Project – Preparedness of Community Health Centres for Humanitarian and Disease Emergencies: Evidence from Selected Primary Healthcare Facilities in Borno State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Primary healthcare (PHC) constitutes the foundation of an effective and resilient health system because it represents the level of healthcare delivery closest to individuals, households and communities. Primary healthcare provides essential preventive, promotive, curative and rehabilitative services and serves as the first point of contact between individuals and the formal healthcare system. The importance of PHC becomes even greater during humanitarian and disease emergencies because community-level facilities are often responsible for early detection, surveillance, health education, immunization, case management, referral and continuity of essential health services. The World Health Organization (WHO, 2024) emphasizes that strengthening primary healthcare is central to building health systems that can absorb shocks while maintaining essential services.

Globally, health systems are increasingly confronted with complex emergencies arising from armed conflict, forced displacement, natural disasters, climate change, disease outbreaks and epidemics. Such emergencies frequently occur simultaneously, creating situations in which health facilities must respond to multiple threats while operating with limited resources. According to the WHO (2019), health emergency preparedness involves the development of capacities, systems and procedures before an emergency occurs so that health institutions can respond rapidly and effectively when risks materialize. Preparedness therefore involves much more than the availability of physical infrastructure; it includes human resources, emergency planning, surveillance, logistics, communication, coordination, infection prevention and control, referral systems and community engagement.

The significance of emergency preparedness became particularly evident during the COVID-19 pandemic. Health facilities across the world experienced shortages of healthcare workers, personal protective equipment, medicines, diagnostic capacity and emergency beds. In Nigeria, the pandemic exposed existing weaknesses within the primary healthcare system, including inadequate infrastructure, insufficient financing, human-resource limitations and weaknesses in coordination. Uzochukwu et al. (2024), in a WHO-supported assessment of Nigeria’s primary healthcare system during the COVID-19 period, observed that although PHC remained central to health service delivery, systemic weaknesses affected the ability of the system to respond effectively to major shocks.

Preparedness is particularly important in fragile and conflict-affected settings where health systems are frequently disrupted by violence, displacement and destruction of infrastructure. Conflict can result in the closure or destruction of health facilities, displacement of health workers, interruption of medicine supply chains and reduced access to communities. Consequently, health facilities operating in conflict-affected environments require stronger preparedness mechanisms than facilities operating under stable conditions. The WHO Health Cluster notes that persistent armed conflict in North-East Nigeria has produced widespread displacement, food insecurity, poor sanitation and increased risks of communicable diseases, thereby creating substantial demands for primary and secondary healthcare services (WHO, 2026).

Nigeria’s North-East region provides a significant example of the relationship between humanitarian crises and health system vulnerability. Since the emergence of the Boko Haram insurgency in 2009, Borno, Adamawa and Yobe States have experienced prolonged armed conflict, population displacement, food insecurity and disruption of basic services. Borno State has been particularly affected. Large numbers of internally displaced persons have depended on humanitarian assistance for food, water, sanitation, shelter and healthcare. The humanitarian crisis has also created conditions conducive to infectious disease transmission because overcrowding, inadequate sanitation, limited access to clean water and disrupted health services increase population vulnerability.

The health consequences of the crisis in Borno extend beyond injuries and trauma associated with armed conflict. Communities have experienced outbreaks and increased risks of cholera, measles, malaria, acute watery diarrhoea and other communicable diseases. The WHO Health Cluster (2026) identifies displacement, poor sanitation and water-borne diseases as important health consequences of the continuing conflict in North-East Nigeria. These conditions place substantial pressure on primary healthcare facilities, which must provide essential services while simultaneously responding to emergencies.

Borno State has therefore become an important setting for examining health emergency preparedness. The state’s health facilities have had to function within an environment characterized by insecurity, population displacement, limited accessibility, humanitarian dependence and recurrent disease threats. The ability of community health centres to continue providing essential services under these circumstances depends heavily on their preparedness, including the availability of trained personnel, medicines, equipment, disease surveillance systems, emergency plans and functional referral mechanisms.

One important component of preparedness is disease surveillance. Effective surveillance allows health authorities to identify unusual patterns of illness and respond before outbreaks become widespread. In response to the humanitarian crisis in North-East Nigeria, the Early Warning Alert and Response System (EWARS) was introduced in Borno State in 2016 to strengthen disease surveillance in conflict-affected communities. Ogundiran et al. (2025), in their five-year assessment of EWARS in conflict-affected Borno State, demonstrated the importance of early warning systems in detecting and responding to epidemic-prone diseases within a severely disrupted health system. Their study underscores the continuing importance of surveillance capacity at the frontline of humanitarian healthcare.

