Health System Strengthening: Primary Healthcare Centres in Nigeria

Nigeria’s healthcare system faces various challenges associated with outbound medical tourism, inadequate infrastructure, a shortage of healthcare workers, low government budget allocation, uneven distribution of healthcare facilities, and limited access to quality healthcare services, especially in rural and underserved areas1, which makes strengthening the health system a major priority that would help to address these challenges, create a more resilient and effective healthcare system, improve the overall healthcare infrastructure, services, and outcomes in the country. The World Health Organization (WHO) has divided health systems into Leadership/Governance, Finance, Information, Workforce, Service Delivery, Medical Products, Vaccines & Technologies, which are the six essential building blocks for a well-functioning health system2. Altogether, they provide a framework for understanding and improving the various components of the healthcare system.

Primary Healthcare (PHC) is considered as the foundation of a strong healthcare system and plays a key role in improving health outcomes and addressing health disparities3. In 2022, a study was carried out in Cross River State, Nigeria to determine the number of nurses, midwives, community health officers (CHOs), community health extension workers (CHEWs), and junior community health extension workers (JCHEWs) required to cope with healthcare service delivery at primary health care facilities in Cross River State indicated shortages of the needed health workforce. The shortages were particularly in nurses and midwives at primary healthcare level 4. Hence, the need for Health System Strengthening (HSS) in primary healthcare.

The Nigerian government, with support from international partners and organizations, has launched various initiatives to strengthen the primary healthcare system. These include the establishment of the National Primary Health Care Development Agency (NPHCDA) in the year 1992, Basic Health Care Provision Fund (BHCPF) in 2014, and the National Health Insurance Authority (NHIA) in 2022. Programs and initiatives aimed to improve maternal and child health outcomes have also been implemented. They include Nigeria State Health Investment Project (NSHIP) established in 2011, Midwives Service Scheme (MSS) in 2009, and Saving One Million Lives (SOML) in 2012. These initiatives reflect Nigeria’s commitment to strengthening PHC services, improving health outcomes, and achieving universal health coverage and sustainable development goals. They involve collaboration between government agencies, international partners, non-governmental organizations, and local communities to enhance the effectiveness and accessibility of primary healthcare services across the country.

Despite these initiatives that have had a great impact, there are still gaps in the primary healthcare system. These gaps require continued commitment and deliberate effort by all stakeholders in the PHC system. Continuous strengthening of the overall PHC system will have profound impacts, which will include:

  1. Increased access to quality services: Regardless of socioeconomic status or geographical location, a resilient health system ensures that all individuals have access to quality PHC services, which helps reduce health disparities.
  2. Improved data-driven decision-making: This leads to improved resource allocation, decision-making, and targeted interventions to address health challenges.
  3. Improved access and equity, especially in remote and underserved areas. By addressing infrastructure gaps, staffing shortages, and resource allocation, more individuals, especially those in marginalized communities, can access essential healthcare services.
  4. Health workforce development:  Adequately trained and motivated staff are more likely to provide comprehensive and effective care to patients.

Strengthening the PHC health system is a long-term and continuous process that requires collaboration among government agencies, non-governmental organizations, international partners, and other stakeholders. While progress has been made in Nigeria’s health system strengthening efforts, more work is still required to ensure that all citizens have access to quality healthcare services.


  1. International Trade Administration. Nigeria – Country Commercial Guide.,budget%20to%20health%20in%202021%2C
  2. World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes: WHO´s framework for action. HEART. 2013
  3. Strasser R, Neusy A. Context counts training health workers in and for rural and remote areas. Bull World Health Org. 2010;88:777–82. https://
  4. Okoroafor, S.C., Ahmat, A., Osubor, M. et al. Assessing the staffing needs for primary health care centers in Cross River State, Nigeria: a workload indicator of staffing needs study. Hum Resour Health 19 (Suppl 1), 108 (2022).
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