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By McNelson Uchenna Amadi
Despite various health reforms and policy interventions, Nigeria’s health sector continues to struggle with inadequate service delivery, particularly at the primary healthcare level. With a population exceeding 200 million, the country faces persistent challenges such as inequitable access, weak infrastructure, underfunded public health institutions, and inefficient governance structures. These obstacles compromise the availability, quality, and equity of healthcare services across the country. Improving service delivery in the Nigerian context, therefore, requires a multidimensional strategy that incorporates systemic restructuring, capacity strengthening, and the application of innovative, context-specific solutions.
Health System Overview and Structural Weaknesses
Nigeria operates a three-tiered healthcare delivery system—primary, secondary, and tertiary. Primary Health Care (PHC) remains the foundational level, intended to handle up to 70% of the population’s health needs. However, studies have consistently highlighted that PHC facilities in Nigeria are poorly equipped, inadequately staffed, and frequently bypassed in favor of higher-level facilities (Uzochukwu et al., 2021; Ogunbekun et al., 2021). These structural weaknesses undermine the goal of universal health coverage (UHC) and perpetuate inequalities in health access and outcomes.
Governance challenges are a critical factor. Health service delivery in Nigeria suffers from overlapping responsibilities between federal, state, and local governments, which often leads to fragmentation and duplication of efforts (Obembe et al., 2023). This fragmented governance structure constrains coordination and reduces accountability.
Workforce and Infrastructure Limitations
Human resources for health in Nigeria are insufficient in both number and distribution. Many rural areas face severe health worker shortages, leading to overburdened urban facilities and high out-of-pocket expenses for underserved populations (Afolabi et al., 2023). Additionally, the problem is exacerbated by poor working conditions, limited career development opportunities, and brain drain.
Infrastructure inadequacies are equally pressing. Many health facilities lack consistent electricity, clean water, functional equipment, and essential drugs (Nnamani & Igwilo, 2022). These gaps erode patient confidence in the public health system, leading to increased reliance on private providers or traditional healers.
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Strategic Innovations and Interventions
Efforts to address service delivery gaps have included a range of strategic interventions. The National Primary Health Care Development Agency (NPHCDA) launched PHC revitalization programs aimed at rehabilitating facilities and improving workforce capacity (Okpani & Abimbola, 2020). Additionally, integration of health services through task-shifting and decentralization policies has demonstrated potential to optimize workforce efficiency and service delivery (Aregbeshola & Khan, 2020).
One promising approach involves applying systems thinking and engineering management to improve healthcare processes. Lean systems, Six Sigma methodologies, and health information technologies can streamline workflows, reduce waste, and increase patient satisfaction (Oleribe et al., 2020). While such models have seen limited application in Nigerian healthcare, their potential for scale-up remains significant, especially in urban public hospitals.
Digital health interventions are also gaining traction. The adoption of mobile health (mHealth) tools for appointment scheduling, remote consultations, and data collection has been shown to improve patient monitoring and administrative efficiency (Yusuf & Bamgboye, 2022). These interventions can bridge service gaps in hard-to-reach communities and enhance coordination among providers.
Financing and Equity
Health financing in Nigeria is heavily reliant on out-of-pocket expenditure, accounting for over 70% of total health spending (Onwujekwe et al., 2020). This financing model exacerbates health inequities and limits access for the poorest populations. Community-Based Health Insurance (CBHI) and national health insurance schemes are potential mechanisms for equitable financing but remain underutilized and poorly implemented due to administrative inefficiencies and public mistrust (Abimbola et al., 2020).
Equitable service delivery requires targeted policy responses to ensure that resource allocation matches population needs. Data from the 2018 Nigerian Living Standards Survey showed stark disparities in service coverage between regions and income groups, underlining the need for redistributive mechanisms and performance-based financing (Eze et al., 2023).
Lessons from the COVID-19 Pandemic
The COVID-19 pandemic exposed and amplified many of the system’s existing weaknesses but also created momentum for reform. During the crisis, Nigerian health authorities demonstrated the capacity to scale testing, deploy emergency operations, and digitize surveillance (Aworh, 2020). These lessons can inform longer-term strategies for health system strengthening, particularly around resilience, adaptability, and cross-sectoral coordination.
Improving health service delivery in Nigeria demands a systemic overhaul rooted in policy coherence, infrastructure investment, workforce development, and adaptive governance. Strengthening PHC, adopting engineering-informed strategies, expanding digital health, and ensuring equitable financing are essential to realigning the health system with the needs of its people. Nigeria has the potential and precedent to improve health outcomes—what is now required is sustained political will, effective leadership, and strategic implementation at all levels.
Mr. McNelson Uchenna Amadi, PGD is a venerated authority in international business and a leading voice in health and social care management. With an extensive background in cross-sector governance, strategic reform, and organizational leadership, he brings a multidisciplinary perspective to global policy and systems development. His research and professional consultancy work have informed institutional frameworks and service delivery models across Africa and beyond. A respected thinker and practitioner, Amadi is known for bridging high-level policy with on-the-ground implementation—positioning him as a pivotal contributor to advancing integrated, sustainable health systems worldwide.
References
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