Part I of this essay examined developments at the frontline of healthcare delivery, particularly in primary healthcare and maternal health. Those areas matter because they are where citizens most directly experience the strengths and weaknesses of the health system. They are also where the consequences of failure are often most severe. A functioning primary healthcare centre, a skilled birth attendant, a timely referral, and access to emergency care can mean the difference between life and death.
Yet the primary healthcare centre and the maternity ward do not exist in isolation. The quality of care available within them is shaped by factors that are often less visible to the public: the availability of trained health workers, the reliability of medicine supplies, the affordability of treatment, the effectiveness of disease prevention programmes, the strength of laboratories and surveillance systems, and the ability of institutions to respond when emergencies occur.
It is in these less visible areas that the long-term resilience of a health system is ultimately determined.
The Workforce Challenge
No health reform can succeed without people to deliver care. Buildings can be renovated. Equipment can be procured. Medicines can be purchased. But every health system ultimately depends on the availability, distribution and motivation of the people who provide care.
This challenge is not unique to Nigeria. The World Health Organization estimates a global shortfall of approximately 11 million health workers by 2030, concentrated largely in low and lower-middle income countries. Growing international demand for doctors, nurses and other health professionals has intensified competition for skilled personnel across the world.
Nigeria has experienced these pressures directly. The departure of health workers (japa syndrome) over the past decade has become one of the defining concerns of the sector. The response has increasingly moved beyond describing the problem to expanding training capacity, improving workforce planning and creating a more structured approach to workforce mobility.
One expression of that approach is the National Policy on Health Workforce Migration. The policy reflects a recognition that workforce mobility is no longer an episodic challenge but a structural feature of the global health labour market. Its emphasis on planning, retention, training, international cooperation and workforce intelligence signals an attempt to manage migration as a policy issue rather than simply react to its consequences.
For patients, workforce shortages are experienced in simpler ways: longer waiting times, overstretched personnel, interrupted services and difficulty accessing care when it is needed.
Health sector reports indicate that more than 78,000 frontline health workers have been trained under current programmes. More than 19,000 skilled birth attendants have been recruited across participating states, while over 2,100 community-based health workers have been deployed in underserved areas. Some 60,000 nurses and midwives have received workwear and protective kits, while revised curricula and digital learning platforms have been introduced to strengthen professional training.
These efforts do not remove the pressures created by a highly competitive global labour market. They do, however, reflect a growing recognition that workforce development must become a permanent feature of health sector planning rather than an occasional response to shortages.
Prevention, Immunisation and Nutrition
If workforce determines whether services can be delivered, prevention determines how much pressure is placed on the health system in the first place.
Immunisation remains one of the most effective public health interventions available to any country. In 2025 alone, approximately 174 million doses of polio vaccine were administered, contributing to a reported 52 per cent reduction in polio cases between 2023 and 2025. More than 541,000 previously unreached zero-dose children were brought into routine immunisation services.
The first phase of the measles-rubella campaign reached almost 60 million children, while approximately 16.7 million adolescent girls received HPV vaccines across the country. Malaria vaccination also commenced in selected states, extending protection against one of the country’s most persistent public health challenges.
Prevention rarely attracts the same attention as treatment because its successes are often invisible. A child who never contracts measles, polio or cervical cancer rarely appears in the dramatic stories of healthcare. Yet those quiet successes remain among the most important achievements of public health.
Nutrition occupies a similar place in the broader picture. Through six rounds of Maternal, Newborn and Child Health Week since 2023, millions of children and mothers have received vitamin supplementation, deworming medicines and micronutrient support. Medical outreach missions have also extended services to communities that have historically had limited access to care.
The proposed National Community Food Bank Programme reflects a broader understanding of health itself. The initiative seeks to connect primary healthcare, child nutrition, food security and local agricultural systems. The premise is straightforward: health systems cannot fully succeed if large numbers of children arrive already burdened by malnutrition.
Another notable development has been the growing role of traditional and religious leaders within the reform process. Their inclusion as signatories to the health sector compact reflects recognition that many of the most important health decisions are ultimately made at community level. Whether a pregnant woman attends antenatal care, whether a child receives immunisation, whether misinformation is resisted, and whether care is sought early often depends on trust long before it depends on infrastructure.
Financial Protection and Access to Care
For many Nigerians, the greatest barrier to healthcare is not distance but cost.
Health insurance coverage remains below the levels required for universal health coverage. Nevertheless, enrolment has expanded to approximately 21.7 million Nigerians, representing growth of about 34 per cent between late 2023 and late 2025. Around 2.7 million citizens are now enrolled through the Basic Health Care Provision Fund.
A diagnosis is of limited value if treatment remains unaffordable. Financial protection therefore occupies a central place in any discussion about access to care.
