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Posted on: Mon 18-08-2025
For more than two decades, Nigeria’s health sector has survived on the scaffolding of international aid. Programmes spearheaded by USAID, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’s Malaria Initiative (PMI) have provided vital support—helping to reduce maternal deaths, treat millions living with HIV/AIDS, and scale up malaria prevention nationwide. But this scaffolding is beginning to crumble, exposing a fragile system that struggles to stand on its own.
The warning signs are already visible. In 2023, USAID’s health portfolio in Nigeria was valued at about S600 million. Just a year later, it had dropped to S464 million—a staggering decline of over S135 million. For a country grappling with some of the world’s worst health indicators, this shortfall is not a budgetary technicality. It is about lives—pregnant women with no access to antenatal care, children under five denied treatment, fewer HIV treatment packs, stalling malaria campaigns, and declining maternal and child health services.
PEPFAR alone has invested over S7.8 billion in Nigeria, supporting more than 1.3 million people living with HIV. Its work has been instrumental in improving testing, treatment, and prevention. But funding uncertainties in Washington are threatening these gains. Nigeria’s government attempted to cushion the blow by allocating N4.8 billion (S10 million) to procure HIV treatment packs. Yet this is barely a dent compared to the gap left behind—raising the specter of increased infections, higher mortality, and a reversal of progress.
Maternal health is also at risk. With one of the highest maternal mortality rates in the world—545 deaths per 100,000 live births in 2022—Nigeria has made modest progress, particularly in contraceptive use, which has inched from 16.6% in 2018 to around 20% in 2024. But unmet needs remain high. Twenty-one percent of Nigerian women still lack access to family planning services, leaving thousands exposed to avoidable risks. Cuts to donor funding threaten to unravel already fragile programmes in child spacing, skilled birth attendance, and emergency obstetric care—especially in rural areas where healthcare is already overstretched.
The battle against malaria tells a similar story. Nigeria bears one of the world’s heaviest malaria burdens, yet declining PMI funding has slowed or halted the distribution of insecticide-treated nets, access to antimalarial drugs, and community-level interventions. The consequence: preventable illness and deaths are likely to rise.
Nowhere is the impact more devastating than in the northeast, where conflict has already crippled health service delivery. In this region, donor agencies sustain 60–70% of healthcare services. With aid shrinking, over 70% of facilities face critical disruptions, deepening a crisis for internally displaced persons (IDPs) and rural communities where untreated conditions and avoidable deaths are on the rise.
The burden falls disproportionately on the most vulnerable—women, children, and low-income households. As resources shrink, inequities widen, reversing progress towards the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC).
Yet amid the crisis, there are opportunities. The private sector, often underestimated, already shoulders much of Nigeria’s healthcare burden. In 2019, private domestic spending made up 71% of total health expenditure, with nearly 90% of that coming directly from households. In Lagos, private providers deliver an estimated 75% of services. But much of this support remains fragmented and informal, limiting its potential for coordinated national impact.
The Private Sector Health Alliance of Nigeria (PSHAN) argues that this moment calls for a new model of partnership. Through its flagship Adopt-A-Healthcare-Facility Programme (ADHFP), PSHAN is mobilising private capital to strengthen one primary healthcare centre (PHC) in each of Nigeria’s 774 local government areas. Early results show that well-structured private engagement can deliver scalable, sustainable outcomes. Alongside this, Nigeria’s health-tech sector is attracting new investments, with telemedicine, digital diagnostics, and pharmaceutical innovations showing strong growth projections.
Still, challenges remain. Health insurance coverage is low, at just 8.8% in 2021, and infrastructure gaps persist. About 85% of PHCs are publicly owned, yet only 20% are fully functional. Many lack equipment, trained staff, or even reliable electricity. Without stronger partnerships to address these weaknesses, the country risks building facilities without improving outcomes.
Encouragingly, some state governments and corporate actors are stepping up. Kano devoted 16.46% of its 2024 budget to health—above the Abuja Declaration target of 15%. Kaduna followed with 15.63%, while Lagos allocated the largest absolute sum, N149.4 billion. The MTN Foundation, Aig-Imoukhuede Foundation, Dangote Foundation, and several corporate players have also invested significantly in strengthening PHCs. But scaling these efforts will require structural reforms, particularly laws that unlock blended finance, incentivize employer-based health insurance, and create frameworks for digital health integration.
Nigeria stands at a crossroads. Continued reliance on external aid is no longer sustainable. The choices made now—by policymakers, the private sector, philanthropists, and communities—will determine whether the country steps into a healthier, more resilient future or sinks deeper into crisis.
As Clifford Egbomeade of PSHAN rightly argues, “The future of Nigeria’s health system will not be shaped by external aid alone, but by the priorities we set and the collective will we bring to building a healthier nation.”
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