By Bobby Luccy Iduozee
Nigeria, Africa’s most populous nation, stands at a critical crossroads in its effort to reform and improve the health and social care systems that serve its more than 200 million citizens. Despite notable policy efforts, systemic weaknesses continue to hinder the delivery of accessible, equitable, and quality care. With growing urban populations, rural health disparities, and a double burden of communicable and non-communicable diseases, the urgency to transform health and social care delivery in Nigeria has never been greater.
This article explores current challenges, policy frameworks, and actionable strategies for building a more inclusive and efficient health and social care system in Nigeria.
Current State of Healthcare and Social Services
Nigeria’s health system remains under-resourced and fragmented. While the government has articulated strong policy intentions—such as in the National Health Policy 2020—implementation remains a persistent challenge. According to the World Bank (2022), the country’s healthcare sector suffers from chronic underfunding, inefficient allocation of resources, and poor service delivery outcomes.
Health service provision is marked by unequal access, with rural communities facing the greatest disadvantage. As Adebayo et al. (2021) highlight, bottlenecks include poor infrastructure, weak supply chains, inadequate staffing, and governance issues that prevent effective service delivery.
Social care services—such as mental health, elderly care, disability support, and child welfare—are often treated as secondary or nonexistent, with no robust national framework for integration into the primary healthcare system. Ibrahim, Danjuma and Yakubu (2021) stress that social care is still not viewed as an essential public health function, leading to significant service gaps for Nigeria’s most vulnerable populations.
The Role of Policy and Reform Efforts
Health system reforms in Nigeria have historically struggled with political inconsistency and lack of follow-through. However, Abubakar et al. (2020) provide evidence that current reform efforts are gaining traction due to increased attention on universal health coverage (UHC) and the role of health as a national development priority.
The National Health Policy 2020 developed by the Federal Ministry of Health aims to shift the focus toward preventive, promotive, and community-based care. Yet, its success depends on sustained funding, stakeholder coordination, and rigorous monitoring and evaluation mechanisms (FMoH, 2020).
A critical turning point is recognizing the importance of social determinants of health—factors like housing, income, education, and environment—which require intersectoral collaboration beyond the traditional health ministries.
Health Financing and Resource Allocation
Nigeria allocates less than 5% of its national budget to health—well below the Abuja Declaration target of 15%. This financing gap contributes to high out-of-pocket payments, which limit access to care, particularly among low-income and rural populations.
Aregbeshola and Khan (2020) argue that improving public healthcare financing—through taxation, health insurance expansion, and donor alignment—is essential to reducing inequalities and achieving financial risk protection. Additionally, rechanneling existing funds toward primary health care (PHC) rather than tertiary institutions can drastically improve efficiency and impact.
Strengthening Primary Health Care and Social Integration
PHC remains the most viable entry point for achieving equitable health outcomes in Nigeria. The WHO Africa (2023) report on PHC performance indicates that the system is highly fragmented, with over 70% of PHC facilities lacking basic infrastructure and skilled workforce.
However, integration of social care into PHC can be a game-changer. Ibrahim, Danjuma and Yakubu (2021) advocate for community-based care models that include not just medical interventions, but also psychosocial support, mental health services, and family welfare—especially in underserved areas. Strengthening the PHC platform with these additions would reduce the burden on secondary and tertiary care while improving quality of life.
Read also: Systems Thinking In Redesigning Health Service Delivery
System Resilience and Human Resources
Health system resilience is another priority. As Olu et al. (2020) note, the COVID-19 pandemic exposed the fragility of Nigeria’s healthcare infrastructure and highlighted the need for flexible, well-funded, and responsive systems. Strengthening resilience involves more than emergency preparedness—it requires long-term investments in workforce development, supply chains, and digital health systems.
Furthermore, a better-trained, better-compensated health and social care workforce is central to system transformation. Nigeria suffers from severe brain drain and a shortage of skilled professionals, especially in rural areas. Strategic recruitment, career development, and incentives for retention must be embedded in reform policies.
Conclusion
Transforming health and social care delivery in Nigeria is both a complex challenge and an urgent necessity. Policy blueprints like the National Health Policy 2020 are a step in the right direction, but their success hinges on the government’s commitment to implementation, financing, and integration of social services into primary care.
By strengthening primary healthcare, expanding financing mechanisms, training and retaining health workers, and embedding social care into national health planning, Nigeria can build a more inclusive, efficient, and resilient health system—one that not only treats illness but promotes well-being across the life course.
Mr. Bobby Luccy Iduozee is a dedicated health and social care professional with a strong foundation in administration and communication. A graduate of Mass Communication from Olabisi Onabanjo University, Ogun State, Nigeria, he brings a unique blend of interpersonal skill and analytical depth to the health sector. He holds a postgraduate diploma in Health and Social Care Management from the New York Center for Advanced Research (NYCAR), where he refined his leadership and policy implementation skills. With his multidisciplinary expertise, Mr. Iduozee is committed to delivering impactful, people-centered care and advancing administrative excellence across health and social care systems.
References
Adebayo, E.F., Uthman, O.A., Wiysonge, C.S., Stern, E.A., Lamontagne, F. and Ebrahim, S., 2021. A systematic review of health system bottlenecks in Nigeria. BMC Health Services Research, 21(1), p.710. https://doi.org/10.1186/s12913-021-06715-3
Abubakar, I., Dalglish, S.L., Onwujekwe, O., Umeh, C. and Olaniran, A., 2020. Health system reforms in Nigeria: A review of policy drivers. BMJ Global Health, 5(10), e002408. https://doi.org/10.1136/bmjgh-2020-002408
Aregbeshola, B.S. and Khan, S.M., 2020. Public healthcare financing in Nigeria: Which way forward? Medical Journal of Zambia, 47(2), pp.91–96. https://www.ajol.info/index.php/mjz/article/view/201571
Federal Ministry of Health (Nigeria), 2020. National Health Policy 2020. Abuja: FMoH. https://www.health.gov.ng
Ibrahim, H.J., Danjuma, M.A. and Yakubu, S., 2021. Strengthening social care integration into primary health in rural Nigeria. Journal of Global Health Reports, 5, e2021031. https://www.joghr.org/article/23290
Olu, O., Usman, A., Woldetsadik, S.F., Chamla, D. and Walker, O., 2020. Strengthening health system resilience in Nigeria: A need for policy alignment and investment. BMJ Global Health, 5(6), e002069. https://doi.org/10.1136/bmjgh-2019-002069
WHO Africa, 2023. Primary Health Care Performance in Nigeria: Assessment Report. Brazzaville: World Health Organization Regional Office for Africa. https://www.afro.who.int/publications
World Bank, 2022. Nigeria Health Sector: Economic Update and Reform Options. Washington, D.C.: World Bank Group. https://documents.worldbank.org/en/publication/documents-reports/documentdetail/