NIGERIA’S health system is facing severe strain and is unlikely to meet global targets for Universal Health Coverage (UHC), according to a new report by the Health Policy Research Group (HPRG) of the University of Nigeria, the Nigerian national centre for the African Health Observatory – Platform (AHOP).

The AHOP Country Health System and Services Profile, released by the World Health Organisation (WHO) African Region, revealed how Nigeria’s health sector had been struggling with weak governance, chronic underfunding, and decaying infrastructure.

The report warned that the system was not on track to achieve UHC, with a service coverage index of just 38.4 per cent. 

It also noted that overall, Nigeria’s health system delivered only 45 per cent of its potential, far below the African regional average of 56 per cent, adding that access, quality, and demand for essential health services scored 41, 40 and 42 per cent respectively.

This, the researchers said, left millions of Nigerians without reliable care.

“Moreover, Nigeria’s overall health system performance, at 45 per cent, is below the World Health Organization African Region average of 56 per cent. Performance in terms of sociocultural access has improved, with more women and girls in education and employment than before, which could in turn improve access to health services if financial risk protection and functional health facilities are implemented,” Executive Summary of the report read in part.

It added that about 80 per cent of the country’s health infrastructures “are dysfunctional”, consequently forcing many Nigerians to seek treatment abroad.

This shortfall is estimated to cost the country over $1 billion annually in outbound medical tourism as Nigerians seek care abroad.

According to the report, the healthcare costs fall heavily on individuals and that out-of-pocket spending accounts for 75 per cent of all health expenditure, leaving many households vulnerable. 

Despite being Africa’s largest economy, Nigeria spends just five per cent of its annual budget on health, well below the 15 per cent target agreed under the Abuja Declaration in 2001. 

While private providers deliver 70 per cent of services, regulation and accountability mechanisms in the private sector remain weak. 

The researchers stressed that Nigerian government struggled with implementing reforms such as the National Health Insurance Authority Act 2023 and the Basic Health Care Provision Fund. 

They noted that Nigeria had 3.95 doctors per 10,000 people, below the recommended 4.45 ratio, adding that domestic pharmaceutical production meets only 30 per cent of national needs, leaving the country dependent on imports, while only 51 per cent of childbirth deliveries are attended by skilled health workers.

“The current health workforce crisis is attributed in part to the insufficient implementation of existing policies and strategies, notably strengthening coordination between the national and subnational levels. 

“Capacity and competency shortfalls, industrial unrest, unfavourable working conditions and poor remuneration, especially in the public health sector, have negatively affected clinical outcomes and eroded public confidence in the health workforce. Mass emigration of health care personnel (brain drain), especially after the COVID-19 pandemic, has significantly weakened the remaining workforce. 

“Health workforce production, distribution, deployment and retention are constrained by common implementation challenges. The unreliability and incompleteness of health workforce data pose a significant challenge, with data on the distribution of the health workforce by cadre, gender,” the report added.

It said while policies and reforms existed on paper, weak coordination between federal, state, and local governments hindered progress.

“National policies and guidelines on medical product regulation and distribution exist but are poorly implemented and audited. Nigeria’s National Agency for Food and Drug Administration and Control plays a critical role in regulation, market authorisation and supply. Annual procurement plans for medical products and health technologies in Nigeria are coordinated and prepared by the FMOH Department of Procurement for ministries, departments and agencies. Assessing the quantities of medical products that need to be produced and imported is based on past consumption patterns. 

“More stringent policy implementation, tighter policy evaluation structures and the stipulation of sanctions are needed to support supply-side regulation. Existing national production capacity meets just 30% of the country’s needs, making Nigeria overly reliant on imported pharmaceuticals and medical supplies. Foreign direct investment in the pharmaceutical sector and tax incentives offered to local producers are needed to increase domestic production capacity,” the report stated.