Experts urge more funding and reforms to solve Nigeria's health worker issues

Health experts are calling for more investment and reforms in Nigeria’s health system. They want to tackle ongoing shortages, uneven distribution, and the migration of healthcare workers. They warn that just shifting tasks around will not solve the country's workforce problems.

The experts made their plea on Thursday during a webinar hosted by the Doctors Medical Aid Foundation (DMAF). The event was titled “Nigeria’s Health Workforce Crisis: An Evidence-Informed Conversation on the Future of Nigeria’s Health Workforce.”

This webinar brought together policymakers, health workers, development partners, and other stakeholders. They discussed workforce shortages, migration trends, retention challenges, and the issues surrounding task-shifting and task-sharing policies.

Hameed Adediran, Country Director of DMAF, moderated the session. He noted that the discussion was timely due to the ongoing challenges in Nigeria’s health workforce and healthcare delivery.

Mr Adediran kicked off the session with a poll. He asked participants to point out the biggest challenges facing Nigeria’s health workforce. Poor pay was the top concern, with 46 percent of respondents highlighting it. Other issues included poor working conditions and not enough healthcare workers.

During the keynote address, Dare Bodunrin, a former Senior Programme Officer at the Gates Foundation, warned against seeing Nigeria’s health workforce crisis as a separate issue from broader health system problems.

Mr Bodunrin stressed that solutions that worked in other countries might not work in Nigeria due to differences in health system capacity. “Every innovation in terms of improving the efficiency of the health workforce can only succeed if the broader system infrastructure is in place,” he said.

He pointed out that many countries where task-sharing and task-shifting have worked well do not face the same level of stock-outs, equipment shortages, and other systemic issues that Nigeria does. He urged stakeholders to look at the whole health workforce value chain, including training, deployment, welfare, and retention.

“The question is not just whether we have a shortage. Have we actually absorbed the total number of health workers we have trained? If not, why?” he asked.

Mr Bodunrin also linked the increasing migration of Nigerian health workers to poor pay and bad working conditions. “The remuneration is really, really poor, abysmally poor, and the working conditions are terrible,” he said.

He argued that while efficiency measures are important, they cannot replace the need for proper funding. “There is a threshold beyond which you can maximize resources. If we truly want quality healthcare, we must begin to think seriously about increasing investment in the system,” he added.

Mr Bodunrin called for more private-sector involvement in healthcare delivery, especially in primary healthcare. He said the government should create frameworks that allow private providers to contribute meaningfully to service delivery while keeping regulatory control.

Nigeria’s health workforce issue is not just about the number of health workers. It is also about their distribution and whether the health system can keep them. The Federal Ministry of Health and Social Welfare mentioned in 2025 that about 75 percent of health workers are based in urban areas, where only 45 percent of the population lives.

The ministry also reported a doctor-to-population ratio of one doctor for every 5,000 people and a nurse-to-population ratio of one for every 2,000. The uneven distribution is worsened by health professionals moving from rural areas to cities and leaving Nigeria for countries that offer better pay and working conditions.

The African Health Observatory Platform, in its 2025 Nigeria Health Systems and Services Profile, pointed out shortages, uneven distribution, poor pay, and working conditions as ongoing challenges for the country’s health workforce.

In response, the federal government has introduced measures to improve workforce planning, recruitment, and retention. This includes a national health workforce registry and policies to manage health worker migration. The government reported that over 37,000 health workers have been employed since 2023, but migration still affects retention.

Gilbert Uwadia, Head of Training at the National Primary Health Care Development Agency (NPHCDA), also spoke at the webinar. He said strengthening primary healthcare facilities is key to improving health outcomes nationwide.

Mr Uwadia explained that a functional primary healthcare center should have the right staff, infrastructure, equipment, and essential supplies to offer quality services. He noted that NPHCDA supports a minimum multidisciplinary team, which includes community health workers, nurses or midwives, and junior community health extension workers.

He added that the agency focuses on integrated training programs. These ensure that frontline health workers have the skills to provide various services and know when to refer complex cases. “It is in PHCs that you find health workers who are expected to provide a wide range of services. They need the competencies to manage different health needs and know when referrals are necessary,” he said.

Mr Uwadia also mentioned the agency's community-based health worker programs, which aim to connect households to health facilities and improve healthcare use at the grassroots level.

Samuel Oyeniyi, Director of Reproductive Health at the Federal Ministry of Health and Social Welfare, said all government levels need to contribute to solving workforce shortages and the uneven distribution of health professionals. He noted that the ministry keeps a national health workforce registry to track the availability and distribution of doctors, nurses, community health officers, and others in healthcare facilities.

According to him, this database helps policymakers spot workforce gaps and create suitable solutions. “In some local government areas, you may not even have one specialist obstetrician and gynaecologist, not to mention other specialists,” he said.

Mr Oyeniyi said the government keeps working on task-shifting and task-sharing policies to fill service delivery gaps, especially in underserved areas. He acknowledged some pushback from professionals but emphasized the need for reforms.

Ruth Adetokunbo, a Health Systems Strengthening Expert with the Clinton Health Access Initiative (CHAI), spoke next. She said Nigeria’s health workforce issue revolves around four main areas: production, absorption, deployment, and retention.

Ms Adetokunbo shared that assessments by CHAI revealed significant differences in workforce challenges across health worker categories. For some, the issue is not enough production, while for others, it is poor distribution or limited capacity in training schools.

She pointed out that many Nigerians want to study health-related fields, but training institutions often struggle with infrastructure and faculty shortages that limit student intake. On deployment, she highlighted the stark inequalities in healthcare personnel distribution across the country.

According to her, less than four percent of doctors are in rural areas, while about 96 percent work in urban centers. This trend also applies to pharmacists and medical laboratory scientists, with Abuja and Lagos having a large share of the workforce.

Ms Adetokunbo stressed that to keep health workers, there needs to be better funding, fair pay, safer working conditions, and clearer paths for career growth.