By Professor Rotimi Jaiyesimi
Nigeria’s health system faces significant challenges despite recent reforms and initiatives. With a population exceeding 220 million, the country struggles with inadequate funding, workforce shortages, and persistent health inequities. This article examines the current state of Nigeria’s health ecosystem, highlighting both achievements and critical gaps, whilst proposing evidence-based recommendations for transformation guided by the fundamental principle that ‘Each Nigerian Life is Priceless’. No Nigerian should be denied healthcare because of financial hardship, and no one should be left behind in the pursuit of healthcare for all.
Current Health Status and Key Indices:
Nigeria’s health indicators reveal a mixed picture of progress and persistent challenges. The country has made notable strides in reducing child mortality, with under-five mortality declining from 213 per 1,000 live births in 2003 to 117 per 1,000 in 2018. However, maternal mortality remains alarmingly high at approximately 512 deaths per 100,000 live births, significantly above the global average.
These concerning maternal and child health statistics have prompted innovative interventions such as the MAMI Initiative (Maternal and Child Mortality Initiative), which represents a comprehensive approach to addressing Nigeria’s persistent challenges in maternal and childhood mortality. The MAMI Initiative focuses on strengthening emergency obstetric care, improving skilled birth attendance, and establishing robust referral systems that ensure pregnant women and newborns receive timely, quality care regardless of their geographic location or economic status.
Life expectancy at birth stands at 54.7 years, considerably lower than the global average of 73.4 years. The burden of communicable diseases remains substantial, with malaria, tuberculosis, and HIV/AIDS accounting for significant morbidity and mortality. Simultaneously, Nigeria faces a growing burden of non-communicable diseases, including diabetes, hypertension, and cardiovascular disease, creating a double disease burden that strains an already fragmented health system.
The country’s health system performance ranking by the World Health Organization places Nigeria 187th out of 191 countries, underscoring the urgent need for comprehensive reform. Regional disparities are stark, with northern states generally exhibiting poorer health outcomes compared to southern counterparts.
Healthcare Funding Landscape:
Nigeria’s healthcare financing remains critically underfunded, with total health expenditure representing approximately 3.89% of GDP, well below the WHO recommendation of at least 5%. Government health expenditure constitutes merely 0.5% of GDP, forcing households to bear the brunt through catastrophic out-of-pocket payments, which account for over 70% of total health expenditure.
The Abuja Declaration commitment of allocating 15% of annual budgets to health remains unmet, with federal and state governments typically allocating between 3-7% of their budgets to healthcare. This chronic underfunding perpetuates a cycle of inadequate infrastructure, equipment shortages, and brain drain of healthcare professionals.
External funding from development partners, including the Global Fund, PEPFAR, and Gavi, provides crucial support for specific disease programmes but creates fragmentation and dependency. The challenge lies in transitioning towards sustainable domestic financing whilst maintaining programme effectiveness.
Innovative financing mechanisms have been proposed to address this critical gap. During a lecture to participants of Senior Executive Course No 41 in 2019, the author opined that the Federal Government, through a scheme preferably framed as corporate social responsibility rather than taxation, could engage telecommunications companies in Nigeria to deduct a small amount from calls made by each Nigerian into a dedicated health fund to support healthcare services for all citizens.
This recommendation recognises the ubiquity of mobile phone usage across Nigeria and presents an opportunity for sustainable, broad-based health financing that aligns with the principle that healthcare should be accessible to every Nigerian regardless of their economic status.
Leadership and Governance Structures:
Nigeria’s health system operates under a three-tier federal structure, with the Federal Ministry of Health providing policy direction, state governments implementing programmes, and local government areas delivering primary healthcare services. This decentralised approach, whilst promoting local ownership, often leads to coordination challenges and inconsistent implementation of national policies.
The establishment of the Nigeria Centre for Disease Control (NCDC) in 2011 marked a significant improvement in disease surveillance and outbreak response capabilities, as demonstrated during the COVID-19 pandemic. However, weak governance structures, limited accountability mechanisms, and political interference continue to hamper effective health system stewardship.
Recent initiatives include the Basic Health Care Provision Fund (BHCPF), established in 2018 to strengthen primary healthcare delivery, and the Nigeria Health Sector Renewal Investment Initiative, aimed at revitalising health infrastructure and service delivery.
Health Reform Committee and Recommendations:
President Buhari established the Health Sector Reform Committee in September 2021, chaired by Vice President Osinbajo. The committee was tasked with developing a comprehensive health sector reform programme to address systemic challenges and achieve Universal Health Coverage (UHC).
