Nigerian Healthcare: The Questions Worth Asking

By ‘Lade Bandele

“How should a nation judge the performance of its health sector?”

Public life has an odd way of allowing the loudest questions to eclipse the most important ones. A claim is made, a rebuttal follows, familiar positions harden, and attention gradually drifts from the matter under discussion to the argument surrounding it. Before long, the debate acquires a life of its own, and the original subject begins to disappear beneath the weight of opinion.

Something of that sort has entered recent discussions about Nigeria’s health sector.

Public scrutiny is neither an inconvenience nor an intrusion. It is one of the disciplines by which democratic societies hold themselves accountable. Governments should expect it, and those entrusted with public institutions should never shrink from it. Confidence in public administration is sustained not by official assurances but by a willingness to submit claims of progress to public examination. Scrutiny asks what has changed, what has resisted change, where institutions have grown stronger and where they continue to fall short.

Few areas of government deserve that discipline more than health. Almost everyone, at some point in life, will depend upon a nurse, a primary healthcare centre, an ambulance, a vaccine or a hospital whose competence may determine whether anxiety gives way to reassurance or to grief. Health is one of the few places where government ceases to be an abstraction and becomes something profoundly personal.

Across contemporary public health thinking there is remarkably little disagreement about how health systems should be judged. Strong systems are distinguished less by the number of initiatives they announce than by the institutions they leave behind. The World Health Organization frames that proposition in terms of governance, financing, workforce, service delivery and resilience. Put simply, a health system earns public confidence by delivering better care, more consistently, to more people than before.

Those standards alter the terms of the present discussion. They shift attention away from personalities and towards performance; away from political exchanges and towards institutional capacity. The question is no longer whether a minister has attracted criticism or praise. Public office has always attracted both. The more consequential inquiry is whether the institutions responsible for protecting life are becoming stronger, whether they inspire greater public confidence than before, and whether the ordinary experience of seeking healthcare is steadily improving.

Those are the questions worth asking. They are also the standards against which Nigeria’s present reforms should be judged.

Looking at the Record

Measured against those standards, the Nigeria Health Sector Renewal Investment Initiative is best understood not as a collection of programmes but as an attempt to correct a structural weakness that had frustrated health reform for decades. Financing, planning, service delivery, workforce development, disease surveillance and accountability too often advanced in parallel rather than together. Individual interventions produced important gains, yet the system itself changed far more slowly.

The Health Sector Compact was designed to address that fragmentation. Adopted by the Federal Government, the thirty-six states, the Federal Capital Territory and development partners, it established a common framework for planning, financing, implementation and accountability. The Sector-Wide Approach translated that commitment into operational discipline, aligning governments and partners behind shared priorities, common performance measures and collective accountability. In a federation as large and complex as Nigeria, that alignment is itself a significant reform. Strong health systems are strengthened not simply by introducing new programmes but by enabling institutions to work towards common objectives.

The results are becoming visible where Nigerians encounter the health system most often. Revitalisation has commenced in 4,161 primary healthcare centres, with 3,158 already completed. Functional primary healthcare facilities have increased by 59 per cent, while more than 14,000 now meet nationally defined functionality standards. More than 8,000 facilities receive direct financing through the Basic Health Care Provision Fund, complemented by investments in solar power, water supply, essential medicines, equipment and digital performance monitoring. Taken together, these reforms point to a primary healthcare system that is becoming more reliable, more functional and more trusted than it was only a few years ago.

The same trajectory is evident in maternal and child health. Across the 172 Local Government Areas covered by the Maternal Mortality Reduction Innovation Initiative, maternal mortality has fallen by 17 per cent and newborn mortality by 10 per cent. More than 40,000 women have received free Caesarean sections through the National Health Insurance Authority, while over 4,000 women living with obstetric fistula have undergone restorative surgery. Antenatal attendance has increased, skilled birth attendance has risen by more than 30 per cent, and over 300,000 pregnant women have been identified and linked to care. These figures represent more than programme outputs. They reflect lives saved, families spared avoidable loss and growing confidence that childbirth need not carry the risks it once did.

Prevention provides another measure of progress. More than 17 million girls have received protection against cervical cancer through HPV vaccination. Over 102 million children have been vaccinated against measles and rubella, while almost 800,000 have received the malaria vaccine. Nigeria has sustained its wild polio-free status through successive nationwide vaccination campaigns and became the first country in Africa to deploy the Mpox vaccine. During recent outbreaks, millions more Nigerians were protected against diphtheria, cholera and cerebrospinal meningitis. Together, these developments point to a health system placing increasing emphasis on preventing illness rather than merely responding to it.

The reforms are equally changing the economics of healthcare. Approximately twenty-two million Nigerians are now covered by health insurance, around six million more than in 2023, while more than ₦70 billion has been channelled through the Basic Health Care Provision Fund to strengthen frontline services and expand care for vulnerable populations. For too many families, illness has historically brought not only suffering but financial hardship. A system that reduces both is delivering social protection as well as healthcare.

People remain the foundation of every health system. More than 78,000 frontline health workers have received additional training. Nearly 20,000 doctors, nurses, midwives and other professionals have been recruited into federal tertiary hospitals, while states are being supported to recruit over 19,000 skilled birth attendants. Two cohorts of the National Health Fellows Programme—774 young professionals in each cohort, representing every Local Government Area—are already supporting implementation across the federation and have delivered more than 1,500 community improvement projects. The reform is therefore investing not only in today’s workforce but in the leadership that will sustain tomorrow’s health system.

– ‘Lade Bandele, a public affairs analyst, writes from Abuja.