Nigeria’s Health System: Report Reveals 80% Infrastructure Failure, 75% Out-of-Pocket Spending, and 45% Performance Score — Minister Pate Says Challenges Are Surmountable
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Nigeria’s health system is in a state of deep crisis, marked by decaying infrastructure, inadequate funding, weak governance, and massive inequality in access to healthcare, according to a newly launched Country Health Systems and Services Profile (CHSSP) for Nigeria, 2025.
The revelation comes from the Nigeria Country Health System and Services Profile (CHSSP) 2025, launched on Wednesday, October 8, 2025, in Abuja, under the African Health Observatory Platform on Health Systems and Policies (AHOP).
The report — the first Nigerian edition of AHOP — was authored and published by the Health Policy Research Group (HPRG), University of Nigeria, Nsukka, which serves as the Nigerian National Centre for AHOP, in collaboration with the World Health Organization (WHO) Regional Office for Africa and the London School of Economics (LSE).
“Nigeria’s health system lacks resilience and is not currently on track to achieve the health-related Sustainable Development Goal targets, especially universal health coverage,” the report noted in the executive summary.
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Government: Health Challenges Are Surmountable
Meanwhile, Prof. Mohammed Pate, Coordinating Minister of Health and Social Welfare, says the health challenges outlined in Nigeria’s Country Health System and Services Profile (CHSSP) report are surmountable.
Pate, represented by Dr. Kamil Shoretire, the Ministry’s Director of Health Planning, Research and Statistics, stated this during the official unveiling of Nigeria’s CHSSP on Wednesday in Abuja.
He said tackling the challenges required multi-stakeholder efforts, adding that the Nigeria Health Sector Renewal Investment Initiative (NHSRII) was conceived by President Bola Tinubu’s administration to address them.
“The initiative provides a unified roadmap to transform Nigeria’s health system through improved governance, reduced financial barriers, and systematic capacity building,” Pate said.
According to him, the Federal Government is addressing the challenges of low government expenditure on health, over-dependence on private health facilities, and high out-of-pocket spending through ongoing reforms.
“We launched the Sector-Wide Approach (SWAp) in August 2024 with a 1.2 billion U.S. dollar investment.
The SWAp initiative ensures that all stakeholders — government, development partners, civil society, and the private sector — operate under a single, unified strategy: One Plan, One Budget, One Conversation, One Monitoring & Evaluation, and One Report.
This coordination is essential to maximize efficiency and impact,” he said.
The minister disclosed that the government, in its drive to achieve Universal Health Coverage (UHC) by 2030, had increased enrollment in the National Health Insurance Scheme (NHIS) from 16.7 million to over 19.4 million people within the past year.
He further announced that the government was strengthening primary health care through the Basic Health Care Provision Fund (BHCPF), disbursing ₦80 billion in 2024 and increasing it to ₦298.42 billion in 2025.
“Through the Presidential Initiative for Unlocking the Health Care Value Chain, we have created a 5 billion U.S. dollar project pipeline and attracted *2 billion dollars in foreign investments,” Pate said.
A Data-Driven Diagnosis
In his remarks, Prof. Obinna Onwujekwe, Director of Nigeria’s National Centre for AHOP and Coordinator of the Health Policy Research Group, University of Nigeria, Nsukka, said the CHSSP aims to provide “standard evidence for informed policy-making in the health sector.”
He explained that the report “assesses Nigeria’s health system performance and service delivery against Africa’s benchmarks to guide appropriate action.”
According to the CHSSP, Nigeria’s health system is performing at only 45 percent, below the African regional average of 56 percent. The report noted that performance outputs — access to, demand for, and quality of health services — have improved over the last decade but “remain insufficient to achieve universal health coverage by 2030.”
Despite progress, Nigeria’s absolute coverage of essential services was found to be 1.7 percent below the regional average.
The report also highlighted that private health providers currently deliver 70 percent of all health services, despite owning only 35 percent of health facilities.
It further stated that about 80 percent of Nigeria’s health infrastructure is dysfunctional, impeding service delivery and leading to an estimated one billion U.S. dollars annual loss to outbound medical tourism.
Additionally, out-of-pocket expenditure accounts for 75 percent of total health spending, with only one in ten Nigerians having access to any form of health insurance or risk-pooling scheme.
Systemic Collapse and Funding Gaps
The report’s Chapter 6 (Health Infrastructure and Equipment) underscores that decades of neglect have left hospitals across the country in poor shape. Equipment failures, lack of maintenance budgets, and undertrained staff have created an environment where citizens “pay heavily for inadequate care or travel abroad for treatment.”
In Chapter 3 (Health Financing), the report points out that Nigeria spends only 5 percent of total government expenditure on health, far below the 15 percent Abuja Declaration target. The total current health expenditure (THE) stands at US$13.56 billion — 3 percent of GDP, versus the global benchmark of 5 percent.
Workforce and Supply Constraints
From Chapter 4, the report notes that Nigeria has 3.95 doctors per 10,000 people, still below the WHO threshold of 4.45. Emigration, poor working conditions, and data gaps worsen the crisis.
In Chapter 5, the report adds that local pharmaceutical production meets just 30 percent of national demand, leaving the country 70 percent dependent on imports, often leading to fake or substandard drugs due to weak regulation.
Poor Service Delivery and Data Fragmentation
Chapter 7 of the report reveals that only 51 percent of births are attended by skilled personnel, while primary health centers remain the weakest link while Chapter 8 highlights data fragmentation and underreporting, noting that although 92.3 percent of facilities submitted data through DHIS2 in 2023, only 84.8 percent met reporting deadlines.
Health System Performance: 45 Percent
According to Chapter 9, Nigeria’s overall health system performance stands at 45 percent, below the regional average of 56 percent, with access (41 percent), quality (40 percent), and demand (42 percent) described as “weak and uneven.”
Reform Roadmap
The CHSSP’s Chapter 11 in the reports conclusions and key considerations outlines key recommendations including full implementation of the Nigeria Health Sector Renewal Investment Initiative (NHSRII) and SWAp reforms, allocation of at least 1 percent of the Consolidated Revenue Fund to the BHCPF, expansion of mandatory health insurance to protect families from catastrophic expenses, increased domestic pharmaceutical production and better regulation and and stronger anti-corruption and accountability mechanisms.
“Nigeria has made consistent efforts to reform its health system, but sustained investment and effective implementation are now essential to drive further progress toward universal health coverage,” the report acknowledged in Chapter 11, p. 293.
A Turning Point
The 2025 CHSSP, launched in Abuja, marks a turning point in evidence-based health policy for Nigeria.
While the report paints a sobering picture of underperformance, Minister Pate’s assurance and the government’s recent investments offer a pathway toward recovery — one grounded in data, collaboration, and renewed political commitment.
As Prof. Onwujekwe noted, “the CHSSP provides the evidence Nigeria needs to take decisive, informed action to strengthen its health system and achieve universal health coverage by 2030.”
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