PHC reforms, disease outbreaks, other events that shaped Nigeria’s health sector in 2025

Nigeria’s health sector began 2025 under intense pressure after US President Donald Trump announced sweeping cuts to foreign aid, threatening programmes that millions depend on, from HIV treatment to immunisation.

This development exposed Nigeria’s heavy reliance on external donors, putting health financing at the centre of national debate.

Throughout the year, questions around sustainability, domestic resource mobilisation, and system resilience dominated policy discussions.

Despite renewed efforts to expand primary healthcare, strengthen immunisation, and improve service delivery, the sector continued to face persistent challenges, including disease outbreaks and workforce shortages.

Experts said the federal government must address these structural weaknesses to prevent further setbacks.

The President of the Nigerian Association of Resident Doctors (NARD), Muhammad Suleiman, described 2025 as “a difficult year for the welfare of doctors, the backbone of Nigeria’s healthcare system,” and called for swift implementation of outstanding salary arrears, specialist allowances, and workforce reforms in the 2026 budget.

Saheed Kehinde, chairman of the Nigerian Medical Association (NMA) Lagos State chapter, added that “without better remuneration, strengthened primary healthcare, and focused federal leadership, the sector risks continuing on this fragile path.”

Below are some of the major developments that shaped Nigeria’s health sector in 2025.

Funding cuts, health financing

The year began with a major shock to the health system: cuts in foreign aid, particularly from the United States.

In February, the Trump administration announced a 92 per cent reduction in USAID funding, affecting HIV services, immunisation, and community health programmes previously supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund.

In response, the federal government earmarked about $200 million and additional domestic resources in the 2025 budget to cushion the shock and sustain essential services.

Health financing remained a major topic throughout the year. Nigeria’s 2025 health budget rose by about 60 per cent to N2.48 trillion (5.18 per cent of the total budget) from around N1.3 trillion (4.6 per cent) in 2024.

Yet, this was still far below the 15 per cent target Nigeria committed to under the 2001 Abuja Declaration.

The government also allocated N2.48 trillion, representing less than six per cent of the total budget, to the health sector in the proposed 2026 budget.

The Minister of State for Health and Social Welfare, Iziaq Salako, acknowledged that despite reforms, Nigeria’s health financing remained critically low, limiting the government’s ability to build a resilient and inclusive health system.

Mr Salako noted that although the National Health Insurance Authority (NHIA) has expanded coverage to an estimated 10-12 per cent of the population, out-of-pocket spending still accounts for 71 per cent of total health expenditure, pushing millions of Nigerians into poverty every year.

“These figures underscore the twin challenges of insufficient investment and catastrophic health expenditure that push millions of Nigerians into poverty annually,” he said.

A diagnostics industry expert, Oghenemaro Onoronu, said 2026 could mark a turning point for the sector if the federal government demonstrates stronger discipline in health budget execution.

Mr Onoronu, the business head of Diagnostics Instruments at ISN Products Nigeria, noted that while the proposed N2.48 trillion health allocation remains below the 15 per cent Abuja Declaration target, the inclusion of health among the government’s priority sectors signals renewed political will.

Primary healthcare reforms

Nigeria placed primary healthcare at the centre of its health reforms in 2025. By December, the National Primary Health Care Development Agency (NPHCDA) announced that 2,125 primary health centres (PHCs) had been fully revitalised nationwide, as part of efforts to strengthen services at the community level.

The reforms were backed by increased funding through the Basic Health Care Provision Fund (BHCPF). Revised BHCPF 2.0 guidelines were also rolled out mid-year to improve accountability, coordination and sustainability in fund utilisation.

In October, the federal government approved the disbursement of N32.9 billion under the revised funding framework for the BHCPF, aimed at expanding access to quality primary healthcare services and improving transparency in resource utilisation.

According to the Coordinating Minister of Health and Social Welfare, Muhammad Pate, Nigeria has recorded a fourfold increase in the utilisation of primary healthcare services, with more than 80 million patient visits recorded in the first two quarters of 2025.

Mr Pate added that over 21 million Nigerians have accessed services through the Vulnerable Groups Health Insurance Fund, while more than 15,000 women have benefited from emergency obstetric care reimbursements.

In November, the federal government announced significant success for its Maternal and Infant Mortality Initiative (MAMII), reporting a 17 per cent drop in maternal deaths and a 12 per cent decrease in newborn deaths in 172 high-burden local government areas (LGAs).

Despite the progress, it is estimated that only about 20 per cent of Nigeria’s 30,000 PHCs are considered fully functional, with many still lacking electricity, clean water, essential equipment, and adequate staffing.

