A few weeks ago, Nigeria was listed among the countries with the worst performing healthcare systems. The findings by the Legatum Prosperity Index highlighted several challenges such as lack of funding, basic access, and shortage of healthcare workers that have plagued the system.
Nigeria’s healthcare is currently underfunded, which has led to the unmet need of more than the country’s 200 million population and infrastructural deficits, contributing to Nigeria’s maternal mortality, which is one of the worst in west africa.
Every year, Nigerians leave the country to spend on average $1.3 billion on medical tourism for adequate health care in foreign countries. From January to June this year, $2.38 million was spent to receive medical care in countries with better healthcare systems.
Many medical experts have faulted this development because the money could have been used to cover the gaps in Nigeria’s healthcare. The former Minister of State for Health and Social Welfare equally protested against it, calling for a reduction in medical tourism to strengthen the country’s health sector.
The minister warned that “spending over $2 billion on health tourism is unsustainable.” He was quoted saying “the federal government is determined to reposition the health sector to match global standards.”
Dr. Solomon Olorunfemi, a medical professional at Federal Medical Centre in Abeokuta said that Nigeria still lacks modern medical facilities, even though there has been some improvement in the infrastructure over the last two decades. He said the health indicators are still one of the worst in Africa.
According to the 2023 Global Health Index by the World Health Organisation, Nigeria scored 38 out of 100 points in universal health coverage, placing Nigeria among the bottom four countries with low performing healthcare systems in West Africa.

Global perspectives
Following the health index, the global perspective for Nigeria is that it does not come close to the minimum score for universal health coverage as detailed under the Sustainable Development Goals 3.8. Earlier this month, the Federal Government claimed that its ultimate objective is to ensure Nigerians have access to quality health care, regardless of their location or socio-economic status.
The report also shows that while Nigeria scored 38 out of 100 points for UHC, healthcare workforce, service capacity and access also scored very low, highlighting the major concerns if the government means to advance the country’s healthcare.

For over five years, Nigeria has been grappling with the gap among the health workers—that is, an estimated ratio of around 20 doctors, nurses, and midwives per 10,000 people. The figure is however below the recommended 44.5 health workers per 10,000 people. As of March 2024, Nigeria has only 55,000 licensed doctors to serve its growing population. Meanwhile, in 2021, Dataphyte reported that for every 10,000 persons in Nigeria, there are only four doctors available, which is below the standard recommendation.
Dr. Olorunfemi said poor compensation by the government has contributed to this shortage of workforce among health workers, affecting healthcare services in Nigeria.
Similarly, Mrs. Rhoda Robinson, an Executive Director of HACEY, a health-focused non-governmental organisation, said Nigerians, especially those in rural areas, lack access to quality healthcare services due to geographical barriers, insufficient facilities and skilled personnel.
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Mrs. Robinson added that “infrastructure costs also limit the number of fully equipped facilities available to respond to the health needs of rural and peri-urban communities, leading people to private healthcare which is unaffordable.”
Based on World Bank data, Nigerians spent 76.24% of money out of their pocket to finance their health, showing that a large proportion of healthcare costs around that year were borne out of individuals, 2.10% increase from the preceding year.

State by state: Which Nigeria’s state has the worst healthcare system?
Dataphyte’s analysis of the Global Health Index shows that Zamfara with over 5 million population was the worst performing state in healthcare delivery, followed by Sokoto, Katsina, and Taraba states. According to the index, only eight states, including Federal Capital Territory (FCT), Enugu, and Anambra among others provide good quality health services.
This is determined by the total aggregate of the service index such as budgetary commitments, health policy, state of public health facilities and the availability of basic services in those facilities. Among these factors, the analysis shows that the people in Zamfara have a poor experience when accessing health services from the public facilities.
In 2023, Zamfara had over 500 Primary Healthcare Centres (PHCs) out of service. Media reports revealed that out of more than 700 PHCs in the state, only about 200 were accessible, making the state and other northern states account for 70% of maternal mortality in Nigeria.
However, Mr. Dauda Lawal, the state governor recently revealed the ongoing works to revamp the healthcare system, after declaring a state of emergency around January. According to a statement on the state’s website, “one year on, these hitherto decrepit, understaffed and life-threatening general hospitals now wear a new look, with state-of-the-art facilities, trained and well remunerated physicians and health workers for effective, safe, people-centred, timely, equitable, and integrated service delivery to the people.”

Sustainable indices for revamping Nigeria’s healthcare
According to HACEY’s executive director, the government must take immediate action by strengthening healthcare infrastructure and improving access to skilled birth attendance. She said “this also includes women having more access to 24-hour maternal health services so emergencies can be adequately attended to.”
In May, the federal government provided N260 million to revitalise the PHCs across the country. According to reports, the fund will be dispensed to renovate existing facilities, procure necessary medical equipment, and employ additional healthcare workers to meet the increasing demand for healthcare services.
Dr. Olorunfemi, while acknowledging the efforts, said health insurance must be mandatory for Nigerians and effectively implemented. He equally said there must be proper financing of the health sector, while the government embraces digital health solutions to further improve access and quality care.
However, he mentioned that a holistic approach that completely overhauls the healthcare system is essential for a country like Nigeria that deals with power outage, network coverage, data safety and security which could negatively impact the optimisation of digital health.