It was a sweltering afternoon in Kano when I met Aisha. She was sitting on a worn-out bench outside a primary health care center, her newborn daughter swaddled tightly against her chest. Aisha had walked for over an hour under the relentless northern sun to get her baby vaccinated. “If I don’t come,” she told me, sweat beading on her forehead, “who will protect her?” Her words have stayed with me ever since—a simple, powerful testament to the everyday courage that fuels Nigeria’s public health journey.
Nigeria, Africa’s most populous nation with over 220 million people, stands at a critical crossroads in public health. On one hand, the country has made remarkable strides in recent years—eradicating wild polio, scaling up HIV treatment, and launching ambitious health reforms. On the other, it continues to grapple with a complex web of challenges: underfunded facilities, a brain drain of health workers, persistent infectious diseases, and the rising tide of non-communicable illnesses like hypertension and diabetes.
This isn’t just a story of statistics and policy papers. It’s about mothers like Aisha, children in remote villages, overworked nurses, and visionary health officials working against the odds. In this deep dive, we’ll explore the current state of public health in Nigeria—the wins, the gaps, the human stories, and what the future might hold. Whether you’re a Nigerian citizen, a global health enthusiast, or simply someone who cares about equity and well-being, this journey matters.
The Triumphs: How Nigeria Is Turning the Tide
Let’s start with the good news—because there’s plenty of it. Nigeria’s public health landscape has seen genuine, hard-won victories in the past decade.
Perhaps the most celebrated achievement is the eradication of wild poliovirus. After decades of effort and countless vaccination campaigns, Nigeria was officially declared free of wild polio by the World Health Organization (WHO) in 2020. This milestone didn’t happen by accident. It was the result of coordinated efforts between the Nigerian government, international partners like the Global Polio Eradication Initiative, and thousands of community health workers who went door-to-door, even in conflict-affected regions like Borno State.
Another major win is the scale-up of HIV treatment. Through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, Nigeria has placed over 1.5 million people on antiretroviral therapy. According to UNAIDS, new HIV infections have declined significantly, and mother-to-child transmission rates are dropping. This progress shows what’s possible when political will meets sustained investment.
Maternal and child health has also seen improvements. The National Primary Health Care Development Agency (NPHCDA) has revitalized thousands of primary health centers, making basic care more accessible. Programs like the Midwives Service Scheme have deployed skilled birth attendants to rural areas, contributing to a gradual decline in maternal mortality. While the numbers are still too high—Nigeria accounts for 23% of global maternal deaths—the trend is moving in the right direction.
Even during the chaos of the COVID-19 pandemic, Nigeria demonstrated resilience. The Nigeria Centre for Disease Control and Prevention (NCDC) quickly established a national emergency operations center, rolled out testing, and later managed one of Africa’s largest vaccine rollouts. Though vaccine hesitancy and logistical hurdles posed challenges, the country avoided the catastrophic surge many feared.
These successes prove that Nigeria can deliver effective public health interventions when systems are aligned and communities are engaged.
The Persistent Gaps: Where the System Still Falters
Yet, for every step forward, structural challenges threaten to pull the nation back. Nigeria’s public health system remains fragile, under-resourced, and deeply unequal.
One of the most glaring issues is chronic underfunding. Despite committing to the Abuja Declaration in 2001—which calls for African governments to allocate at least 15% of their annual budgets to health—Nigeria has never met this target. In 2024, health spending hovered around just 4% of the national budget. This shortfall trickles down: clinics lack basic supplies, laboratories run without reagents, and ambulances sit idle for lack of fuel.
Compounding this is the health workforce crisis. Nigeria has one of the worst doctor-to-patient ratios in the world—approximately 1 physician per 5,000 people, far below the WHO’s recommended 1 per 1,000. Worse, many trained professionals leave the country each year in search of better pay and working conditions—a phenomenon known as “brain drain.” The UK alone welcomed over 600 Nigerian-trained doctors in 2022, according to the British Medical Journal.
Then there’s the dual burden of disease. While malaria, tuberculosis, and cholera remain leading causes of death, non-communicable diseases (NCDs) like cancer, diabetes, and heart disease are rising rapidly. The Nigerian health system, historically geared toward infectious diseases, is ill-equipped to handle this shift. Screening programs are scarce, specialist care is concentrated in urban centers, and out-of-pocket expenses push families into poverty.
Access is another critical barrier. A woman in Lagos might receive world-class care at a private hospital, while her counterpart in Sokoto may walk 10 kilometers to a clinic with no electricity or running water. This urban-rural divide is stark and systemic. According to the World Bank, only 38% of Nigerians live within a one-hour walk of a functional primary health facility.