Historical evidence from Borno also demonstrates the consequences of inadequate emergency preparedness. During the 2017 cholera outbreak in internally displaced persons’ camps, health authorities and humanitarian partners encountered challenges relating to treatment-centre availability, coordination, water and sanitation, laboratory confirmation and case management. Alabi et al. (2020) found that the response involved multiple governmental and humanitarian organizations and highlighted the importance of coordination, surveillance, laboratory capacity and appropriate case-management structures during outbreaks.

The 2017 cholera emergency also demonstrated the importance of preparedness before disease outbreaks occur. Following the outbreak, the Nigerian government and its partners strengthened cholera response mechanisms, including vaccination, treatment centres, water and sanitation interventions and surveillance. Abubakar et al. (2020) documented the implementation of an oral cholera vaccination campaign in Borno following the outbreak, illustrating how emergency preparedness and response require coordination between government institutions, health agencies and humanitarian partners.

Insecurity presents another major challenge to emergency preparedness. Healthcare workers may be unable to reach communities because of insecurity, while vaccination teams and disease surveillance personnel may encounter difficulties accessing hard-to-reach areas. Babakura et al. (2021), in their assessment of the 2017/2018 measles vaccination campaign in Borno State, found that insecurity significantly affected vaccination activities and efforts to control measles. Their findings demonstrate that emergency preparedness in conflict-affected settings must account for security conditions, access restrictions and alternative approaches to reaching vulnerable populations.

The experience of Borno also shows that emergency preparedness requires strong coordination between government and humanitarian partners. During the 2017 cholera response, the Borno State Ministry of Health provided leadership while federal agencies and international organizations supplied technical and operational support. The establishment of a Public Health Emergency Operations Centre strengthened coordination and facilitated incident management. The Nigeria Centre for Disease Control (NCDC, 2017) reported that government agencies worked with WHO, UNICEF, Médecins Sans Frontières and other partners to establish treatment centres, strengthen water, sanitation and hygiene interventions and coordinate vaccination activities.

The importance of government leadership and local capacity has become even more relevant as humanitarian actors increasingly emphasize localization and strengthening national health systems. The International Organization for Migration (IOM, 2025), for example, identified capacity development for government stakeholders and local health actors as a priority for improving public-health response and reducing dependence on humanitarian assistance. Its Nigeria Crisis Response Plan specifically includes support for primary healthcare facilities in Borno and other crisis-affected states.

Borno’s emergency preparedness requirements are not limited to infectious diseases. The state also faces humanitarian emergencies associated with displacement, malnutrition, flooding, mental health problems and interruptions to essential services. The WHO (2024) reported that the prolonged humanitarian crisis in Borno, Adamawa and Yobe had generated substantial mental health needs among displaced and underserved populations and supported the integration of mental health services into primary healthcare. This illustrates the need for community health centres to possess preparedness capacities that extend beyond outbreak response to encompass broader humanitarian health needs.

Flooding has further demonstrated the vulnerability of healthcare infrastructure in Borno. In September 2024, severe flooding in Maiduguri displaced thousands of people and affected health facilities and other critical infrastructure. WHO (2024) reported that health facilities were among the structures affected by the flooding, thereby creating additional pressure on an already fragile health system.

The 2024 flood also demonstrated how humanitarian and disease emergencies can interact. Flooding can contaminate water sources, disrupt sanitation systems, displace communities and increase the risk of cholera and other water-borne diseases. WHO outbreak reporting identified Borno among the states severely affected by the 2024 floods and noted the need for early warning systems to monitor cholera and other epidemic-prone diseases (WHO, 2024).

Preparedness at the community health-centre level therefore requires an integrated approach. Facilities need trained health workers who understand emergency procedures; adequate stocks of essential medicines and supplies; functioning surveillance and reporting systems; infection prevention and control facilities; emergency communication systems; reliable electricity and water; referral arrangements; and mechanisms for coordination with local government, state health authorities and humanitarian organizations.

The WHO (2024) High-Priority Health Services for Humanitarian Response framework similarly emphasizes that health services delivered during protracted humanitarian crises must be adapted to the local disease burden, service-delivery platforms and existing health-system capacity. This reinforces the need to assess the actual preparedness of community health centres rather than assuming that national or state-level preparedness automatically translates into facility-level readiness.