Programmes linked to maternal health, emergency obstetric care and treatment support have also sought to reduce the financial barriers that frequently delay care-seeking behaviour among vulnerable populations. The gains remain modest relative to the size of the population, but they point towards gradual movement away from a system in which households shoulder almost the entire financial burden of illness on their own.
Beyond Primary Care
Primary healthcare forms the foundation of every health system, but it cannot meet every need.
Cancer, cardiovascular disease, trauma, kidney failure, complex surgery and a range of other conditions require specialist services, advanced diagnostics and highly trained personnel. A resilient health system must therefore be capable of managing both routine and complex conditions.
Recent investments have extended beyond primary healthcare. Across federal tertiary institutions, approximately 1,491 projects are underway, covering teaching hospitals, specialist centres, laboratories, emergency facilities, accommodation and medical training infrastructure. New oncology centres in Katsina, Nsukka and Benin are among the most visible examples of efforts to expand access to specialist care that has historically been concentrated in relatively few locations.
The significance of these investments lies not only in the infrastructure itself, but in the recognition that primary care and specialist care are complementary parts of the same continuum.
Health Security, Local Production and National Resilience
The COVID-19 pandemic demonstrated how quickly disruptions in global supply chains can affect access to medicines, vaccines, diagnostics and medical consumables. Shortages that begin thousands of kilometres away can rapidly become challenges for hospitals, clinics and patients at home.
It is against this backdrop that the Presidential Initiative for Unlocking the Healthcare Value Chain assumes significance.
For many years, discussions about healthcare focused largely on hospitals, personnel and medicines. Increasingly, attention is turning to the industries that produce those medicines, diagnostics, consumables and technologies in the first place.
The initiative reflects a recognition that health outcomes cannot be separated from the systems that support them. Recent commitments across pharmaceuticals, diagnostics, medical consumables and nutrition products point to growing interest in strengthening domestic capacity in areas that have historically depended heavily on imports.
For citizens, the connection may not always be obvious. Yet medicine shortages, diagnostic delays and supply disruptions often begin far from the consulting room. Strengthening local production is, in part, an attempt to reduce those vulnerabilities before they reach patients.
The significance of this effort extends beyond manufacturing itself. It reflects a broader attempt to connect public health objectives with industrial development, investment, research, innovation and job creation. In that sense, the healthcare value chain is increasingly being viewed not only as a support function for the health sector but also as a productive sector of the economy in its own right.
Public health preparedness forms another part of the same story.
The Nigeria Centre for Disease Control and Prevention reports surveillance coverage across more than 95 per cent of the country through the Surveillance Outbreak Response Management and Analysis System. Public Health Emergency Operations Centres are operational in all states and the Federal Capital Territory, while laboratory and genomic surveillance capacity has continued to expand.
Recent Ebola outbreaks elsewhere on the continent provide a timely reminder of why these capacities matter. Although Nigeria has recorded no confirmed case, surveillance systems, laboratory networks, port health services and emergency coordination structures have been activated as part of preparedness efforts.
The absence of crisis often makes preparedness easy to overlook. Yet the periods between outbreaks are precisely when surveillance systems, laboratories and response structures must be strengthened. Their effectiveness is tested only when they are needed most.
Taken together, these developments point towards a broader shift in how health policy is being understood. Workforce development, prevention, financial protection, specialist care, local production and preparedness are increasingly being approached not as separate programmes but as interconnected elements of the same system.
The Test of Implementation
Perhaps the most significant feature of the current phase of reform is that initiatives once pursued separately are increasingly being connected. The National Health Fellows Programme, which places trained young professionals across all 774 local government areas, reflects a similar emphasis on local leadership, accountability and problem-solving capacity. The effort to align primary healthcare, maternal health, workforce development, financing, domestic production and health security within a common framework has been a defining feature of health sector policy under the administration of President Bola Ahmed Tinubu, implemented through the Federal Ministry of Health and Social Welfare under the leadership of the Coordinating Minister, Professor Muhammad Ali Pate.
That coherence may ultimately prove as important as any individual intervention.
Whether this approach ultimately delivers its full promise will depend on factors that extend beyond policy design. Financing must be sustained. States must continue implementation. Health workers must be retained. Procurement systems must improve. Facilities must remain functional long after they are commissioned.
After 27 years of democracy, Nigerians are entitled to judge progress not by announcements but by experience. The measure of success is not found in policy frameworks, institutional arrangements or performance reports alone. It is found in whether care is available closer to home, whether families face fewer financial barriers, whether health workers remain within the system, whether medicines are consistently available, and whether communities feel better protected against disease and public health emergencies.
The available evidence points to a sector that continues to confront serious challenges while recording measurable developments across several of the indicators by which health systems are commonly assessed. Whether those developments mature into lasting improvements will depend on consistency, implementation and the ability of institutions to sustain momentum over time.
That is the test that lies ahead. It is also the measure by which the current phase of health sector renewal will ultimately be judged.
‘Lade Bandele is a public affairs analyst based in Lagos.
