For over two decades, Nigeria’s health system has leaned heavily on the support of international partners like USAID, PEPFAR, and the President’s Malaria Initiative (PMI). These partners have helped reduce maternal deaths, treat millions living with HIV, scale up malaria prevention, and respond to public health emergencies.
In many ways, foreign aid has served as the scaffolding propping up Nigeria’s fragile health infrastructure. But now, that scaffolding is being dismantled.
Declining Donor Support, Rising Risks
In 2023, USAID’s health portfolio in Nigeria stood at approximately $600 million. By 2024, it had fallen to $464 million—a drop of over $135 million in just one year. While this may seem modest in global terms, the impact on Nigeria’s already overstretched health system is severe.
Lives are at stake: pregnant women are losing access to antenatal care, children under five face higher risks without essential services, and supplies for HIV treatment and malaria prevention are dwindling.
PEPFAR, which has invested over $7.8 billion in Nigeria, has enabled access to life-saving HIV services for 1.3 million Nigerians. But ongoing uncertainty in U.S. policy now threatens the sustainability of this progress. Though the Nigerian government has allocated ₦4.8 billion to procure HIV treatment packs, it only partially fills the gap—leaving millions vulnerable to rising infection and mortality rates.
Maternal Health and Malaria Setbacks
Nigeria continues to have one of the world’s highest maternal mortality rates—estimated at 545 deaths per 100,000 live births. While contraceptive use has risen to 20% by 2024, 21% of women still face unmet family planning needs. As donor-funded programs decline, services such as skilled birth attendance, emergency obstetric care, and antenatal support are being scaled back—particularly in underserved rural areas.
In malaria control, reductions in PMI funding have slowed the distribution of insecticide-treated nets and antimalarial drugs. For a country with one of the highest malaria burdens globally, this is a serious setback.
The Strain on Health Infrastructure
Beyond disease-specific programs, the broader health system is also under stress. Shrinking aid has worsened existing challenges: underfunded facilities, staff shortages, unreliable supply chains, and declining supervision capacity.
In northeastern Nigeria, where conflict has devastated healthcare infrastructure, donor support accounts for 60–70% of services. With funding reductions, more than 70% of health facilities in the region now struggle to deliver basic care—leaving vulnerable communities, especially those in IDP camps, without help.
The Most Vulnerable Bear the Burden
The human cost is undeniable. Women, children, and low-income communities are the hardest hit. The reduction in donor support deepens existing inequities, jeopardizes Nigeria’s Universal Health Coverage (UHC) ambitions, and threatens progress toward the Sustainable Development Goals.
A Hidden Opportunity: Unlocking Private Sector Potential
Yet within this crisis lies an opportunity to transform. Nigeria’s private health sector is robust—but largely underutilized. In 2019, private domestic spending made up 71% of total health expenditure, with nearly 90% paid out-of-pocket. In urban areas like Lagos, up to 75% of healthcare is delivered by private providers—many of them informal and unregulated.
Efforts like the Private Sector Health Alliance of Nigeria (PSHAN) and the Adopt-A-Healthcare-Facility Programme (ADHFP) are beginning to shift this narrative by mobilizing private capital to revamp primary health centers nationwide.
Between 2019 and 2022, Nigeria attracted over $18 million in private health-tech investments, boosting innovation in diagnostics, data, supply chains, and genomics. The digital health and pharmaceutical sectors are projected to grow significantly over the next decade.
But Barriers Remain
Health insurance coverage remains low, rising only from 5.1% in 2018 to 8.8% in 2021. Without policy reforms to support microinsurance, employer-based schemes, and subsidies for the poor, most Nigerians remain excluded from coverage.
Meanwhile, workforce shortages, inadequate infrastructure, and poor regulation hinder private sector scalability. The average Nigerian hospital has just 250 beds—far below what’s needed for the population size.
Bright Spots and the Road Ahead
Some states are leading the way: Kano allocated 16.46% of its 2024 budget to health, surpassing the Abuja Declaration’s 15% target. Kaduna and Lagos have also made significant commitments. Yet, only 20% of primary health centers nationwide are fully functional.
Philanthropic efforts are helping fill the gap. Foundations like MTN, Dangote, Aig-Imoukhuede, Jim Ovia, and others are investing in revitalizing PHCs—providing drugs, power, clean water, and trained staff. Corporates like Zenith Bank and Access Corporation contribute through CSR programs.
What Must Change
To fully realize the potential of private sector engagement, Nigeria needs:
Legislation for blended finance models
Tax incentives and de-risking instruments to attract private investment
Regulations to expand health insurance coverage
Targeted subsidies for the most vulnerable
Robust public-private partnerships to scale proven solutions
Conclusion: Act Before It’s Too Late
Nigeria stands at a critical juncture. The decline in donor aid exposes the fragility of our health system—but also reveals an opportunity to build resilience from within. Mobilizing domestic resources, harnessing private sector potential, and enacting enabling policies can ensure that progress is not only sustained but scaled.
The silent threat must not be ignored. Our response today will define the health outcomes of millions tomorrow.
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