Beyond Commitments: Making Nigeria’s Health Investments Count for Mothers and Communities

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Nigeria’s health sector is at an important moment. Across the country, renewed investments in primary health care, maternal and newborn health, health insurance and local production are beginning to show measurable results.

At the 2026 Joint Annual Review (JAR), the government reported progress across several priority areas, including the revitalisation of primary healthcare centres (PHCs), the recruitment of health workers and expanded support for pregnant women and newborns.

These are important developments in a country where preventable maternal and newborn deaths remain a persistent challenge. But the real measure of health sector reform is not the number of commitments announced, funds released or facilities renovated.

It is whether a pregnant woman in a rural community can reach a functioning health facility, receive timely and respectful care, access the medicines she needs and avoid being pushed into financial hardship because of illness.

The next phase of Nigeria’s health sector reforms must move beyond commitments and focus on measurable improvements in the lives of Nigerians, particularly women, newborns and underserved communities.

Investment and reform are beginning to show results

The 2026 JAR provided an opportunity to assess progress under the Nigeria Health Sector Renewal Investment Initiative and the Sector-Wide Approach (SWAp). The figures presented point to a significant increase in public investment and a stronger focus on primary healthcare.

Professor Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare, said that cumulative releases under the Basic Health Care Provision Fund (BHCPF) had reached approximately ₦422.3 billion between 2019 and October 2026. Of this amount, ₦323.6 billion had been disbursed to implementing gateways, including ₦249.5 billion under the current administration.

At the service-delivery level, 3,504 PHCs had been revitalised, with work ongoing in another 850 facilities, and 8,309 facilities were receiving support through the Basic Primary Health Care Provision Fund (BHCPF). The government also reported the training of 78,142 frontline health workers, according to the available data in the Joint Annual Review Nigeria Health Sector Statistical Book 2026.

There were also encouraging developments in maternal and newborn health. Through the Maternal and Newborn Mortality Reduction Innovation Initiative (MAMII), the total number of deliveries in 172 LGAs has increased from 669,866 in 2025 to 844,687 in 2026.

The initiative also expanded the activation of emergency transport systems from 12 LGAs in 2025 to all 33 LGAs targeted in 2026. The government further reported that BHCPF facilities account for the smallest share of maternal deaths (3–8%) compared to non-BHCPF facilities (59–65%) each year, between 2023 and 2026.

The National Health Insurance Agency (NHIA) reported that health insurance coverage increased from 16,797,451 to 24,098,965 Nigerians over three years, and that a total of 1,737 women had free surgeries for fistula repair in 2026, compared with 2,564 in 2025. 80,906 women benefited from emergency obstetric care, according to the available data in the Nigeria Health Sector Statistical Book 2026.

These figures suggest that reforms are moving beyond policy design into implementation. They are important indicators of progress, but they also raise a more fundamental question: how consistently are these investments improving the quality, availability, and affordability of care across communities?

More investment does not automatically mean better care

The distinction between funding a health facility and ensuring that it delivers quality care is critical.

A Primary Health Care Centre (PHC) may have a renovated building but lack the staff to provide round-the-clock services. It may have equipment but no reliable electricity or water supply. It may be listed as a beneficiary of a financing programme, yet experience delays in receiving funds or lack essential medicines. For women facing obstetric emergencies, these gaps can determine whether care arrives in time.

The Joint Annual Review (JAR) discussions acknowledged some of these persistent challenges, including shortages of skilled health workers, gaps in comprehensive emergency obstetric and newborn care, difficulties deploying community health workers and concerns about data quality. These are not marginal issues. They are central to whether increased investments translate into lives saved.

The financing figures also need to be understood beyond their headline value. Money released by government, money disbursed to implementing gateways and money received and effectively spent by health facilities are different stages of the financing process.

Each requires transparent tracking. The same scrutiny should apply to health insurance. Increased enrolment is important, but it does not necessarily mean that people can access services when needed, receive quality care or are protected from significant out-of-pocket expenses.

This is where community participation becomes essential to health sector accountability. National performance data can show how many facilities have been revitalised or how many women have been linked to care.

