By Adedayo ADERIBIGBE, Public Health Physician
Nigeria is internationally classified as a low-middle-income country (LMIC) despite its regional reputation as one of Africa’s economic giants.
With a surging population of over 230 million, the classification reflects multiple socio-economic and health indicators, where the latter remain particularly concerning.
Nigeria’s life expectancy hovers at about 56 years; infant mortality stands at 63 deaths per 1,000 live births, maternal mortality is around 990 per 100,000 live births, and only about 40% of children are fully immunized.
While progress has been made in reducing neonatal and infant mortality rates, and total fertility rates have slightly declined, the country is far from achieving outcomes that would justify a reclassification or truly reflect its economic potential.
Since the advent of a new leadership in 2023, Nigeria has witnessed the rise of dedicated and focused health programs aimed at tackling these systemic challenges.
Reports presented by the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, indicate that maternal deaths have dropped by 17 percent, while newborn deaths have reduced by 12 percent across 172 high-burden local government areas.
Skilled birth attendance coverage has increased by 33 percent, and over 4,000 free caesarean sections have been performed in National Health Insurance Authority (NHIA)-empanelled facilities.
Similarly, there has been a surge in the utilization of primary healthcare facilities nationwide. Visits to Basic Health Care Provision Fund (BHCPF) facilities rose from 10 million in early 2024 to 45 million by mid-2025.
These figures demonstrate public confidence in the healthcare system and measurable progress in several indicators.
Yet, despite these encouraging developments, the sector is still grappling with a critical and often underappreciated challenge: the hemorrhaging health workforce.
Numerous reports cite alarming numbers of clinical health workers who have left the country over the past five years. More than 16,000 medical doctors, over 42,000 nurses, and countless other health professionals, including pharmacists, radiographers, and social care workers, have emigrated in search of better opportunities abroad.
The pace of this migration continues to rise exponentially. A combination of factors drives this exodus: poor remuneration, unfavorable workplace conditions, policy neglect, burnout due to understaffing, insecurity, and perceived government insensitivity.
This crisis is particularly pernicious because health sector programs are people-driven. Infrastructure, equipment, and technology cannot function in isolation.
Health programs, monitoring and evaluation systems, immunization drives, maternal and child health interventions, and even emergency responses all depend on the presence of a competent, motivated workforce.
A fully equipped facility without staff is effectively a hollow structure; a well-designed health program without practitioners is just an unimplemented blueprint.
The implications are profound: despite government efforts, the lack of human capital undermines program effectiveness, delays service delivery, and erodes public trust.
Recognizing this, the government has attempted to address the brain drain by increasing the production of health workers. This includes expanding the intake of students into medicine, nursing, and allied health programs.
However, a paradox has emerged. Due to persistent challenges in the health sector, these courses are becoming increasingly unattractive. Many students interested in clinical disciplines are motivated not by a desire to serve within Nigeria but by the potential for better remuneration and working conditions abroad.
Surveys among medical students reveal a strong intent to leave the country upon graduation, underscoring the failure of mere production expansion as a long-term solution. Without a supportive ecosystem, more graduates only translate into higher potential migration.
Another approach attempted has been to limit the ease with which health workers leave the country. This involves measures such as increasing fees for migration-related documents, tightening timelines, and introducing new procedural guidelines.
While such measures may temporarily delay migration, they do not address the root causes. Moreover, the characteristic resilience and determination of Nigerian professionals often find ways around bureaucratic hurdles, rendering restrictive policies largely ineffective. Simply put, delaying migration is not the same as preventing it.
To truly address this challenge, a holistic, multi-dimensional approach is required, one that tackles both push and pull factors systematically. The most critical element is wage-reflective remuneration. Health workers must be compensated in a manner commensurate with their skills, responsibilities, and the societal value of their work.
Fair, consistent, and timely pay is the foundation upon which other motivational strategies can build. Without adequate remuneration, even the most well-intentioned policies will fall short.
In addition to financial incentives, workplace conditions must be improved. This includes ensuring safe and secure work environments, providing functional equipment, guaranteeing adequate staffing to reduce burnout, and promoting equitable distribution of health workers across rural and urban areas.
Overworked, overstressed professionals cannot sustain quality service delivery, regardless of their personal commitment or patriotism. Enhancing the physical and psychological work environment is therefore essential for retention and motivation.
Professional development and career growth opportunities represent another critical dimension. Health workers need access to continuous training, skill upgrades, specialization programs, and clear career pathways.
Structured mentorship, access to conferences, workshops, and evidence-based training not only improve clinical outcomes but also create a sense of professional satisfaction and long-term belonging.
When workers perceive that the system invests in their growth, loyalty and engagement increase significantly.
Finally, there is a need for comprehensive policy reform and institutional support that reinforces workforce stability.
This includes health workforce planning based on evidence, mechanisms to monitor staffing needs, and incentives that encourage retention, such as housing, rural allowances, and recognition programs.
Policies should also promote flexibility and inclusivity, integrating task-shifting approaches where appropriate to optimize service delivery without overburdening individual practitioners.
Holistic governance ensures that workforce management becomes proactive rather than reactive, preventing crises before they emerge.
The success of Nigeria’s health programs ultimately hinges on a happy, vibrant, and motivated health workforce.
The infrastructure, equipment, and funding provided by the government can only achieve their intended outcomes when paired with competent, engaged professionals.
Efforts to improve maternal and child health, expand immunization coverage, strengthen primary care, and respond effectively to epidemics depend entirely on the people driving these interventions.
Without investing in the human element, through fair remuneration, safe work environments, professional development, and supportive policies even the most ambitious programs will underperform.
In conclusion, while government programs have shown measurable improvements over the past two years, the sustainability and effectiveness of these initiatives remain threatened by workforce migration and low motivation.
Expanding the number of health workers, delaying migration, and increasing infrastructural investments are necessary but insufficient steps.
A holistic approach addressing wages, workplace conditions, professional development, and institutional support is imperative.
Only when Nigeria values and invests in its health workforce as its most critical asset can it hope to fully realize the potential of its health programs and achieve lasting improvements in public health outcomes.
The path forward is clear: people, not just programs or equipment, are the drivers of a healthy nation.