By Dr. Sabiu Adamu, FPCPharm
Introduction
The quality of a nation’s healthcare system is one of the clearest indicators of its level of development. When hospitals are functional, medicines are available, healthcare professionals are motivated, and citizens can obtain quality treatment without being pushed into poverty, the benefits extend beyond health to economic growth and national stability.
For many years, however, Nigeria’s healthcare system has grappled with persistent challenges, including inadequate funding, weak infrastructure, shortages of healthcare professionals, and unequal access to healthcare services between urban and rural communities.
To address these longstanding problems, the Federal Government introduced the National Health Policy (NHP) 2016, titled Promoting the Health of Nigerians to Accelerate Socio-Economic Development. More than just a policy document, it was conceived as a strategic blueprint for strengthening healthcare delivery and improving the health and wellbeing of all Nigerians.
Since its launch, the policy has guided reforms in primary healthcare, disease prevention, health financing, public health preparedness, and the pursuit of Universal Health Coverage (UHC). Nearly a decade later, it is appropriate to ask an important question: How much progress has Nigeria made in translating the policy into better healthcare for its people?
This article reviews the implementation of the National Health Policy (2016), highlighting its achievements, the challenges that continue to hinder its success, and the practical steps needed to build a stronger healthcare system.
Understanding the National Health Policy (2016)
The National Health Policy was developed by the Federal Ministry of Health to provide strategic direction for healthcare delivery across Nigeria. It is founded on the principle that healthcare is a fundamental human right and should be accessible to every Nigerian, irrespective of income, social status, or geographical location.
The policy seeks to:
– Strengthen the healthcare system.
– Improve access to quality healthcare services.
– Reduce inequalities in healthcare delivery.
– Improve healthcare financing.
– Develop and retain healthcare manpower.
– Promote disease prevention and public health awareness.
One of the policy’s central pillars is Primary Health Care (PHC). Recognising that most Nigerians first seek care at community health facilities, the policy prioritises strengthening PHC centres to provide immunisation, maternal and child healthcare, treatment of common illnesses, and health education.
The policy is also aligned with the Sustainable Development Goals (SDGs) and the global aspiration of achieving Universal Health Coverage (UHC).
Areas of Progress and Success
Renewed Attention to Primary Health Care
Perhaps the most visible achievement of the policy has been renewed investment in Primary Health Care.
Government agencies, development partners, and donor organisations have supported PHC through:
– Expanded childhood immunisation programmes.
– Improved antenatal and maternal healthcare.
– Community health education.
– Disease prevention initiatives.
– Increased financial support through the Basic Health Care Provision Fund (BHCPF).
These efforts have strengthened healthcare delivery in many communities and helped reduce unnecessary pressure on tertiary hospitals.
However, Progress Remains Uneven
Despite these gains, many Primary Health Care centres continue to operate under difficult conditions.
Common challenges include:
– Inadequate medical equipment.
– Shortage of healthcare professionals.
– Irregular electricity supply.
– Lack of clean water.
– Frequent shortages of essential medicines.
In some rural communities, health facilities exist physically but lack the personnel and resources needed to provide meaningful healthcare services. This illustrates that while policy direction has improved, implementation has been inconsistent across the country.
Progress Towards Universal Health Coverage
The National Health Policy emphasised financial risk protection so that Nigerians would not suffer economic hardship because of illness.
Although the policy laid the foundation for health financing reforms, a major institutional milestone came later with the National Health Insurance Authority (NHIA) Act, 2022, which transformed the former National Health Insurance Scheme (NHIS) into the NHIA and expanded the legal framework for health insurance coverage.
Several states have also established State Health Insurance Agencies to widen access to affordable healthcare.
Yet Millions Still Pay Out-of-Pocket
Despite these reforms, out-of-pocket expenditure remains the dominant means of financing healthcare in Nigeria.
Many Nigerians still struggle because:
– Health insurance coverage remains relatively low.
– Public awareness of health insurance is inadequate.
– Confidence in public healthcare services remains limited.
– Most Nigerians work in the informal sector, making enrolment more challenging.
For countless families, illness continues to create serious financial hardship.
Improved Disease Surveillance and Emergency Response
Nigeria has made notable progress in disease surveillance and emergency preparedness.
The Nigeria Centre for Disease Control and Prevention (NCDC) has played an increasingly important role in responding to:
– COVID-19.
– Lassa fever.
– Cholera.
– Mpox (formerly known as monkeypox).
Public health surveillance, laboratory coordination, and emergency response systems have improved considerably compared with previous years.
Nevertheless, Important Gaps Remain
Significant weaknesses still exist.
These include:
– Under-equipped laboratories.
– Weak surveillance in remote communities.
– Heavy dependence on donor funding during public health emergencies.
These limitations leave Nigeria vulnerable to future disease outbreaks.
Greater Attention to Maternal and Child Health
Implementation of the policy has also increased focus on maternal and child health through programmes promoting:
– Safe pregnancy.
– Antenatal care.
– Routine immunisation.
– Child nutrition.
– Child survival interventions.
Government and development partners have supported numerous initiatives aimed at reducing maternal and infant mortality.
But Maternal Mortality Remains High
Despite these interventions, Nigeria continues to record one of the highest maternal mortality burdens globally.
Contributing factors include:
– Poor access to skilled healthcare.