HIV control amid funding shift

Even as donor funding declined, Nigeria made notable progress in its HIV response in 2025. Officials said the country is edging closer to the UNAIDS 95-95-95 targets, particularly in treatment coverage and viral suppression.

On the other hand, abrupt freezes in US PEPFAR support early in the year triggered disruptions, especially for community-led and prevention programmes.

To prevent reversals, the government committed domestic funds to ensure an uninterrupted supply of antiretroviral drugs.

States like Lagos launched their own HIV prevention action plans, while authorities also pushed for local production of HIV commodities, including test kits, condoms and antiretrovirals, to reduce dependence on imports.

Recently, the Director General of the National Agency for the Control of AIDS (NACA), Temitope Ilori, said the country is committed to adopting the twice-yearly injectable HIV prevention drug, lenacapavir, under a global agreement making it accessible at $40 per year in low- and middle-income countries.

Workforce crisis

The health workforce crisis further deepened in 2025, shaped by strikes, migration and long-standing welfare disputes.

In April, Mr Pate disclosed that over 16,000 Nigerian doctors had emigrated in the past five to seven years, leaving the country with a doctor-to-population ratio of about 3.9 per 10,000 people, far below global benchmarks.

Industrial actions by health workers further worsened the strain. In November, the Nigerian Association of Resident Doctors (NARD) embarked on a nationwide strike over unpaid allowances, residency training funds and welfare issues.

The action lasted nearly a month before it was suspended following government assurances.

Also, the Joint Health Sector Unions (JOHESU) commenced an indefinite nationwide strike in November over salary disparities and poor working conditions. These strikes disrupted healthcare services in public hospitals nationwide.

“2025 has not been good for the welfare of resident doctors and doctors in general,” NARD President, Mr Suleiman, told PREMIUM TIMES. “We still have about 18 months of salary arrears that are yet to be implemented, and issues around specialist allowances that are policy problems, not even budget problems.”

He said agreements on collective bargaining and remuneration for health workers have stalled, despite government assurances.

According to him, a committee that promised to begin work within weeks had still not sat months later.

Mr Suleiman urged the federal government to ensure that the 2026 budget captures outstanding promotion arrears, salary shortfalls affecting approximately 40 per cent of his association’s members, and unresolved welfare issues, including the reinstatement and compensation of the “Lokoja Five,” a group of doctors previously dismissed due to labour disputes.

“I hope that in 2026, all these will be finalised, included in the budget, and implemented. Our doctors are overstretched, and without better welfare, the system cannot survive,” he said.

Outbreaks test Nigeria’s health security

In 2025, Nigeria continued to battle multiple disease outbreaks, further testing the country’s public health preparedness and response systems.

Lassa fever remained endemic, with the Nigeria Centre for Disease Control and Prevention reporting 195 deaths across several hotspots, including Ondo, Edo and Bauchi states.

Cholera outbreaks, linked to flooding, unsafe water and poor sanitation, also persisted. The World Health Organisation (WHO) reported 244 deaths and over 10,000 suspected cases in Nigeria between January and September, with a case fatality rate of 2.4 per cent.

Diphtheria outbreaks also persisted, linked to low routine immunisation. In March, Lagos emerged as the most affected state, accounting for 20 of the new cases, followed by Katsina with three. Health authorities linked the spike in Lagos to an outbreak at King’s College, where 14 students were infected, and one fatality was recorded.

Meningitis outbreaks affected large parts of northern Nigeria, claiming more than 150 lives by April, before emergency vaccine shipments arrived.

Following the outbreak, Nigeria received over one million doses of the pentavalent meningococcal conjugate vaccine (Men5CV) in April to curb the spread of meningococci C and W in northern states.

PREMIUM TIMES reported that the vaccine shipment, funded by Gavi, the Vaccine Alliance, was received by the Federal Ministry of Health and Social Welfare.

On Mpox, the WHO announced that the disease is no longer a public health emergency of international concern, though the Africa CDC maintained it remains a continental threat, urging sustained surveillance.

Mr Onoronu also called for the integration of genomics into Nigeria’s disease surveillance system to better respond to outbreaks and the growing threat of antimicrobial resistance, noting that this could also support local drug and vaccine production.

Immunisation expands, but zero-dose gap persists

Amid the outbreaks, Nigeria recorded notable immunisation milestones. Millions of children and adolescents received vaccines against malaria, yellow fever, measles and Human papillomavirus (HPV), with the malaria vaccine rollout hailed as a breakthrough in the fight against one of the country’s deadliest diseases.

The rollout of the malaria vaccine marked a milestone in efforts to reduce childhood deaths, while the HPV vaccine continued to be scaled up to protect girls from cervical cancer.

