NIGERIA’S health system remains heavily reliant on private providers who deliver about 70 per cent of healthcare services in the country, according to the newly launched Country Health System and Services Profile (CHSSP).
The CHSSP, unveiled on Wednesday, October 8, in Abuja, exposes deep-seated challenges within the system, including low public spending on health, poor infrastructure, inadequate workforce retention, and heavy reliance on out-of-pocket payments by citizens.
The report was produced by the Health Policy Research Group (HPRG) of the University of Nigeria, Nsukka (UNN), in collaboration with the Federal Ministry of Health and Social Welfare (FMOH&SW) and the World Health Organisation (WHO), among others.
While presenting findings of the profile, the lead researcher, Obinna Onwujekwe, a professor, noted that private healthcare providers deliver 70 per cent of services in Nigeria in the health sector.
He also stressed that the private sector operates under weak regulatory oversight and fragmented coordination.
“Private health providers deliver 70% of health care services. Regulation and accountability mechanisms for the private sector remain weak,” he stated.
“Reforms in the past have not delivered up to expectations, with hopes high for the recent Nigeria Health Sector Renewal Investment Initiative (NHSRII).”
The CHSSP also identified gaps in financing, showing that out-of-pocket spending accounts for 75 per cent of total health expenditure, leaving millions of Nigerians vulnerable to financial shocks when seeking medical care.
The ICIR had, on September 30, reported other details of the report published days earlier by the WHO African Region, under the African Health Observatory Platform on Health Systems and Policies (AHOP) initiative.
The report, published in September, warned that the system was not on track to achieve UHC, with a service coverage index of just 38.4 per cent.
Meanwhile, speaking on behalf of the Coordinating Minister of Health and Social Services, Kamil Shoretire, commended the efforts of the group, adding that the government takes responsibility for the challenges highlighted in the report.
He further outlined the federal government’s ongoing efforts to strengthen Nigeria’s health system through targeted investments in primary healthcare, infrastructure, workforce development, and digital innovation.
Pate further stated that the government is implementing strategies to train, recruit, and retain health workers through competitive remuneration, professional development, and improved working conditions.
He further noted that the government is leveraging digital health and innovation to enhance service delivery, health information systems, and supply chain management.
Persistent gaps and slow progress toward universal health coverage
Despite reforms, the CHSSP indicated that Nigeria remains off-track to achieve Universal Health Coverage (UHC) by 2030.
The researchers noted that the country’s UHC Social Coverage Index score stands at 38.4 per cent, among the lowest globally, due to weak infrastructure, human resource shortages, and inequitable access to essential services.
They also noted that overall, Nigeria’s health system delivered only 45 per cent of its potential, below the African regional average of 56 per cent.
This, the researchers said, left millions of Nigerians without reliable care.
According to the report, the healthcare costs fall heavily on individuals and 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.
The report also revealed that about 80 per cent of public health infrastructure is dysfunctional, contributing to the $1 billion annual loss to outbound medical tourism.
Workforce challenge
The lead researcher, while presenting the findings of the research group, stressed that while Nigeria’s health workforce is one of the largest in Africa and is expanding, it’s still short of meeting demands.
According to him, health workforce challenges negatively affect clinical outcomes in the health system
He said that many health workers are leaving the country due to the country’s poor working conditions, while many of those who are trained in Nigeria are not being employed.
“National policies and guidelines on medical product regulation and distribution are poorly implemented and audited. National production capacity meets just 30% of demand. Foreign direct investment and tax incentives would reduce reliance on imports.
“The lack of a systematic, well-regulated drug distribution system leads to drug deterioration, stock shortages, patronage of informal providers and the circulation of substandard medicines. PVAC is expected to change things,” he said.
He, however, said “improvements rely on enhanced political will to increase funding and drive stronger governance, accountability and efficiency in health financing.
‘A one-stop reference for reform’
On his part, BSC Uzochukwu, a professor and researcher with the HPRG, who presented Chapters 9–11 of the report, described the CHSSP as a “one-stop reference document” for policymakers, researchers, and development partners, designed to promote evidence-based decision-making.
He noted that health sector comparisons in the region is targeted at stimulating healthy competition, adding that it’s an opportunity for cross-learning to design multi-country studies on specific issues in the region.
Mustapha Usman is an investigative journalist with the International Centre for Investigative Reporting. You can easily reach him via: musman@icirnigeria.com. He tweets @UsmanMustapha_M