The committee’s final report, submitted in May 2023, recommended increasing health insurance coverage, particularly for vulnerable populations; establishing new institutions like the National Tertiary Health Institutions Commission and the National Quality and Healthcare Standards Commission; and improving healthcare funding through better budget allocation and execution.
The committee emphasised the need for increased public financing and private investment in the health sector. Notably, the committee’s report included the aforementioned telecommunications-based health funding mechanism, presented as a telecom tax in the final recommendations.
This innovative financing approach, rooted in the principle of collective responsibility for healthcare access, remains yet to be actualised but represents a significant step towards sustainable health financing that ensures no Nigerian is left behind due to financial constraints.
Healthcare Workforce Challenges:
Nigeria faces a severe healthcare workforce crisis, with significant shortages across all cadres. The physician-to-population ratio stands at approximately 0.4 per 1,000 population, far below the WHO minimum recommendation of 1 per 1,000. The nursing workforce, whilst larger, remains inadequate with geographic maldistribution favouring urban areas.
Brain drain represents a critical challenge, with thousands of Nigerian-trained healthcare professionals emigrating annually to developed countries seeking better opportunities. The ‘japa’ phenomenon has accelerated post-COVID-19, with the UK alone registering over 10,000 Nigerian nurses between 2020-2023.
Rural-urban disparities in healthcare workforce distribution exacerbate access challenges, with over 60% of physicians concentrated in urban areas despite 53% of the population residing in rural communities. Limited continuing professional development opportunities, poor working conditions, and inadequate remuneration contribute to low morale and high attrition rates.
Procurement Systems and Infrastructure:
Nigeria’s healthcare procurement system suffers from inefficiencies, corruption, and lack of transparency. The establishment of procurement agencies at federal and state levels has improved processes, but challenges persist in ensuring timely procurement of quality medical supplies and equipment.
Infrastructure deficits are widespread, with many health facilities lacking basic amenities including reliable electricity, water supply, and functional medical equipment. The 2018 National Health Facility Survey revealed that only 23% of health facilities had access to improved water sources, and merely 36% had reliable electricity supply.
Recent initiatives include the Health Infrastructure Credit Guarantee scheme, designed to facilitate private sector investment in health infrastructure, and partnerships with development finance institutions to upgrade tertiary health facilities.
Health Insurance and Financial Protection:
The National Health Insurance Scheme (NHIS), established in 2005, has achieved limited coverage, reaching approximately 5% of the population primarily comprising formal sector workers and their dependents. The scheme faces challenges including limited benefit packages, restricted provider networks, and inadequate premium collection mechanisms.
Recent reforms have led to the establishment of the National Health Insurance Authority (NHIA) in 2022, replacing the NHIS with expanded mandates and improved governance structures.
The new framework promotes multiple insurance schemes, including state-based programmes and community-based insurance models.
Several states have implemented innovative health insurance programmes, including Lagos State Health Scheme (LSHS) and Kwara State Social Health Insurance Programme, demonstrating the potential for subnational innovation in achieving universal health coverage. These initiatives reflect the core belief that financial hardship should never be a barrier to accessing essential healthcare services.
Innovation and Digital Health:
Nigeria’s digital health landscape has experienced remarkable growth, driven by a vibrant technology ecosystem and increasing mobile phone penetration exceeding 85%.
Notable innovations include telemedicine platforms such as Reliance Health, DrugStoc for pharmaceutical supply chain management, and LifeBank for blood delivery services.
The COVID-19 pandemic accelerated digital health adoption, with the government launching virtual consultation platforms and contact tracing applications. The National Digital Health
Strategy (2020-2025) provides a framework for harnessing digital technologies to improve health outcomes and system efficiency.
However, challenges persist, including limited internet connectivity in rural areas, inadequate digital literacy among healthcare providers, and concerns about data privacy and security. Regulatory frameworks for digital health remain nascent, requiring strengthening to ensure quality and safety standards.
Telehealth Developments:
Telehealth adoption in Nigeria has gained momentum, particularly following COVID-19 disruptions. The Federal Ministry of Health issued interim guidelines for telemedicine practice, providing regulatory clarity for practitioners and platforms. Leading telehealth initiatives include:
MobiHealth International, which has emerged as the foremost telehealth provider in Nigeria, offering comprehensive virtual healthcare services including remote consultations, chronic disease management, and 24/7 medical support across multiple states.
Their innovative platform integrates with existing healthcare infrastructure and provides services in local languages, making healthcare accessible to underserved populations and ensuring that geographic and linguistic barriers do not prevent Nigerians from accessing quality healthcare.
Other notable players include DoctoR, providing virtual consultations and medication delivery services across major cities; Talktomedics, offering 24/7 medical consultations via multiple channels; and partnership programmes between state governments and telehealth providers to extend services to underserved communities.
