To cure Nigeria’s ailing health system, empower its unsung heroes

By Emmanuel Nwanya

Nigeria stands at a defining moment in its healthcare journey, confronted by a paradox that demands urgent and strategic action. While national conversations—particularly in major urban centres—celebrate economic growth, renewed policy reforms, and ambitious social programmes, nearly half of the population still lives in rural or hard-to-reach communities where access to even the most basic healthcare remains painfully inadequate. An estimated 46% of Nigerians continue to face chronic deprivation, not only due to deteriorating health facilities, but also because of entrenched socioeconomic barriers and a critical shortage of healthcare workers. What Nigeria faces is not merely a gap in services; it is a full-scale national emergency that undermines human capital, fuels avoidable deaths, and constrains the country’s economic aspirations.

The statistics are stark and sobering. Nigeria still bears one of the world’s highest maternal mortality burdens—512 deaths per 100,000 live births—an unacceptably high figure despite decades of national and global interventions. At the same time, non-communicable diseases account for nearly 30% of all deaths, putting immense pressure on secondary and tertiary hospitals that were never designed to absorb such an overwhelming volume of chronic cases. Meanwhile, primary healthcare centres, which should serve as the backbone of the country’s health system, are overstretched, underfunded, and often unable to respond to the triple burden of infectious diseases, maternal complications, and increasingly prevalent lifestyle-related illnesses. With universal health coverage by 2030 slipping further out of reach, Nigeria must urgently rethink its strategy by shifting from expensive, centralised hospital care to a decentralised, community-driven primary healthcare model.

This shift requires one thing above all: the strategic empowerment of Community Health Workers (CHWs). Too often overlooked, CHWs are the most cost-effective, culturally grounded, and scalable tool for expanding access to healthcare in Nigeria. Doctors and nurses, indispensable as they are, remain heavily concentrated in urban areas. It is therefore unrealistic to expect them to meet the needs of scattered rural populations. CHWs, by contrast, are embedded within the communities they serve. They speak local languages, understand cultural norms, navigate complex gender dynamics, and appreciate the social determinants of health that shape how people seek care. Their proximity gives them the power to translate health policies into real, tangible impact. Beyond providing services, they build trust, encourage behaviour change, and ensure continuity of care—qualities that no tertiary hospital can replicate.

Global evidence is unequivocal: well-designed CHW programmes deliver immense health and economic returns. They reduce maternal and child deaths, expand immunisation coverage, improve family planning uptake, and facilitate early detection of diseases. But the economic case is even stronger. When primary healthcare fails, patients bypass local facilities entirely and flood urban hospitals with complications that could have been managed—and prevented—at the community level. A mild malaria case, easily handled by a CHW, becomes a life-threatening condition requiring costly hospitalisation. In maternal health, CHWs encourage early antenatal care, support skilled birth attendance, and detect warning signs before emergencies develop. They break the costly chain of delayed care by providing affordable, timely, and continuous support.

International studies show that every dollar invested in CHWs yields up to ten dollars in returns through reduced medical costs, fewer hospital admissions, improved productivity, and better school attendance. For economic planners, this makes CHWs not just a social asset but a strategic national investment. They also serve as the first line of defence in outbreaks, detecting early signs of epidemics before they spiral into national crises. Yet beyond all metrics, CHWs hold a unique advantage: they are trusted. In communities where decades of failed promises have eroded confidence in the health system, CHWs remain familiar, reliable, and influential voices.

Despite their potential, Nigeria’s CHW programmes have not achieved the impact they should—not due to lack of dedication but due to systemic weaknesses. Many CHWs operate informally, work as volunteers, or receive inconsistent stipends. Without clear career pathways, professional certification, or structured remuneration, turnover is high and skilled workers drift away. Nigeria must now institutionalise CHWs as a recognised professional cadre with formal training, clear promotion structures, and adequate compensation. Task-shifting must be strengthened to enable CHWs to provide essential services while freeing doctors and nurses to handle more complex care.

The digital era also presents an opportunity. Nigeria’s continued reliance on paper-based data systems at the primary care level significantly limits CHW efficiency. Investing in scalable digital tools—mobile apps for reporting, tele-mentorship, logistics tracking, and patient follow-up—would transform the quality and speed of healthcare delivery. Real-time data would allow managers to respond quickly to declining immunisation coverage or medicine stockouts.

Furthermore, CHW programmes remain overly dependent on short-term donor funding, making them vulnerable to disruptions. Sustainable national impact requires long-term government financing embedded within federal and state budgets. CHWs must be recognised not as temporary project staff but as essential pillars of Nigeria’s health architecture.

Transforming CHW programmes will require coordinated, multisectoral action. Government must professionalise the cadre, allocate dedicated funding, and strengthen digital infrastructure. The private sector should support training and invest in scalable technology. Civil society and the media must sustain public awareness and accountability. Foundations like the Aig-Imoukhuede Foundation have already begun revitalising primary health centres and building public health leadership—efforts that should be amplified nationwide.

Nigeria cannot meet its health and economic goals without fully unlocking the potential of Community Health Workers. Empowering them is essential to reducing mortality, managing chronic diseases, and securing a healthier future for the nation. The moment for decisive action is now.

• Nwanya is the Health Philanthropy Team Lead at the Aig-Imoukhuede Foundation and a public health professional specialising in evidence-based strategies for health system strengthening and the pursuit of universal health coverage.