Twenty-seven years after Nigeria returned to democratic governance, the health sector remains a stark measure of the nation’s development journey. It’s where policy meets daily life: the primary healthcare centre that opens on time, the maternity ward with skilled staff, the pharmacy with stocked medicines, the cold chain preserving vaccines, the ambulance that arrives when called, and the family that can seek care without financial ruin. The challenges are neither new nor insignificant. Population growth has surged demand. Maternal mortality remains stubbornly high. Out-of-pocket spending crushes households. Workforce shortages persist across many regions. Specialist care is unevenly distributed, especially outside major cities. Medicines and supplies are still scarce where they’re needed most. But a fair assessment demands attention to both the problems that remain and the changes taking root.
Many recent developments have been driven by the Nigeria Health Sector Renewal Investment Initiative, launched in 2023. This framework aims to improve coordination across financing, service delivery, workforce development, health security, and the healthcare value chain. Its core principle is simple: one conversation, one plan, one budget, and one report. The initiative emerged from a system where programs, funding streams, reporting requirements, and implementation often ran in parallel. Federal agencies, state governments, development partners, and organizations frequently pursued similar goals through separate structures, creating duplication, fragmentation, and inefficiency. The reform seeks to align priorities, strengthen government stewardship, improve accountability, and create a common performance measurement standard.
The starting conditions were daunting. Health insurance coverage languished below nine percent in most states. Health spending hovered around three percent of GDP, far below the World Health Organization’s five percent benchmark. Only about 21 percent of primary healthcare centres supported by the Basic Health Care Provision Fund met Level-2 service readiness standards. Roughly 16,000 health workers had emigrated within five years. Family planning commodities faced stock-out rates of about 41 percent. Maternal mortality stood at an estimated 512 deaths per 100,000 live births. These indicators pointed to problems beyond funding alone. Financing gaps mattered, but so did fragmentation, weak coordination, uneven readiness, workforce losses, stock-outs, and a lack of a common performance framework. The challenge wasn’t just how much money was available, but whether institutions worked together effectively to turn resources into results.
Primary healthcare is where most Nigerians first encounter the system. It’s where children are immunized, pregnant women receive antenatal care, common illnesses are treated, and referrals begin. Recent data shows a surge in activity. Health sector performance reports recorded about 45 million health visits and treatments in the third quarter of 2025 alone. Across the country, 2,382 primary healthcare centres have been upgraded, with another 1,607 undergoing improvements. These upgrades include skilled birth attendants, reliable power, staff housing, extended hours, and capacity for antenatal, immunization, and delivery services. Financing has become more direct. Over 65.9 billion naira has been disbursed through the Basic Health Care Provision Fund, while Direct Facility Financing allocations have risen from about 300,000 naira to between 600,000 and 800,000 naira per facility. Alongside increased funding, accountability has grown. Digital management systems, facility dashboards, and strengthened financial oversight aim to ensure resources reach facilities and link to actual service delivery. In a sector where funding was often discussed separately from performance, this distinction is increasingly vital.
Maternal and newborn health offers another critical test. Nigeria’s maternal mortality burden remains one of the world’s gravest public health challenges. Under the Maternal and Neonatal Mortality Reduction Innovation Initiative, 172 priority local government areas across 33 states were identified as accounting for about 55 percent of the country’s maternal deaths. The program focuses on early identification of pregnant women, linking them to care, supporting referrals, reducing transportation barriers, improving emergency obstetric services, and strengthening follow-up and mortality reviews. It has also tackled barriers that separate women from care. About 438,000 pregnant women have been identified and registered in priority areas. More than 4,000 free Caesarean sections have been performed in approved facilities. Approximately 15,000 women and newborns have been transported through emergency referral systems. Over 110,000 delivery support kits have been distributed. Between 2023 and December 2025, more than 5.26 million antenatal care visits were recorded, along with about 1.96 million skilled deliveries. Across the health initiative, 236 Comprehensive Emergency Obstetric and Newborn Care facilities have been established, while hundreds of primary healthcare centres in priority areas have been upgraded for maternal and newborn services.
These figures don’t suggest Nigeria has solved its maternal mortality crisis. They do indicate that interventions are increasingly targeting where preventable deaths occur: delayed identification, weak referral systems, transportation barriers, inadequate emergency obstetric care, financial constraints, and limited follow-up. Available data shows an average of 92.6 percent of facility deliveries attended by skilled personnel. DHIS2 reporting for 2025 indicates reductions in both newborn and maternal deaths during the period. Whether these gains can be sustained long-term remains to be seen. What’s clear is that effort is now concentrated where the burden has been intractable and failure most severe: the primary healthcare centre, the maternity ward, and the journey between them. That’s where the success or failure of any health reform is ultimately decided. Part II examines workforce development, immunisation, nutrition, financial protection, tertiary-care expansion, the Presidential Initiative for Unlocking the Healthcare Value Chain, public health preparedness, and the broader effort to build a more resilient health system. ‘Lade Bandele is a public affairs analyst based in Lagos.