Finally, misinformation and vaccine hesitancy continue to undermine public health efforts. Rumors about polio vaccines causing infertility once fueled resistance in the north. More recently, false claims about COVID-19 vaccines spread like wildfire on social media, reducing uptake. Building trust requires more than just information—it demands community engagement and cultural sensitivity.
The Game-Changer: Nigeria’s Health Sector Renewal Initiative
Amid these challenges, a bold new vision is emerging. In 2023, President Bola Ahmed Tinubu launched the Health Sector Renewal Investment Initiative, a comprehensive reform package aimed at transforming Nigeria’s health system over the next decade.
At its core is the National Health Insurance Authority (NHIA) Act, signed into law in 2022. This landmark legislation mandates that all Nigerians enroll in a Basic Health Care Provision Fund (BHCPF), which pools resources to provide free essential services—including maternal care, immunizations, and treatment for major diseases—to the poorest and most vulnerable. The goal? Universal health coverage (UHC) by 2030.
The initiative also prioritizes primary health care revitalization. Over ₦100 billion (roughly $120 million) has been allocated to upgrade 10,000 primary health centers with solar power, clean water, digital records, and telemedicine capabilities. These “model PHCs” are designed to be the first point of contact for 80% of health needs.
Digital innovation is another pillar. The NCDC’s Surveillance and Epidemiology Platform now uses real-time data from health facilities across the country to detect outbreaks early. Apps like mHero enable health officials to communicate directly with frontline workers during emergencies. And the Nigeria Health Informatics Association is training a new generation of data scientists to drive evidence-based decisions.
Critically, the government is also investing in local vaccine production. The newly revitalized National Veterinary Research Institute and partnerships with institutions like the African Union’s Partnerships for African Vaccine Manufacturing (PAVM) aim to reduce Nigeria’s dependence on imported vaccines—a vulnerability exposed during the pandemic.
While implementation remains a hurdle—bureaucracy, corruption, and funding gaps loom large—the ambition is undeniable. As Dr. Ifedayo Adetifa, Director-General of the NCDC, stated in a recent interview, “This is not just about fixing clinics. It’s about building a system that works for every Nigerian, everywhere.”
Voices from the Ground: Stories That Define the Struggle
Behind every policy and statistic are real people navigating Nigeria’s health landscape daily.
Take Dr. Chike, a general practitioner in Enugu. He runs a small private clinic because the public hospital where he trained couldn’t pay salaries for six months. “I wanted to serve in the public sector,” he says, “but how can I support my family on promises?” Yet every Thursday, he volunteers at a rural outreach clinic, treating children for malaria and malnutrition for free.
Then there’s Fatima, a community health extension worker in Adamawa State. Armed with a backpack of vaccines, rapid tests, and health education materials, she bikes through villages to reach pregnant women and newborns. “Some days, the road is washed out. Other days, people don’t trust me,” she admits. “But when I see a child grow strong because of a vaccine I gave—that’s my reward.”
And consider the story of the Lagos State Health Scheme (LSHS), one of Nigeria’s most successful state-level health insurance programs. Launched in 2015, it now covers over 2 million residents, including informal workers like market traders and artisans. Mrs. Bello, a pepper seller in Oshodi, used her LSHS card to get surgery for a hernia that had plagued her for years. “Before, I thought hospitals were only for the rich,” she says with a smile. “Now I know my health matters too.”
These stories remind us that public health isn’t abstract—it’s personal, human, and deeply rooted in community.
Nigeria vs. Its Peers: A Public Health Snapshot
How does Nigeria’s public health performance stack up against other large, developing nations? The comparison reveals both strengths and urgent areas for improvement.
| Indicator | Nigeria | Kenya | Ghana | South Africa |
|---|---|---|---|---|
| Health Spending (% of GDP) | 3.8% | 4.7% | 3.6% | 8.1% |
| Doctor-to-Population Ratio | 1:5,000 | 1:4,500 | 1:3,000 | 1:1,300 |
| Under-5 Mortality Rate (per 1,000) | 107 | 43 | 52 | 36 |
| Maternal Mortality Ratio | 1,047 | 342 | 279 | 119 |
| % Population with Health Insurance | ~10% | ~20% | ~60% | ~15% |
| Polio Status | Wild polio-free (2020) | Wild polio-free (1996) | Wild polio-free (2008) | Wild polio-free (1989) |
Sources: World Bank, WHO, UNICEF, Nigeria Demographic and Health Survey 2018
As the table shows, Nigeria lags significantly in maternal and child survival metrics—despite having a larger economy than Kenya or Ghana. However, its recent success in polio eradication demonstrates that targeted, well-coordinated efforts can yield world-class results. The key lesson? Political commitment and community trust are as vital as funding.