Despite these gains, Nigeria continued to account for a large proportion of the world’s zero-dose children, those who have not received any routine vaccines.

Health authorities attributed the challenge to insecurity, misinformation, weak health systems and access barriers in hard-to-reach communities.

The federal government also sought increased funding for vaccine procurement and routine immunisation to address these gaps, amid concerns about declining donor support.

Local drug manufacturing

In 2025, Nigeria intensified efforts to boost local pharmaceutical production, driven by shrinking donor funding, foreign exchange constraints and lessons from recent global health emergencies.

PREMIUM TIMES reported that the federal government advanced the Presidential Initiative on Unlocking the Healthcare Value Chain (PVAC), aimed at strengthening domestic production of medicines, vaccines and health commodities.

Several memoranda of understanding (MoU) were signed with international partners, including agreements to support technology transfer, regulatory strengthening and investment in pharmaceutical manufacturing.

Regulatory authorities, including NAFDAC, urged local manufacturers to invest in vaccine production, noting that Nigeria’s heavy reliance on imports posed risks to medicine security.

Insurance coverage remains thin

In 2025, President Bola Tinubu directed all ministries, departments and agencies to ensure their staff are enrolled under the NHIA scheme.

The order, which ties insurance compliance to access to government services and procurement, underscores the commitment to enforce the 2022 NHIA Act, which mandates coverage for all Nigerians.

To support implementation, the NHIA rolled out plans for digital platforms to verify insurance certificates and expedite referrals, while federal and state governments intensified their enrollment drives.

NHIA revealed in September that over 20 million Nigerians are enrolled in the health insurance scheme across Nigeria, with an ambitious target of 44 million by 2030, as part of efforts to reduce the heavy burden of out-of-pocket spending.

The insurance reforms were linked to primary healthcare changes, including progress on the National Primary Healthcare Development Bill at the National Assembly and renewed investment under the Health Sector Renewal and Investment Initiative.

New infrastructure and specialised centres

Expansion of health infrastructure featured prominently in 2025, particularly in specialised care.

New oncology centres were commissioned in selected states to improve access to cancer diagnosis and treatment. The African Medical Centre of Excellence in Abuja was also launched, offering advanced cardiology, oncology and haematology services, to reduce medical tourism.

Government officials stated that such investments would enhance tertiary care and retain patients within the country.

However, experts warned that infrastructure without adequate staffing, maintenance, and referral systems may have a limited impact.

National Health Dialogue

The 2025 National Health Dialogue, hosted by PREMIUM TIMES and the Centre for Journalism Innovation and Development (CJID), provided a platform for states to outline their health priorities and financing plans.

States like Jigawa, Abia, Akwa Ibom, and Katsina showcased efforts to expand PHC services, upgrade facilities, boost insurance enrollment, and increase health spending beyond national averages.

The dialogue emphasised that achieving universal health coverage depends not only on federal reforms but also on subnational commitment, accountability and innovation.

Mr Pate, during a fireside discussion at the event, urged constructive engagement on health sector reform, noting that solutions require both federal leadership and proactive subnational implementation.

READ ALSO: Group urges Nigeria to scale up infection prevention, control at PHCs

Priorities for 2026

With health successes overshadowed by disease outbreaks and workers’ protests, the NMA Lagos chairman, Mr Kehinde, argued that there was “not much development, initiatives and progress in the health sector in 2025, especially at the federal level.”

“The lack of focus by the Ministry of Health and by the President on the healthcare delivery system is unfortunate, unacceptable and disappointing,” he said.

He listed poor remuneration, weak welfare packages, inadequate training, and the government’s failure to address the mass emigration of doctors, known as the “Japa” syndrome, as key setbacks.

He also criticised the handling of strike actions, low health insurance coverage, high cost of care, and poor attention to primary healthcare.

“Health insurance coverage is poor, and healthcare is becoming more expensive and less accessible to ordinary Nigerians,” he said, adding that unreliable power supply in hospitals further undermined service delivery.

While acknowledging some improvements in hospital buildings and infrastructure, Mr Kehinde said these gains mean little without staff, equipment, and affordable services.

Looking ahead to 2026, Mr Kehinde said the government must prioritise better wages and welfare for health workers, stronger primary healthcare, improved health insurance coverage, and higher budgetary allocation to health in line with the Abuja Declaration.

He also called for affordable housing and car loans for health workers, overseas training opportunities, safer working environments, non-taxable call duty allowances, and collaboration with private hospitals to improve access and reduce deaths.

“Healthcare workers need better pay, better tools, and better conditions to stay,” he said. “If we don’t fix this, the brain drain will continue, and citizens will keep suffering.”