primary Health Center, Balkisu Abdulbasir, one of the newly deployed SBAs, says her work has been “smooth but demanding.” “I work with the staff here even though we are few,” she explains. “I handle both deliveries and weekly antenatal care (ANC). The free delivery kits we provide have really encouraged women to come.”
Between May and September, Balkisu attended about 20 deliveries. A member of the community herself, she says her roots make her job easier. “Because I’m from here, they trust me. They come to me with their worries.”
Her regular salary, paid promptly on the 28th of every month, has also boosted her morale. “It keeps me motivated,” she says, adding that difficult cases such as prolonged obstructed labor are referred to the sister hospital nearby. Fauziya nods in agreement. Despite the pressure of juggling ANC, deliveries, and immunizations, she says, “It’s the timely payment of my allowance that keeps me going.”
The Officer-in-Charge (ICO) of the Baima PHC, Hamza Sale Gambo, confirms that one SBA was deployed to the center in May. “It has made a difference,” he says. “Before, we had a gap. I sometimes had to conduct deliveries myself.”
He outlines the range of services the center offers: antenatal care, routine immunization, family planning, growth monitoring, and clinical consultations. But despite these improvements, he laments the lack of mattresses, manpower, and an ambulance.
“We depend on the National Union of Road Transport Workers (NURTW) and motorcycle riders for referrals,” he explains. “When there’s an emergency, that’s our only option.”
Hamza believes that five SBAs per LGA are not enough. “We need at least 15 more,” he says. “The demand is high, and the facilities are far apart.”
Even so, he describes the community’s growing confidence in the center as one of the project’s biggest successes. “More women are now attending ANC. The SBA’s presence has earned us respect and trust,” he says.
Community leader Sa’idu Hassan, the Mai Unguwar Muna Bingi Baima, echoes this view. “Families now allow pregnant women to deliver at the hospital,” he says. “We also help follow up on those missing ANC or immunization appointments.”
Sa’idu suggests more incentive-based interventions like the New Incentives program, which gives ₦1,000 to mothers during BCG immunization, could encourage even higher participation in maternal services.
For Balkisu, these efforts are already changing the narrative. “We are saving lives,” she says with a smile. “I just pray this project continues.”
Ningi: Progress, Pressure, and Persistent Gaps
In Ningi town, the maternity ward is alive with the sound of crying newborns and the shuffle of nurses in pale blue uniforms. The center handles more deliveries than any other in the LGA, yet remarkably, no Skilled Birth Attendant (SBA) has been deployed here.
Lauratu Muhammad Yaro, the Officer-in-Charge, flips through thick, dog-eared delivery registers. “In August alone, we recorded 133 deliveries, and by the 22nd of September, there were already 125 births,” she says. “We work every day, even weekends.”
Ningi is one of 20 LGAs meant to benefit from the Impact Project, but with only five SBAs deployed across a population of over 689,300 people, the reach remains limited. Lauratu says even one midwife in the town’s busiest maternity ward could make a dramatic difference.
She attributes the rising turnout to the free delivery kits provided under the Impact Project, a government initiative that has made childbirth more affordable for low-income families. “Before the project, a normal delivery cost was between ₦4,000 and ₦5,000 (about $2.50–$3.30),” Lauratu explains. “If complications arose, it could cost up to ₦10,000(around $6.60). Now, it’s completely free, that’s why the women come.”
Still, the absence of an SBA is taking a toll. “If we had even one skilled attendant here, the number of safe deliveries could double,” she says. “We are overstretched, but we can’t turn them away.”
When Tradition Meets Tragedy
For some families, the price of relying on traditional birth attendants alone remains devastating.
Hannatu Buhari, a mother from Jimi town, sits on a wooden stool, her voice low but steady as she recounts her loss. “I’ve given birth to two children,” she says. “One is alive, the other died.”
Her second child died moments after a prolonged obstructed labor that caused heavy bleeding. The traditional birth attendant who handled her delivery could not manage the crisis. “They rushed me to the hospital, and the doctor saved my life,” Hannatu recalls. “But my baby is already gone.”
In her community, she says, about 80 percent of women still deliver with TBAs. “It’s what we inherited from our mothers,” she explains. “People here believe strong women deliver at home. It has become a kind of competition.”
Nearby, in Bukutumbe town, Zaliha Muhammad, a 45-year-old mother of five, admits she has never delivered in a hospital. “All my children were born at home with the help of TBAs,” she says. “I’ve never had complications, so I see no reason to change.”
These testimonies reveal the delicate balance between old habits and new interventions, a reminder that maternal health reform in Ningi is as much about mindset as it is about manpower.
The Lone Midwife of Yadagungume
In Yadagungume Primary Health Center, Farida Ismail, an SBA deployed in June 2025, stands as the face of progress and exhaustion.
