A Three-Tier Structure
Nigeria's healthcare system is organised into three tiers, each assigned to a different level of government. Primary healthcare — health posts, dispensaries, and primary health centres delivering preventive care, maternal and child health services, and basic treatment — falls under the 774 Local Government Areas. Secondary care, delivered through general hospitals and specialist clinics, is the responsibility of the 36 state governments and the Federal Capital Territory. Tertiary care — teaching hospitals, federal medical centres, and national specialist hospitals offering the most advanced treatment and medical training — sits with the Federal Government. This division is codified in the National Health Act 2014 and elaborated in the National Health Policy of 2016, both of which formalised a system that had operated informally along similar lines since the 1980s S1
Coordinating Bodies
Each tier has an institutional anchor. The National Primary Health Care Development Agency (NPHCDA), operating since 1992, provides technical and programmatic support to states and LGAs on primary care planning, immunisation, and workforce development, and is the primary vehicle through which national immunisation campaigns — including the polio eradication effort covered at nigeria polio eradication — reach the community level S5. At the federal level, the Federal Ministry of Health and Social Welfare sets policy and regulatory standards, while specialised agencies handle discrete mandates: the Nigeria Centre for Disease Control and Prevention (NCDC, profiled further at ncdc) leads surveillance and outbreak response for communicable disease, and the National Agency for Food and Drug Administration and Control (NAFDAC) regulates medicines, food, and related products S6
From NHIS to NHIA: Financing Reform
For over two decades, health insurance in Nigeria ran through the National Health Insurance Scheme (NHIS), created by decree in 1999 but structured as a largely voluntary scheme that left the great majority of Nigerians uncovered. On 19 May 2022, the National Health Insurance Authority Act repealed and replaced the NHIS framework, establishing the National Health Insurance Authority (NHIA) with a mandate to achieve universal health coverage by 2030 and, for the first time, made health insurance mandatory for all residents. NHIA administers both contributory schemes — for formal-sector, informal-sector, and private-plan enrollees — and non-contributory mechanisms for vulnerable groups, chiefly the Basic Health Care Provision Fund (BHCPF) and the Vulnerable Group Fund. By the mid-2020s the authority reported coverage through 38 state and federal offices, 82 accredited Health Maintenance Organisations, and over 15,000 accredited healthcare providers S2
Primary Care Infrastructure
Primary care remains the tier with the widest reach and the largest infrastructure gap. Nigeria has roughly 17,600 political wards, and federal policy — restated under the Tinubu administration — calls for at least one fully functional, fully equipped primary health centre in each ward. As of a December 2025 briefing, NPHCDA's Executive Director, Muyi Aina, reported that 2,125 primary health centres had been fully revitalised nationally, with a further 1,671 at various stages of completion; the effort is financed in part through an expanded Basic Health Care Provision Fund, disbursing quarterly grants (₦600,000 for lower-volume centres, ₦800,000 for higher-volume centres, adjusted for inflation) to facilities across 31 approved states S7
Financing and the Out-of-Pocket Burden
Despite the NHIA reform, most Nigerian healthcare spending still comes directly from patients' pockets rather than through insurance or government budgets. The National Health Accounts 2023–2024 report, compiled by the Federal Ministry of Health and Social Welfare with the National Bureau of Statistics and WHO and published in December 2025, put out-of-pocket spending at 58.3% of Nigeria's ₦10.42 trillion total health expenditure in 2024 — a marginal improvement on the 58.8% recorded in 2023, but still leaving households as the largest single source of health financing, at roughly two-thirds of the total. The same report found capital expenditure — spending on hospitals, equipment, and infrastructure — at only 10.5% of total health spending in 2024, pointing to continued underinvestment in the system's physical base S4
Workforce Shortages
Access to care is further strained by a shortage of health workers, driven substantially by emigration of Nigerian-trained doctors and nurses — commonly termed "japa" (a Yoruba-derived colloquialism for fleeing abroad) — to the United Kingdom, United States, Canada, and Gulf states. In July 2024, the Nigerian Medical Association's president, Prof. Bala Audu, stated that the country's doctor-to-patient ratio had fallen far short of the World Health Organization's recommended standard of roughly one doctor per 600 people; estimates circulating in Nigerian media in 2024–2025 placed the actual ratio anywhere between one doctor per 2,500 people and one per 8,000, with a commonly cited figure of about 30,000 practising doctors against a population above 200 million — a range that reflects how differently outlets define "practising" and count emigration. In response, the Federal Government announced plans to roughly double annual enrolment quotas at medical and health training institutions, an effort that connects to the wider training pipeline covered at nigeria education system S3
Outlook
The formal three-tier structure coexists with persistent gaps in insurance uptake, capital investment, and workforce retention, and it coexists too with widespread traditional and indigenous practice, described at traditional medicine S1