– Shortage of trained birth attendants.
– Delays in emergency referrals.
– Poverty.
– Weak emergency obstetric care.
These realities demonstrate that policy intentions have yet to translate into equitable healthcare outcomes nationwide.
Major Challenges Limiting Effective Implementation
Inadequate Healthcare Funding
One of the greatest obstacles to implementing the National Health Policy is inadequate financing.
Healthcare requires sustained investment in:
– Hospitals.
– Medical equipment.
– Medicines.
– Laboratories.
– Healthcare workers.
– Infrastructure.
Nigeria has consistently allocated less than the 15% health budget target endorsed by African Union member states under the 2001 Abuja Declaration.
The consequences are evident:
– Overcrowded hospitals.
– Aging medical equipment.
– Poorly maintained facilities.
– Limited healthcare services.
Without adequate financing, even well-designed policies struggle to succeed.
Brain Drain and Shortage of Healthcare Workers
Nigeria continues to experience significant emigration of healthcare professionals.
Many doctors, pharmacists, nurses, laboratory scientists, and other health workers leave the country seeking:
– Better remuneration.
– Improved working conditions.
– Safer environments.
– Greater career opportunities.
This has resulted in:
– Longer waiting times.
– Increased workload.
– Staff burnout.
– Reduced quality of care.
– Frequent industrial disputes.
Although manpower development is recognised within the policy, implementation has not kept pace with the growing workforce crisis.
Corruption and Weak Governance
Weak governance continues to undermine healthcare delivery.
Persistent concerns include:
– Mismanagement of public funds.
– Abandoned healthcare projects.
– Procurement irregularities.
– Political interference.
– Weak accountability mechanisms.
Improving transparency remains essential to restoring public confidence and ensuring efficient use of healthcare resources.
Rural–Urban Inequality
Healthcare access remains highly unequal across Nigeria.
Urban areas generally enjoy:
– Better hospitals.
– More specialists.
– Better infrastructure.
– Greater access to medicines.
Meanwhile, many rural communities continue to experience severe shortages of healthcare facilities and qualified personnel.
For many rural residents, reaching a health facility requires travelling long distances over poor roads, often resulting in delayed treatment or reliance on self-medication and unregulated healthcare providers.
The Way Forward: Strengthening Nigeria’s Healthcare System
The goals of the National Health Policy remain achievable if implementation is strengthened through sustained commitment.
Increase Investment in Healthcare
– Increase budgetary allocation to health.
– Maintain healthcare facilities.
– Procure modern equipment.
– Ensure reliable medicine supply.
Strengthen Primary Health Care
– Upgrade PHC centres.
– Recruit and retain healthcare workers.
– Improve water and electricity supply.
– Expand digital health technologies.
Improve Welfare of Healthcare Workers
– Provide competitive remuneration.
– Improve working conditions.
– Strengthen career development.
– Enhance staff welfare to reduce migration.
Expand Health Insurance Coverage
– Increase enrolment, particularly among vulnerable groups and workers in the informal sector.
– Intensify public awareness campaigns.
– Improve confidence in health insurance programmes.
Strengthen Transparency and Accountability
– Improve financial oversight.
– Monitor healthcare projects effectively.
– Enforce accountability at all levels of government.
Conclusion
The National Health Policy (2016) remains one of Nigeria’s most comprehensive efforts to reform the healthcare sector. It has contributed to important gains in Primary Health Care, disease surveillance, public health coordination, and the broader pursuit of Universal Health Coverage.
Nevertheless, millions of Nigerians still face enormous barriers to accessing affordable, quality healthcare. Chronic underfunding, weak infrastructure, corruption, workforce shortages, and persistent inequalities continue to limit the policy’s full impact.
Nigeria’s experience underscores an important lesson: a sound policy alone cannot transform a healthcare system. Lasting improvement depends on political commitment, sustained investment, transparent governance, and effective implementation.
Ultimately, the success of the National Health Policy will be judged not by the aspirations contained in its pages, but by its ability to improve the health and lives of ordinary Nigerians.
References
– Federal Ministry of Health. (2016). National Health Policy: Promoting the Health of Nigerians to Accelerate Socio-Economic Development. Abuja: Federal Ministry of Health.
– Federal Government of Nigeria. National Health Insurance Authority Act, 2022.
– . Nigeria Country Office (health systems, Universal Health Coverage, and country health profiles).
– . Annual Reports and Weekly Epidemiological Reports.
– . Nigeria Public Finance Review and publications on health financing and Universal Health Coverage.
– . Human Development Reports.
– Aregbeshola, B. S., & Khan, S. M. (2018). “Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria.” International Journal of Health Policy and Management, 7(9), 798–806.
– Welcome, M. O. (2011). “The Nigerian Health Care System: Need for Integrating Adequate Medical Intelligence and Surveillance Systems.” Journal of Pharmacy & Bioallied Sciences, 3(4), 470–478.
– . Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases (2001). This version is more conversational and newspaper-friendly while remaining evidence-based. It also corrects the health insurance timeline, uses consistent bold headings, bullet points throughout, and cites authoritative, verifiable sources rather than generic references.
Dr. Sabiu Adamu FPCPharm, Consultant Clinical Pharmacist, Rtd Director of Pharmaceutical Services, Federal Medical Centre, Keffi, Nasarawa State. Email: sabiudm@gmail.com
