Health Reforms, Outbreaks, and Key Events Shaping Nigeria's 2025 Healthcare Landscape

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Challenges and Progress in Nigeria’s Health Sector in 2025

Despite renewed efforts to expand primary healthcare, strengthen immunisation, and improve service delivery, the health sector in Nigeria continued to face persistent challenges. These included disease outbreaks, workforce shortages, and financial constraints. The year began with intense pressure on the system after the Trump administration announced significant cuts to foreign aid, which affected critical programs such as HIV treatment and immunisation.

This development highlighted Nigeria's heavy reliance on external donors, bringing health financing to the forefront of national discussions. Throughout the year, there were ongoing debates about sustainability, domestic resource mobilisation, and system resilience. Despite these challenges, experts emphasized that the federal government must address structural weaknesses to prevent further setbacks.

Funding Cuts and Health Financing Issues

The year started 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% reduction in USAID funding, affecting HIV services, immunisation, and community health programmes supported by PEPFAR and the Global Fund. In response, the federal government allocated about $200 million and additional domestic resources in the 2025 budget to cushion the impact and sustain essential services.

Health financing remained a central topic throughout the year. Nigeria’s 2025 health budget increased by approximately 60% to N2.48 trillion (5.18% of the total budget) from around N1.3 trillion (4.6%) in 2024. However, this was still far below the 15% target set under the 2001 Abuja Declaration. The proposed 2026 budget allocated N2.48 trillion to the health sector, representing less than six percent of the total 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. He noted that while the National Health Insurance Authority (NHIA) has expanded coverage to an estimated 10-12% of the population, out-of-pocket spending still accounts for 71% of total health expenditure, pushing millions of Nigerians into poverty every year.

Primary Healthcare Reforms

Nigeria placed primary healthcare at the center 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. 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 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.

HIV Control Amid Funding Shifts

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.

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.

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.

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.

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.

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.

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

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." 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.

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.