After 27 years of democracy, Nigeria's health sector shows how far the country has come. It reflects how policies affect daily life. It's about the health centre that opens on time, the maternity ward with skilled staff, the pharmacy stocked with medicines, the cold chain that keeps vaccines safe, the ambulance that responds quickly, and families who can access treatment without financial stress.
The health sector faces serious challenges. Population growth has raised the demand for services. Maternal mortality rates are still too high. Many families struggle with out-of-pocket expenses. There are not enough health workers in many areas. Specialist services are not evenly spread, especially outside big cities. Medicines and medical supplies are often not available where they are most needed.
To truly understand the health sector, we must look at both the ongoing issues and the positive changes that are starting to happen.
The Need for Change
Recent years have seen some important developments through the Nigeria Health Sector Renewal Investment Initiative, which started in 2023. This plan aims to improve how financing, service delivery, workforce development, health security, and the overall healthcare system work together. The main idea is straightforward: one conversation, one plan, one budget, and one report.
This initiative came about because many programs, funding, reporting, and implementation often worked separately. Federal agencies, state governments, partners, and organizations often aimed for similar goals but through different means. This caused duplication, fragmentation, and inefficiency. The reform plan aims to align priorities, strengthen government oversight, improve accountability, and create a common way to measure performance in the sector.
The challenges at the start were significant. Health insurance coverage was below nine percent in most states. Health spending was around three percent of GDP, below the World Health Organization's five percent goal. Only about 21 percent of primary healthcare centres supported by BHCPF met essential service standards. About 16,000 health workers left the country in five years. Family planning commodities had about 41 percent stock-outs. Maternal mortality was estimated at 512 deaths per 100,000 live births.
These numbers show that the problems go beyond just funding. While financing gaps are important, issues like fragmentation, weak coordination, uneven service availability, workforce losses, and stock-outs also matter. The challenge is not just about how much money is available, but whether institutions are working together effectively to turn resources into results.
Primary Healthcare as Starting Point
Primary healthcare is the best place to start when looking at the sector. It is where most Nigerians first interact with the health system. It is where children get vaccines, expectant mothers receive care, common illnesses are treated, and referrals to higher care levels begin.
Recent reports show a significant rise in activity at this level. In the third quarter of 2025 alone, there were about 45 million health visits and treatments. Across Nigeria, 2,382 primary healthcare centres have been upgraded, with another 1,607 under improvement. These upgrades include skilled birth attendants, reliable electricity, housing for staff, longer service hours, and the ability to provide antenatal, immunization, and delivery services.
Primary healthcare financing has also become more straightforward. Over β¦65.9 billion has been sent to facilities through the Basic Health Care Provision Fund. Direct Facility Financing has increased from about β¦300,000 to between β¦600,000 and β¦800,000 per facility.
With more funding has come a stronger focus on accountability. Digital management systems, facility dashboards, and better financial oversight aim to ensure that resources reach facilities and link to actual service delivery. In a sector where funding has often been talked about separately from performance, this distinction is becoming more important.
The importance of these changes is not just in the amount of money spent, but in what they aim to achieve. For many years, health funding debates focused mainly on allocations. Now, the focus is also on whether resources reach facilities, if they are managed well, and if investments lead to real improvements for citizens.
Maternal Health and Mortality Concerns
Maternal and newborn health is another critical area to consider.
Nigeria's maternal mortality rates are among the highest in the world. We cannot ignore this fact. It is also crucial to see if interventions are tackling the main reasons for preventable maternal and newborn deaths.
Under the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII), 172 local government areas in 33 states were identified. These areas account for about 55 percent of Nigeria's maternal mortality burden. The program focuses on finding pregnant women early, linking them to care, supporting referrals, reducing transport issues, improving emergency services, and strengthening follow-up systems.
The scale of implementation has been significant. More than 5.26 million antenatal visits were logged between 2023 and December 2025, along with about 1.96 million skilled deliveries. Across NHSRII-supported programs, 236 Comprehensive Emergency Obstetric and Newborn Care facilities have been set up, while many primary healthcare centres in key areas have been upgraded for better maternal and newborn services.
The program also aims to remove barriers that keep women from getting care. About 438,000 pregnant women have been identified and registered in key local government areas. Over 4,000 free Caesarean sections have been performed in approved facilities, around 15,000 women and newborns have been transported through emergency systems, and more than 110,000 delivery support kits have been distributed.
These numbers show that Nigeria is still facing its maternal mortality issue. But they also show that efforts are being made to focus on the specific areas where preventable deaths happen: late identification, poor referral systems, transport issues, weak emergency care, financial barriers, and limited follow-up.
There are signs of better service use. Data showed that an average of 92.6 percent of facility deliveries were attended by skilled personnel. DHIS2 reporting for 2025 indicated lower rates of both newborn and maternal deaths during the review period.
Whether these improvements can last over time is still uncertain. What is clear is that the focus is increasingly on areas where the burden is high and the consequences are severe: the primary healthcare centre and the maternity ward. That is where any health reform will ultimately be judged.
To be continued.
Part II will look at workforce development, immunization, nutrition, financial safety, expansion of tertiary care, the Presidential Initiative for Unlocking the Healthcare Value Chain, public health readiness, and the broader goal of building a stronger health system.
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