Nigeria’s health reforms need sustained investment, CSO feedback-Minister

By Ojoma Akor

Nigeria’s Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, has said Nigeria’s ongoing health-sector reforms require sustained investment, stronger coordination among stakeholders and continuous feedback from civil society organizations to deliver lasting improvements in healthcare.

Pate spoke in Abuja during the civil society- and media-led mid-year review of Nigeria’s health reforms dialogue, organized by the Health Sector Reform Coalition (HSRC) and the Nigeria Universal Health Coverage (UHC) Forum.

The minister said rebuilding Nigeria’s health system after years of challenges would take time, adding that the government could not address all the sector’s problems within a few years.

According to Pate, civil society organizations play a critical role in identifying gaps in government policies and helping realign reforms with community needs.

He explained that feedback from civil society had contributed to the development of the Health Sector Renewal Investment Initiative (HSRII), which brings together the federal and state governments, local governments, development partners and other stakeholders under a more coordinated framework.

Pate said the government needed continuous engagement with civil society, communities and other non-state actors to ensure that policies translated into effective programs and services.

He noted that Nigeria’s health system had experienced years of decline and fragmentation, making the reform process necessarily gradual.

Pate also stressed the importance of strengthening domestic health financing, particularly as donor countries face competing demands and external health assistance becomes less predictable.

He said Nigeria must increasingly rely on domestic resources from the federal, state, and local governments to finance essential health services.

“The path out of that dependency that we have enjoyed over the last several decades is to put domestic resources, federal, state, and local government, to invest in health for people,” Pate said at the dialogue.

The minister linked sustainable health financing to broader economic growth and tax reforms, arguing that increased government revenue would create greater fiscal space for investments in health and other social sectors.

He also pointed to the need for better coordination of development assistance so external resources complement, rather than substitute for, government responsibility for healthcare.

Pate further highlighted local manufacturing of medicines, diagnostic kits and other medical products as an important component of Nigeria’s health reforms.

He said increased domestic production could reduce dependence on imported health commodities, ease foreign-exchange pressures and create economic opportunities.

Pate said the government recognized that substantial challenges remained and that the reform process would require continuity, collaboration and sustained implementation.

Civil society organizations (CSOs) have also called on the Nigerian government to make the functionality of primary healthcare facilities the main measure of progress in the country’s ongoing health sector reforms, rather than the number of facilities renovated.

The call was contained in a communiqué issued at the end of the dialogue in Abuja.

The coalition said that while the reforms had recorded measurable progress in coordination and the architecture of health financing, service delivery at the point where citizens interact with the health system had not kept pace.

It cited findings from the Nigeria Demographic and Health Survey 2023–24 showing that only about half of live births were assisted by a skilled provider, while 39 percent of children aged 12–23 months were fully vaccinated and 40 percent of children under five were stunted.

“Where the staff, the medicines, the power and the referral arrangements are absent, renovation buys a building and little else,” the coalition said.

Five priority demands

The CSOs outlined five priority actions they want government and its partners to deliver within the next 12 months.

They called for the National Primary Health Care Development Agency (NPHCDA), working with State Primary Health Care Boards, to publish by June 30, 2027, a baseline showing the number of facilities meeting the minimum service package in each local government area.

They also demanded greater transparency in health financing, including full and timely release of appropriated health funds and traceability of Basic Health Care Provision Fund (BHCPF) resources from the federal gateway to individual health facilities.

The coalition also called for a National Health Act 2014 Alignment and Implementation Matrix to identify gaps, overlaps, institutional responsibilities, and timelines across major health policies and programs.

On community participation, it urged states to institutionalize Ward Development Committees and make BHCPF allocations and expenditure a standing agenda item.

The fifth demand was for state governments to ensure that health workers are paid monthly without arrears and to publish information on rural postings, incentives, supervision and staff deployment by facility.

The coalition said progress in health reforms remained uneven across states, arguing that variations in state-level performance were limiting national outcomes.

It also highlighted weak community participation and data challenges.

The coalition acknowledged improvements in coordination under SWAp, regulatory capacity, domestic production of health commodities, health worker training and access to emergency obstetric care.

But it stressed that these remained largely inputs unless staffing, coverage and functionality at the point of service are demonstrated.

Coalition sets up reform accountability tracker.

The CSOs also committed to tracking government implementation of the agreed actions.

According to the communiqué, the coalition will publish a quarterly reform tracker, conduct independent monitoring of health facilities using open data, publish an annual scorecard on delivery of the Health Sector Renewal Compact and maintain a public register of commitments.

The dialogue brought together participants from government, civil society, professional associations, development partners, academia, media and the private sector.