Expert Insights: What Leaders Are Saying
Public health experts agree that Nigeria’s path forward requires systemic change, not just piecemeal fixes.
Dr. Akin Abayomi, Lagos State Commissioner for Health, emphasizes integration: “We can’t treat malaria in isolation from nutrition, or HIV from mental health. Our programs must be holistic.”
Meanwhile, Professor Isaac Adewole, former Minister of Health, stresses accountability: “Funds must reach the last mile. Digital platforms that track every naira spent at the PHC level are non-negotiable.”
International partners echo this. The WHO Country Representative, Dr. Walter Mulombo, recently praised Nigeria’s NHIA law but cautioned: “Legislation is the beginning, not the end. Implementation will determine whether millions gain access or remain excluded.”
And grassroots advocates like Dr. Ameyo Adadevoh’s family foundation highlight the need for health literacy: “When people understand their rights and how their bodies work, they become active participants in their own care—not passive recipients.”
What You Can Do: Actionable Steps for Every Nigerian
Public health isn’t just the government’s job—it’s a shared responsibility. Here’s how you can contribute, no matter your role:
- Enroll in your state’s health insurance scheme (like LSHS or Osun Health Insurance Scheme). If none exists, advocate for one through community groups or social media.
- Demand transparency. Use platforms like BudgIT to track health budgets in your state and ask local officials how funds are being used.
- Combat misinformation. Before sharing health news online, verify it with trusted sources like the NCDC or WHO Nigeria.
- Support community health workers. Donate supplies, volunteer your skills, or simply thank them—they’re the backbone of the system.
- Prioritize preventive care. Get vaccinated, attend antenatal visits, screen for hypertension, and encourage others to do the same.
Small actions, multiplied across millions, create seismic change.
Frequently Asked Questions (FAQ)
Q: Is healthcare free in Nigeria?
A: Not entirely. While the Basic Health Care Provision Fund provides free essential services to the poorest Nigerians, most people still pay out-of-pocket for care. State health insurance schemes aim to reduce this burden.
Q: How can I find a functional primary health center near me?
A: The NPHCDA’s “Find a PHC” portal (when fully operational) and state health ministry websites often list accredited facilities. You can also ask at local government offices.
Q: Are vaccines safe in Nigeria?
A: Yes. All vaccines used in Nigeria are prequalified by the WHO and regulated by NAFDAC. The rumors about infertility or microchips are false and have been debunked repeatedly.
Q: What’s being done about doctor shortages?
A: The government is expanding medical schools, offering rural incentives, and exploring task-shifting (training nurses and community workers to perform certain doctor-led tasks). Retaining talent remains a challenge.
Q: How did Nigeria eradicate polio despite insecurity in the North?
A: Through “hit-and-run” vaccination teams, engagement with traditional and religious leaders, and innovative surveillance—even using satellite imagery to locate hidden settlements.
Q: Can I access mental health services under the new health insurance?
A: Mental health is included in the minimum service package, but availability is limited. Advocacy groups are pushing for greater integration of mental health into primary care.
The Road Ahead: Hope, Hard Work, and Collective Will
Nigeria’s public health story is far from over. It’s a narrative still being written—in dusty clinics, bustling urban hospitals, policy meetings in Abuja, and the quiet determination of citizens like Aisha.
The challenges are immense, yes. But so is the potential. With its youthful population, growing tech ecosystem, and increasing civic engagement, Nigeria has the ingredients for a health revolution. The Health Sector Renewal Initiative offers a roadmap; now it needs sustained political will, transparent governance, and active citizen participation to succeed.
As you reflect on this journey, remember: public health is not just about preventing disease. It’s about dignity. It’s about a mother knowing her child will survive a fever. It’s about a farmer getting treatment for diabetes without selling his land. It’s about a nation that values every life equally.
The path won’t be easy. But if Nigeria can conquer polio in the midst of conflict, it can build a health system that leaves no one behind. The question isn’t whether it’s possible—it’s whether we’re all willing to walk that path together.
So the next time you hear about public health in Nigeria, don’t just think of statistics. Think of Aisha. Think of Dr. Chike. Think of Fatima biking through the rain. And ask yourself: how can I be part of the solution?
Because in the end, health isn’t a privilege. It’s a promise—and Nigeria is finally ready to keep it.