Despite extensive humanitarian and health-sector interventions in Borno State, important questions remain regarding the readiness of individual primary healthcare facilities to respond to emergencies. A facility may be designated as functional while lacking adequate medicines, emergency equipment, trained personnel, electricity, water, surveillance tools or referral capacity. Consequently, facility functionality and emergency preparedness should be assessed separately.

The assessment of community health-centre preparedness is therefore important for health policy and planning in Borno State. Evidence on existing capacity can assist government authorities and development partners in identifying gaps, prioritizing investments, strengthening training programmes, improving emergency supply chains and enhancing disease surveillance. It can also contribute to the broader objective of developing resilient primary healthcare systems capable of maintaining essential services during periods of crisis.

It is against this background that this study examines Preparedness of Community Health Centres for Humanitarian and Disease Emergencies: Evidence from Selected Primary Healthcare Facilities in Borno State.

1.2 Statement of the Problem

Borno State has experienced prolonged humanitarian crises resulting from armed conflict, population displacement, food insecurity, disease outbreaks and environmental emergencies. These crises have placed considerable pressure on the state’s health system, particularly primary healthcare facilities that serve as the first point of contact for many vulnerable populations. The continuing humanitarian situation means that community health centres must simultaneously provide routine healthcare and respond to emergencies, creating substantial demands for institutional preparedness.

The problem is particularly serious because humanitarian emergencies can rapidly develop into public health emergencies. Conflict-induced displacement can result in overcrowding, poor sanitation and limited access to safe water, thereby increasing the risk of infectious diseases. The WHO Health Cluster (2026) identifies water-borne diseases and communicable diseases as major health concerns associated with displacement in North-East Nigeria. Consequently, community health centres require strong surveillance and early-warning capacity to detect outbreaks promptly.

Evidence from previous emergencies demonstrates that preparedness gaps can adversely affect response effectiveness. During the 2017 cholera outbreak in Borno, patients from Muna Garage IDP camp had to be transported to a health facility some distance away because an appropriate cholera treatment centre had not initially been established within the camp. Alabi et al. (2020) identified weaknesses relating to treatment-centre availability, coordination and laboratory capacity during the response. Such experiences raise questions about the extent to which existing primary healthcare facilities are adequately prepared to manage future outbreaks.

Insecurity constitutes another major obstacle. Babakura et al. (2021) demonstrated that insecurity affected the implementation of measles vaccination campaigns in Borno State. When health workers cannot safely access communities, essential preventive and emergency interventions may be delayed. Community health centres operating in insecure areas therefore require contingency plans, alternative service-delivery mechanisms, trained personnel and strong coordination arrangements to maintain healthcare access.

Disease surveillance remains another area of concern. Although EWARS has strengthened disease detection in Borno, Ogundiran et al. (2025) noted that surveillance has operated within a context of conflict and health-system disruption. This raises an important question about the capacity of individual community health centres to generate accurate and timely information required by surveillance and emergency response systems. Without timely reporting, health authorities may not detect emerging outbreaks early enough to prevent wider transmission.

Furthermore, primary healthcare facilities may face shortages of essential medicines, medical equipment, personal protective equipment, laboratory materials, electricity, water and trained healthcare workers. Such resource limitations can weaken the capacity of facilities to provide emergency services. The WHO’s assessment of Nigeria’s PHC system highlights broader structural challenges affecting primary healthcare delivery and resilience (Uzochukwu et al., 2024).

The situation is further complicated by recurring environmental emergencies. The 2024 Maiduguri flood affected health facilities and displaced thousands of residents. WHO (2024) reported that the flooding created additional humanitarian and health needs in Borno. Such events demonstrate that preparedness must address multiple hazards rather than focus exclusively on infectious disease outbreaks.

Although government and humanitarian partners have invested considerable resources in strengthening health services in Borno, there remains insufficient empirical evidence concerning the preparedness of individual community health centres for simultaneous humanitarian and disease emergencies. Existing studies have tended to focus on particular outbreaks, vaccination campaigns, disease surveillance or humanitarian interventions rather than comprehensively assessing facility-level preparedness across multiple dimensions.

This creates a significant knowledge and policy gap. Without reliable information about the availability of emergency plans, trained personnel, medicines, equipment, surveillance mechanisms, infection-control resources, referral systems and coordination arrangements, policymakers may find it difficult to determine which facilities are adequately prepared and which require urgent intervention.

Therefore, the central problem addressed by this study is the uncertainty surrounding the actual preparedness capacity of selected community health centres in Borno State to detect, manage and respond effectively to humanitarian and disease emergencies. Addressing this problem is important for strengthening health-system resilience, improving emergency response and protecting vulnerable populations in one of Nigeria’s most crisis-affected states.

