Health System in Nigeria: From Underperformance to Measured Optimism

Why Has the System not Achieved Effective Coverage for all Nigerians, Especially the Poor? Prospects References Fifty-five years after independence, indicators of Nigeria’s health outcomes and coverage of basic health services show underperformance, both in absolute terms and relative to other countries at similar levels of economic development. Yet, though the decline in infant and child mortality could be swifter, the trend of these indicators overall is in the right direction. Furthermore, the country’s recent successes against Guinea worm disease, poliomyelitis, and Ebola Virus Disease show areas of high performance despite systemic weaknesses. There are marked variations across geopolitical zones and states; some of these, such as indicators of maternal and child health service coverage and outcomes, correlate strongly with educational status and wealth. Significant positive associations between education and the use of maternal health services in Nigeria are well documented, and so are the historical crossregional variations in education policies and school enrollment. The past five decades have seen numerous health policies and development plans in Nigeria, culminating in the National Health Act of 2014. The Act provides for a range of responsibilities, instruments, and institutions, covering but not limited to responsibility for health, eligibility for health services, and establishment of a national health system; financing; health establishments and technologies; rights and obligations of patients and health care personnel; national health research and information system; human resources for health; control of blood, blood products, tissue, and gametes in humans; and regulations and miscellaneous provisions. It is, potentially, a very consequential Act. To understand what needs to be different for this Act to succeed where prior national policies mostly underachieved, it is worth examining the context and some key drivers of Nigeria’s health.