“I handle everything, including family planning, ANC, deliveries, and sometimes help in the female ward,” she says. “There’s only one bed in the delivery room. If two women come at once, we improvise.”
“There’s only one bed in the delivery room. When two women arrive in labor, Farida spreads a clean mat on the floor or moves one patient to a bench so she can attend to both.”
The center’s ambulance is grounded, forcing referrals to the general hospital in Ningi, which is nearly 70 kilometers away, located on a rough, unpaved road. “Most women go by motorcycle,” Farida says. “Sometimes it’s too late.”
Yet despite the challenges, she sees progress. “Since my posting, more women attend antenatal care. Some still prefer home births, but at least they come for checkups.” Like other SBAs, Farida considers her uninterrupted stipend payment a rewarding compensation for the hard work.
Dogon Ruwa: The Forgotten Outpost
About 50 kilometers from Ningi, the road thins into a rocky path that leads to Dogon Ruwa, one of the most isolated communities in the area. Its primary health center, a crumbling building with leaking roofs and cracked walls, is the only medical facility serving miles of scattered settlements.
“There are no beds fit for delivery, no water, no light,” says Amadu Gimba, one of the few staff posted there. “During the rainy season, the roof leaks so badly we can’t admit patients.”
No SBA has been deployed to Dogon Ruwa. The few staff are all male, a cultural barrier that keeps many women from coming for antenatal care. “Some husbands refuse to let their wives be seen by male workers,” Amadu explains to WikkiTimes.
Jamilu Dogon Ruwa, a community member, describes the consequences starkly. “Many women die on the way to Ningi Hospital,” he says. “The road is bad, and the motorcycles can’t move fast. The TBAs are still our only hope.”
The TBAs, though untrained, often act as the first responders in emergencies, a stopgap in a health system still finding its footing.
Behind the Numbers: The Pressure on Bauchi’s Midwives
Bauchi’s health workforce data reveals deep structural challenges beneath the Impact Project’s promise. While Bauchi’s effort to deploy five midwives per LGA is a step forward, the overall numbers reveal a deeper crisis. The state’s ratio of midwives to population remains one of the lowest in Nigeria.
As of June 2022, the state had 0.05 midwives per 1,000 population, far below the WHO threshold of 2.28. Out of a total health workforce of 14,591, only 262 were midwives and 1,107 were nurses, leaving a gap of 274 midwives and nurses across the 20 LGAs.The State Primary Health Care Development Agency (SPHCDA )oversees nearly half of all staff, mostly at the primary health care level. The chart below illustrates just how wide the gap remains between Bauchi and global standards for maternal health staffing.
Despite years of interventions, as of December 2024, just 30% of births in Bauchi occur in health facilities, with about 7 in 10 women still choosing to deliver at home. In one study area, only 29% of deliveries were attended by skilled professionals. Assessments using the WHO’s Workload Indicators of Staffing Need (WISN) found that many midwives are working beyond capacity, multitasking, and overstretched due to the shortages.
A review of the State government health budget shows that the state has never allocated more than 15% of its annual budget to health, and on average, only 61% of that amount is released. These shortfalls affect the recruitment, retention, and motivation of frontline staff.
To cope, the state has turned to task-shifting training Community Health Extension Workers (CHEWs)and community midwives to perform some duties of professional midwives. While this approach expands reach, reviews warn it cannot replace skilled hands, especially in emergencies. TBAs remain active in rural communities but are encouraged to take on limited, safer roles such as health education and misoprostol distribution.
A Fragile Fix
Bauchi’s Impact Project has shown that when trained midwives are deployed, mothers respond. In both Warji and Ningi, antenatal attendance is up, home deliveries are declining, and community trust is slowly shifting from TBAs to SBAs—while TBAs have begun to find value in modern medicine. Regular stipends have kept midwives committed, and free delivery kits have removed key financial barriers.
But the initiative’s fragility is evident. One midwife per facility cannot handle dozens of patients a day. Poor infrastructure, bad roads, grounded ambulances, and shortages of basic equipment, such as chairs and beds, threaten to undermine the project’s impact.
Meanwhile, TBAs still attend more than 20 deliveries per month in some communities and remain deeply embedded in local life. Many want training, not exclusion. As Salamatu Auwal in Baima puts it, “If they teach us, we will help them. We all want to save mothers.”
In Warji and Ningi, the Impact Project is changing perceptions and saving lives, but only just. It has been proven that community-based midwifery can be effective. Yet, it also reveals that the human gap between a policy and its promise can be as wide as the unpaved road between a clinic and a village in Bauchi State.
Edited by Nelly Kalu
This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, http://solutionsjournalism.org
Editor’s note: This story is part of our effort to bring a Solutions Lens to investigative reporting on gender bias, particularly in reproductive health. Guided by four pillars—the response to the problem, the evidence for that response, its limitations, and the insights that can be replicated—we aim to show not just the problems, but how people are responding and building resilience in the face of challenges.
