Introduction to the HS&R Nigeria Issue

Reference This issue of Health Systems & Reform is dedicated to the challenges of improving health system performance in Nigeria. This is no small task. The Nigerian population was estimated at 182 million in 2015, making it the most populous country in Africa and including one out of five people in the sub-Saharan region. While the country is rich in material resources (especially oil) and human resources (with many universities and educational institutions), the obstacles to development remain daunting. The New York Times captured this challenge succinctly (and provocatively) in its summer 2016 article titled “Nigeria Finds a National Crisis in Every Direction it Turns.” In this issue, we examine the deep-seated challenges in Nigeria’s health system and the efforts of various organizations—governmental, multilateral development banks, nongovernmental development consultants, and private foundations—to make progress. What can be done to improve the quantity and quality of health services delivered? How can those improvements be achieved in the Nigerian context? This is the first issue of an international journal devoted to the Nigeria health system. We hope that the articles will help advance both understanding and actions for innovative reforms that will make tangible improvements in the Nigerian health system. We begin the issue with two commentaries: one from current Nigerian Minister of Health Isaac Adewole and his team, and the other from seasoned Nigerian global health expert Olusoji Adeyi, who has participated in many health reform efforts around the world (through his position at the World Bank). Minister Adewole and his team at the Federal Ministry of Health recognize Nigeria’s long history of seeking to develop its primary health care system, starting with the establishment of a federal agency in 1992. They also recognize that primary care suffers from institutional fragmentation across three levels of government and within each one as well. They call this the “most critical challenge for primary health care in Nigeria” along with the assignment of managing primary health care to the “weakest and most chronically underfunded tier *Correspondence to: Michael R. Reich; Email: reich@hsph.harvard.edu