27 Years Of Democracy And Nigeria’s Health Renewal (II): Building Resilience For The Future (1)

By ‘Lade Bandele

Part I of this essay examined developments at the frontline of healthcare delivery, particularly in primary healthcare and maternal health. Those areas matter because they are where citizens most directly experience the strengths and weaknesses of the health system. They are also where the consequences of failure are often most severe. A functioning primary healthcare centre, a skilled birth attendant, a timely referral, and access to emergency care can mean the difference between life and death.

Yet the primary healthcare centre and the maternity ward do not exist in isolation. The quality of care available within them is shaped by factors that are often less visible to the public: the availability of trained health workers, the reliability of medicine supplies, the affordability of treatment, the effectiveness of disease prevention programmes, the strength of laboratories and surveillance systems, and the ability of institutions to respond when emergencies occur.

It is in these less visible areas that the long-term resilience of a health system is ultimately determined.

The Workforce Challenge

No health reform can succeed without people to deliver care. Buildings can be renovated. Equipment can be procured. Medicines can be purchased. But every health system ultimately depends on the availability, distribution and motivation of the people who provide care.

This challenge is not unique to Nigeria. The World Health Organization estimates a global shortfall of approximately 11 million health workers by 2030, concentrated largely in low and lower-middle income countries. Growing international demand for doctors, nurses and other health professionals has intensified competition for skilled personnel across the world.

Nigeria has experienced these pressures directly. The departure of health workers (japa syndrome) over the past decade has become one of the defining concerns of the sector. The response has increasingly moved beyond describing the problem to expanding training capacity, improving workforce planning and creating a more structured approach to workforce mobility.

One expression of that approach is the National Policy on Health Workforce Migration. The policy reflects a recognition that workforce mobility is no longer an episodic challenge but a structural feature of the global health labour market. Its emphasis on planning, retention, training, international cooperation and workforce intelligence signals an attempt to manage migration as a policy issue rather than simply react to its consequences.

For patients, workforce shortages are experienced in simpler ways: longer waiting times, overstretched personnel, interrupted services and difficulty accessing care when it is needed.

Health sector reports indicate that more than 78,000 frontline health workers have been trained under current programmes. More than 19,000 skilled birth attendants have been recruited across participating states, while over 2,100 community-based health workers have been deployed in underserved areas. Some 60,000 nurses and midwives have received workwear and protective kits, while revised curricula and digital learning platforms have been introduced to strengthen professional training.

These efforts do not remove the pressures created by a highly competitive global labour market. They do, however, reflect a growing recognition that workforce development must become a permanent feature of health sector planning rather than an occasional response to shortages.

Prevention, Immunisation and Nutrition

If workforce determines whether services can be delivered, prevention determines how much pressure is placed on the health system in the first place.

Immunisation remains one of the most effective public health interventions available to any country. In 2025 alone, approximately 174 million doses of polio vaccine were administered, contributing to a reported 52 per cent reduction in polio cases between 2023 and 2025. More than 541,000 previously unreached zero-dose children were brought into routine immunisation services.

The first phase of the measles-rubella campaign reached almost 60 million children, while approximately 16.7 million adolescent girls received HPV vaccines across the country. Malaria vaccination also commenced in selected states, extending protection against one of the country’s most persistent public health challenges.

Prevention rarely attracts the same attention as treatment because its successes are often invisible. A child who never contracts measles, polio or cervical cancer rarely appears in the dramatic stories of healthcare. Yet those quiet successes remain among the most important achievements of public health.

Nutrition occupies a similar place in the broader picture. Through six rounds of Maternal, Newborn and Child Health Week since 2023, millions of children and mothers have received vitamin supplementation, deworming medicines and micronutrient support. Medical outreach missions have also extended services to communities that have historically had limited access to care.

The proposed National Community Food Bank Programme reflects a broader understanding of health itself. The initiative seeks to connect primary healthcare, child nutrition, food security and local agricultural systems. The premise is straightforward: health systems cannot fully succeed if large numbers of children arrive already burdened by malnutrition.

– ‘Lade Bandele is a public affairs analyst based in Lagos.