Despite progress, significant barriers remain, including limited broadband infrastructure, high data costs, regulatory uncertainties, and resistance among traditional healthcare providers. Rural communities, where telehealth could have the greatest impact, face the most severe connectivity challenges.
Recent Government Initiatives:
The current administration has launched several ambitious health sector initiatives. The Basic Health Care Provision Fund, operationalised in 2019, channels 1% of the Consolidated Revenue Fund to strengthen primary healthcare delivery. By 2023, the fund had supported over 8,000 primary healthcare centres with infrastructure upgrades, equipment, and human resources.
The Health Sector Renewal Investment Initiative represents a comprehensive approach to health system strengthening, focusing on infrastructure development, workforce training, and service delivery improvement. The initiative aims to revitalise 10,000 primary healthcare centres and upgrade federal tertiary institutions.
The Nigeria COVID-19 Action Recovery and Economic Stimulus (CARES) programme included significant health sector components, supporting health system resilience and pandemic preparedness. These investments have strengthened laboratory networks, disease surveillance systems, and emergency response capabilities.
A particularly noteworthy initiative by the government of President Bola Tinubu is the MAMI Initiative (Maternal and Child Mortality Initiative), which addresses one of Nigeria’s most pressing health challenges.
This comprehensive programme focuses on reducing maternal and child mortality through targeted interventions including strengthening healthcare infrastructure at primary and secondary levels, training healthcare workers in emergency obstetric and newborn care, establishing efficient referral systems, and promoting community-based interventions that encourage skilled birth attendance and early antenatal care seeking.
The MAMI Initiative exemplifies the principle that each Nigerian life is priceless by ensuring that no mother or child dies from preventable causes due to lack of access to quality care.
Universal Health Coverage Progress:
Nigeria’s journey towards Universal Health Coverage (UHC) remains challenging but has gained political momentum. The National Health Act 2014 provides the legal framework for UHC, establishing the Basic Health Care Provision Fund and mandating health insurance coverage for all Nigerians.
The UHC Gateway, launched in 2019, represents an integrated approach to achieving UHC through improved service delivery, health financing, and system governance. The initiative targets vulnerable populations, including -pregnant women, children under five, and the elderly, with essential health services packages.
State-level UHC programmes have shown promising results, with several states achieving significant coverage increases through innovative financing mechanisms and service delivery models. However, coordination between federal and state programmes remains inconsistent.
The MAMI Initiative aligns closely with UHC objectives by ensuring that maternal and child health services are accessible, affordable, and of high quality for all Nigerians, regardless of their ability to pay. This initiative demonstrates how targeted programmes can contribute to broader health system goals whilst addressing specific population health challenges.
Critical System Gaps:
Several critical gaps impede Nigeria’s health system transformation. Financing gaps remain the most significant challenge, with inadequate domestic resource mobilisation and over-reliance on external funding creating sustainability concerns. The absence of comprehensive social protection mechanisms leaves millions vulnerable to catastrophic health expenditures, contradicting the fundamental principle that every Nigerian life is priceless and deserves protection.
Human resource gaps extend beyond numbers to include skill mix imbalances, with shortages in specialised areas such as anaesthesia, pathology, and mental health.
Geographical maldistribution compounds these challenges, with rural and remote communities bearing the greatest burden.
Infrastructure gaps encompass both physical infrastructure and health information systems.
Many facilities lack basic diagnostic capabilities, emergency care capacity, and robust supply chain systems.
Data systems remain fragmented, limiting evidence-based decision-making and performance monitoring.
Governance gaps manifest in weak regulatory oversight, limited accountability mechanisms, and insufficient coordination between different levels of government.
Quality assurance systems are underdeveloped, with limited accreditation and certification processes for health facilities and providers.
Recommendations for System Transformation:
Nigeria’s health system transformation requires comprehensive reforms across multiple domains, guided by the unwavering commitment that healthcare for all Nigerians is not negotiable.
Sustainable financing mechanisms must be prioritised, including increased domestic resource mobilisation through innovative taxation, health bonds, and public-private partnerships.
The implementation of mandatory health insurance with progressive premium structures could significantly improve financial protection.
The telecommunications-based health financing mechanism, as recommended to the Health Sector Reform Committee, should be urgently implemented to create a sustainable funding stream that ensures universal access to healthcare services.
Health workforce development requires a multi-pronged approach, including massive expansion of training capacity, implementation of retention strategies such as rural allowances and career progression pathways, and strategic partnerships with diaspora healthcare professionals. Task-shifting and community health worker programmes could help address immediate workforce shortages whilst building system capacity.
