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Chapter 2 of AHOP's Nigeria Health Systems and Services Profile.
Key messages
- Nigeria’s three-tier (primary, secondary and tertiary) health system structure is governed by the National Health Act (2014) and National Health Policy (2016). Health governance is regionally devolved in line with the existing democratic federal governance structure.
- The federal level is primarily responsible for tertiary health services and the state level for secondary health services. State governments work with local government authorities to supervise primary health services delivered at the local or ward level, guided by the Primary Health Care Under One Roof (2013) policy. Overlaps between tiers and party or political influences weaken coordination in the system.
- Private health providers currently deliver an estimated 70% of all health care services, despite being responsible for only 35% of health facilities. Partnerships for health are recognized as building blocks of the health system, and strengthening public–private partnerships is seen as key to enhancing health system performance. However, mechanisms for engagement, regulation and accountability in the private sector remain weak.
- Nigeria has a federal governance structure with federal, state and local levels. There are 36 states and the Federal Capital Territory at state level, and 774 local government areas. Weak core governance indicators, including control of corruption, freedom of expression and the rule of law, remain causes for concern, with knock-on effects on health system governance.
- Political commitment to global health targets is strong, and reforms including the Nigeria Health Sector Renewal Investment Programme (2023) have put in place the policies and plans needed to guide health service delivery. However, policy implementation remains challenging, exacerbated by the complexity of the regionally devolved health sector and weak accountability and law enforcement at all governance levels. Consequently, progress towards universal health coverage remains slow.