1.3 Aim of the Study

The main aim of this study is to assess the preparedness of community health centres for humanitarian and disease emergencies in selected primary healthcare facilities in Borno State.

1.4 Objectives of the Study

The specific objectives are to:

1. assess the level of preparedness of selected community health centres for humanitarian and disease emergencies in Borno State;
2. examine the availability of human, infrastructural, medical and logistical resources required for emergency preparedness;
3. assess the disease surveillance and early-warning capacity of selected community health centres;
4. examine the challenges affecting the preparedness of community health centres for humanitarian and disease emergencies; and
5. identify strategies for strengthening emergency preparedness among primary healthcare facilities in Borno State.

1.5 Research Questions

1. What is the level of preparedness of selected community health centres for humanitarian and disease emergencies in Borno State?
2. To what extent are human, infrastructural, medical and logistical resources available for emergency preparedness?
3. What is the level of disease surveillance and early-warning capacity of the selected community health centres?
4. What challenges affect the preparedness of community health centres for humanitarian and disease emergencies?
5. What strategies can strengthen emergency preparedness among primary healthcare facilities in Borno State?

1.6 Research Hypothesis

H₀: There is no significant relationship between the availability of emergency preparedness resources and the preparedness of selected community health centres for humanitarian and disease emergencies in Borno State.

1.7 Significance of the Study

The study will be significant to the Borno State Ministry of Health, Borno State Primary Health Care Development Board, National Primary Health Care Development Agency, Nigeria Centre for Disease Control and Prevention, humanitarian organizations, healthcare workers, communities and researchers.

For the Borno State Ministry of Health and Borno State Primary Health Care Development Board, the study will provide empirical evidence regarding the preparedness strengths and weaknesses of selected PHC facilities. Such evidence can support resource allocation, emergency planning, staff training and infrastructure development.

For the Nigeria Centre for Disease Control and Prevention, the findings may provide useful information concerning facility-level surveillance, early warning and outbreak-response capacity. This is particularly relevant given the importance of EWARS and other surveillance systems in conflict-affected Borno.

For humanitarian organizations and development partners, the findings can guide capacity-building interventions and help organizations identify areas where technical, logistical and financial support are most needed. This aligns with the increasing emphasis on strengthening local health actors and reducing excessive dependence on external humanitarian assistance.

For healthcare workers, the study will identify gaps in training, equipment, infection prevention, emergency planning and referral systems. The findings may therefore contribute to the development of targeted capacity-building programmes.

For communities in Borno State, improved preparedness of primary healthcare facilities can contribute to faster detection of disease outbreaks, timely treatment, continuity of essential healthcare services and reduced morbidity and mortality during emergencies.

For researchers and students, the study will add to the relatively limited literature on facility-level preparedness for combined humanitarian and disease emergencies in conflict-affected Nigerian communities.

1.8 Scope of the Study

The study focuses on the preparedness of selected community health centres for humanitarian and disease emergencies in Borno State, Nigeria.

The study covers four broad dimensions of preparedness: human-resource capacity; infrastructure, equipment and logistics; disease surveillance and early warning; and emergency planning and coordination.

The geographical scope is limited to selected primary healthcare facilities in Borno State. The study is situated within the contemporary humanitarian context of Borno State, while drawing on evidence from previous emergencies and preparedness interventions to understand current institutional capacity.

1.9 Operational Definition of Terms

Community Health Centre: A primary healthcare facility located within or serving a community and providing essential preventive, promotive, curative and referral services.

Disease Emergency: A situation involving an outbreak or imminent threat of disease requiring urgent public-health intervention.

Emergency Preparedness: The knowledge, plans, systems, resources and capacities developed before an emergency to enable an effective response.

Humanitarian Emergency: A situation arising from conflict, displacement, disaster or other crisis that creates widespread human suffering and requires coordinated assistance.

Primary Healthcare Facility: A first-level healthcare facility providing essential health services to individuals and communities.

Disease Surveillance: The systematic collection, analysis, interpretation and reporting of health information for the early detection and control of diseases.

Early Warning System: A system designed to detect unusual disease events or other threats early enough to facilitate timely intervention.

Health-System Resilience: The ability of a health system to prepare for, withstand, adapt to and recover from shocks while maintaining essential services.

Emergency Resources: Human, financial, medical, infrastructural, technological and logistical resources required for emergency preparedness and response.

Project – Preparedness of Community Health Centres for Humanitarian and Disease Emergencies: Evidence from Selected Primary Healthcare Facilities in Borno State