Infrastructure development should leverage blended financing mechanisms, combining public resources with private sector investment and development finance. The establishment of regional health infrastructure development banks could facilitate coordinated investment across states. Digital infrastructure development must prioritise rural connectivity and interoperability standards.
Governance reforms should focus on strengthening regulatory frameworks, implementing performance-based contracting mechanisms, and establishing robust accountability systems. The creation of independent health system oversight bodies with technical expertise and political autonomy could improve system stewardship.
Innovation ecosystems require deliberate nurturing through targeted investment in health technology incubators, regulatory sandboxes for digital health solutions, and intellectual property protections. Public-private partnerships in research and development could accelerate indigenous innovation whilst building local capacity.
Quality improvement initiatives should include mandatory accreditation systems for all health facilities, clinical governance programmes, and patient safety frameworks. The establishment of quality improvement agencies at federal and state levels could drive systematic improvements in care quality.
The scaling up and expansion of successful initiatives like the MAMI Initiative should be prioritised, with increased funding and broader geographic coverage to ensure that interventions targeting maternal and child mortality reach all communities across Nigeria.
Such programmes demonstrate the effectiveness of focused, evidence-based interventions in addressing specific health challenges whilst contributing to overall system strengthening.
Nigeria’s health ecosystem stands at a critical juncture, with significant opportunities for transformation alongside persistent challenges.
The country possesses substantial human capital, growing technological capabilities, and increasing political commitment to health sector reform. However, realising this potential requires sustained investment, political will, and coordinated action across multiple sectors, all anchored on the fundamental belief that each Nigerian life is priceless.
The path forward demands bold leadership, innovative financing mechanisms, and evidence-based policy implementation. Success will require collaborative efforts from government, private sector, civil society, and international partners, all working towards the common goal of achieving universal health coverage and improved health outcomes for all Nigerians.
The recommendations outlined in this paper provide a roadmap for transformation, but their implementation requires careful sequencing, adequate resource allocation, and robust monitoring and evaluation systems.
With sustained commitment and strategic action, Nigeria can build a resilient, equitable, and efficient health system that serves as a model for other countries in the region whilst ensuring that no Nigerian is denied healthcare because of financial hardship.
A Clarion Call to Policy Makers:
The time for half-measures and incremental changes in Nigeria’s health sector has passed. Our nation stands at a defining moment where decisive action can either propel us towards a healthcare system worthy of our people or condemn millions more to preventable suffering and death.
To our esteemed policy makers at federal, state, and local government levels: the evidence is overwhelming, the solutions are clear, and the moral imperative is undeniable. Each day of delay translates to Nigerian lives lost unnecessarily, families impoverished by medical expenses, and communities left behind in our march towards development.
We call upon you to:
Act with unprecedented urgency to implement sustainable health financing mechanisms, including the telecommunications-based health fund that can generate billions annually for healthcare whilst ensuring every Nigerian contributes to our collective health security.
Prioritise health in every budget cycle, moving beyond rhetoric to actual allocation that reflects the true value of human life. The 15% Abuja Declaration commitment is not an aspiration—it is a minimum requirement for a nation that values its people.
Champion innovation and digital health solutions that can leapfrog infrastructure deficits and bring quality healthcare to the most remote communities. Support indigenous companies like MobiHealth International and others who are pioneering accessible healthcare delivery models.
Strengthen governance structures that ensure transparency, accountability, and results in health sector investments. Establish independent oversight bodies with the authority and resources to drive systemic improvements.
Invest boldly in human capital development through expanded medical training, improved retention strategies, and partnerships that bring our diaspora expertise home to serve Nigeria.
Scale up successful interventions like the MAMI Initiative that demonstrate tangible results in reducing preventable deaths and improving health outcomes. Such programmes prove that with focused effort and adequate resources, Nigeria can achieve remarkable progress in health indicators.
The philosophy that guides this call is simple yet profound: ‘Each Nigerian Life is Priceless’. This is not merely a slogan, it is a call to action that should permeate every policy decision, every budget allocation, and every governance choice you make.
Our children and grandchildren will judge us not by the roads we built or the monuments we erected, but by whether we ensured that every Nigerian could access quality healthcare when they needed it most. The choice is ours to make, and the time to make it is now.
Healthcare for all Nigerians is not just a policy objective. It is a moral obligation, an economic imperative, and a pathway to national greatness. We urge you to seize this moment, embrace these recommendations, and lead Nigeria towards a healthcare system that truly serves all its people.
The future of Nigeria’s health and indeed the future of our nation rests in your hands.
Professor Rotimi Jaiyesimi
