Reviving Nigeria’s Primary Healthcare System: A Call for Urgent Reform

In recent years, Nigeria’s healthcare system has continued to grapple with longstanding challenges that hinder the delivery of basic health services. At the heart of these issues lies the primary healthcare system — the cornerstone of accessible, affordable, and equitable health care. Once envisioned as the foundation of the nation’s healthcare delivery, Nigeria’s primary healthcare (PHC) system is now teetering on the brink of collapse due to underfunding, poor infrastructure, workforce shortages, and weak governance.

With over 70% of the country’s population residing in rural and underserved communities, the revitalization of the PHC system is no longer optional — it is a national emergency. This article explores the critical state of Nigeria’s primary healthcare, the root causes of its decline, and the roadmap to sustainable reform.

The Current State of Primary Healthcare in Nigeria

Nigeria’s healthcare system is structured in three tiers: primary, secondary, and tertiary. The primary level is meant to be the first point of contact for individuals seeking health services. Which includes community-based clinics, dispensaries, and health posts tasked with providing essential services such as maternal and child health, immunizations, treatment for common illnesses, and health education.

However, according to data from the National Primary Health Care Development Agency (NPHCDA), fewer than 30% of the 30,000 PHC facilities in Nigeria are fully functional. Many operate without electricity, potable water, or adequate medical supplies. In several cases, health workers are either absent or overwhelmed due to poor staffing.

In 2022, a joint report by UNICEF and the World Health Organization revealed that Nigeria loses more than 1,000 children under the age of five every day due to preventable causes. Most of these deaths could be averted with timely access to basic primary care services.

Root Causes of Decline

The dismal state of Nigeria’s PHC system is the result of multiple interconnected factors:

Underfunding

Despite the Abuja Declaration of 2001 where African Union countries pledged to allocate at least 15% of their annual budget to health, Nigeria has consistently fallen short. As of 2024, the federal allocation to health hovers around 5%, with a significant portion going to tertiary institutions rather than PHCs.

Poor Infrastructure and Equipment

Most PHC centers lack basic amenities such as beds, oxygen, ambulances, and even toilets. A 2023 NPHCDA audit found that only 20% of PHC facilities had access to electricity and clean water, compromising both service delivery and infection control.

Workforce Shortage

The shortage of trained healthcare personnel is another major setback. Many health workers prefer urban centers or migrate abroad due to poor remuneration and lack of career development opportunities. Rural PHCs are often manned by community health extension workers who operate without supervision or updated training.

Fragmented Governance and Weak Accountability

The management of PHC facilities is a shared responsibility between the federal, state, and local governments. This has led to fragmented oversight, duplication of efforts, and lack of accountability. In many cases, local governments are too cash-strapped to maintain the facilities under their jurisdiction.

Implications on Public Health

The collapse of primary healthcare has far-reaching consequences. It leads to overcrowding in tertiary hospitals as patients bypass PHC centers in search of better care. This not only drives up healthcare costs but also strains an already burdened secondary and tertiary system.

Insecurity in the northern regions has further complicated access to primary care, as health workers abandon facilities and patients are unable to travel due to ongoing violence. Additionally, the resurgence of preventable diseases like measles, cholera, and malaria highlights the urgent need to strengthen immunization and disease surveillance programs at the community level.

The Way Forward: Strategies for Reform

Reviving Nigeria’s primary healthcare system requires a coordinated, multisectoral approach anchored on political will and community ownership. Here are key strategies that can make a difference:

Increased Investment and Efficient Financing

The federal and state governments must significantly increase budgetary allocations to PHC and ensure timely release of funds. Innovative financing models such as public-private partnerships, health insurance schemes, and donor collaboration can help bridge funding gaps.

Rehabilitating Infrastructure

Targeted investments should focus on refurbishing existing PHC facilities, providing essential medical equipment, and ensuring basic amenities like electricity and water supply. The use of solar power and mobile health units in off-grid areas should be scaled up.

Strengthening the Workforce

A robust recruitment and retention strategy is essential. This includes offering rural posting incentives, continuous professional development, housing, and security for health workers. Partnerships with health institutions can facilitate training for community health workers.

Integrating Technology and Data Systems

Digital health innovations such as electronic medical records, telemedicine, and mobile health apps can improve patient tracking and service delivery. Real-time data systems will also enable better planning, resource allocation, and disease surveillance.

Improved Governance and Community Engagement

The decentralization of PHC management must be matched with accountability mechanisms. Community Health Committees (CHCs) should be empowered to monitor service delivery, while traditional rulers and civil society organizations must play a role in mobilizing support.

Policy Reforms and Implementation of PHC Under One Roof

The PHC Under One Roof policy introduced by NPHCDA should be fully operationalized across all states. This framework ensures integrated governance, planning, and financing at the state level, eliminating duplication and inefficiencies.

Hope on the Horizon?

Despite the grim statistics, there is cause for cautious optimism. In 2023, the federal government launched a renewed PHC revitalization agenda with a pledge to refurbish 10,000 PHC centers by 2030. Some states, including Kaduna, Ondo, and Ekiti, have made strides in implementing state-level health insurance schemes and community-led initiatives.

However, the time for piecemeal reform is over. What is needed now is a bold, decisive national response to reposition primary healthcare at the center of Nigeria’s health agenda.


Reviving Nigeria’s primary healthcare system is not just a health issue; it is a national security and development imperative. A well-functioning PHC system is essential to reducing maternal and child mortality, controlling disease outbreaks, and achieving universal health coverage. The road ahead requires commitment, investment, and innovation — but above all, a collective resolve to ensure that no Nigerian is left behind.