But communities can help establish whether those facilities are actually open, whether health workers are present, whether medicines are available, whether women are treated with dignity and whether referral arrangements work in an emergency.

In Kano State, for example, Nigeria Health Watch community engagement and scorecard assessment at Gurjiya Primary Health Centre helped draw attention to the theft of its solar battery, which affected the facility’s ability to provide services. Through follow-up involving community structures and local leadership, the issue was escalated and the battery replaced.

The experience illustrates an important point: when citizens have channels to report problems and public officials respond, community participation can contribute to practical improvements in service delivery.

Make accountability part of the investment

As Nigeria approaches 2027, the final year of the 2023–2027 Nigeria’s Health Sector Renewal Investment Initiative (NHSRII), the priority should be to consolidate progress and address the implementation gaps that continue to affect service delivery.

First, health financing must be measured by what reaches facilities and what it delivers. Federal and state governments should strengthen transparency around budget releases, BHCPF disbursements and facility-level expenditure.

States must improve budget execution and ensure that resources are released on time and used for agreed priorities. Tracking should extend beyond financial transactions to whether facilities have the staff, medicines, equipment and basic infrastructure required to provide quality care.

Second, investments in maternal and newborn health must strengthen the entire continuum of care. Linking pregnant women to facilities is an important starting point, but it must be supported by accessible antenatal care, skilled birth attendance, functional referral systems, emergency transport, comprehensive emergency obstetric and newborn care, and appropriate postnatal services.

On the margins of the Joint Annual Review, the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, launched the MAMII Private Sector Compact, securing over US$65 million in financial and in-kind commitments to accelerate the reduction of maternal and newborn deaths.

Coordinated through the Sector-Wide Approach, these resources are directed at government-identified gaps in the 172 high-burden LGAs that account for more than half of Nigeria’s maternal deaths. The expansion of MAMII and related interventions should be accompanied by transparent reporting on service quality, outcomes and the experiences of women using these services.

Third, community accountability should become a routine part of PHC performance management. Community scorecards, town hall meetings, Ward Development Committees and other citizen-engagement platforms can help identify gaps that routine administrative data may not capture.

However, collecting community feedback is not enough. Governments and facility managers must provide clear channels for responding to concerns, agree on corrective actions and report back to the communities that raised them.

Finally, the country needs to strengthen the quality and use of health data. The JAR theme, Make Reform Data Count, should mean more than producing performance reports. Data must be sufficiently reliable to guide decisions, identify inequalities, track commitments and establish whether interventions are improving outcomes.

Community-generated evidence should complement routine health information and help make national and state performance assessments more responsive to realities at the point of care.

Beyond 2026: What should progress look like?

In his presentation at the Basic Health Care Provision Fund (BHCPF) side event, Dr Uzoma Nwankwo, BHCPF Secretariat, shared the government’s longer-term ambitions, including the expansion of Basic Health Care Provision Fund (BHCPF) facilities with an addition of 5,212 to the current 8,309 facilities, closing the gap to about 77% of the 17,600 target by 2027.

These targets provide a direction, but their credibility will depend on the accountability mechanisms and implementation milestones established along the way.

By the next review, progress should be visible not only in the number of facilities renovated, funds disbursed or people enrolled in insurance schemes, but also in the number of facilities consistently providing essential services, the availability of skilled health workers, timely emergency referrals, improved maternal and newborn outcomes and reduced financial barriers to care.

Communities should be able to see and influence these improvements. They should know what their PHCs are expected to deliver, have opportunities to report service gaps and be able to track whether the concerns they raise lead to action.

Nigeria has made important commitments and reported encouraging progress. The task now is to ensure that these investments reach the last mile and translate into reliable, affordable and quality healthcare.

Ultimately, the success of health sector reform will not be determined by the volume of resources mobilised or the number of policies launched, but by whether mothers, newborns and families experience a meaningful difference when they seek care.

The real test of reform is what happens at the point of care and whether the people who depend on the health system have a meaningful voice in making it work.

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