Experts seek increased investment, reforms to tackle Nigeria’s health workforce crisis

Health experts have called for increased investment and broader reforms in Nigeria’s health system to address persistent shortages, uneven distribution and migration of healthcare workers, warning that task shifting alone cannot resolve the country’s workforce crisis.

The experts made the call on Thursday during a webinar organised by the Doctors Medical Aid Foundation (DMAF) titled “Nigeria’s Health Workforce Crisis: An Evidence-Informed Conversation on the Future of Nigeria’s Health Workforce.”

The event brought together policymakers, healthcare professionals, development partners and other stakeholders to examine workforce shortages, migration trends, retention challenges and the opportunities and concerns surrounding task-shifting and task-sharing policies.

The webinar was moderated by Hameed Adediran, Country Director of DMAF, who described the conversation as timely given the persistent challenges affecting Nigeria’s health workforce and healthcare delivery.

Mr Adediran began the session with a poll asking participants to identify the biggest challenges facing Nigeria’s health workforce. Poor remuneration emerged as the leading concern, cited by 46 per cent of respondents, followed by poor working conditions and inadequate numbers of healthcare workers.

System gaps

Delivering the keynote address, Dare Bodunrin, former Senior Programme Officer at the Gates Foundation, warned against treating Nigeria’s health workforce crisis in isolation from broader health system challenges.

Mr Bodunrin said interventions that have worked in other countries may not necessarily succeed in Nigeria because of differences in health system capacity.

“Every innovation in terms of improving the efficiency of the health workforce can only succeed if the broader system infrastructure is in place,” he said.

According to him, many countries where task-sharing and task-shifting have proved successful are not grappling with the scale of commodity stock-outs, equipment shortages and other systemic constraints confronting Nigeria’s healthcare system.

He urged stakeholders to move beyond what he described as marginal improvements and instead examine the entire health workforce value chain, including production, deployment, welfare and retention.

“The question is not just whether we have a shortage. Have we actually absorbed the total number of health workers we have trained? If not, why?” he asked.

Mr Bodunrin also linked the growing migration of Nigerian health professionals to poor remuneration and unfavourable working conditions.

“The remuneration is really, really poor, abysmally poor, and the working conditions are terrible,” he said.

He argued that while efficiency measures remain important, they cannot substitute for adequate funding.

“There is a threshold beyond which you can maximise resources. If we truly want quality healthcare, we must begin to think seriously about increasing investment in the system,” he added.

Mr Bodunrin further called for greater private-sector participation in healthcare delivery, including primary healthcare, saying the government should create frameworks that enable private providers to contribute meaningfully to service delivery while maintaining regulatory oversight.

Nigeria’s worsening health workforce crisis

Nigeria’s health workforce challenge is not only about the number of health workers available but also where they work and whether the health system can retain them.

The Federal Ministry of Health and Social Welfare said in 2025 that about 75 per cent of health workers were concentrated in urban areas, where 45 per cent of the population lives.

The ministry also put Nigeria’s doctor-to-population ratio at one doctor to 5,000 people and the nurse-to-population ratio at one to 2,000.

The uneven distribution is compounded by the movement of health professionals from rural areas to cities and from Nigeria to countries offering better remuneration and working conditions. The African Health Observatory Platform, in its 2025 Nigeria Health Systems and Services Profile, identified shortages, maldistribution, remuneration and working conditions among the persistent challenges affecting the country’s health workforce.

In response, the federal government has introduced measures aimed at improving workforce planning, recruitment and retention, including a national health workforce registry and policies on health workforce migration.

The government said more than 37,000 health workers had been employed since 2023, while acknowledging that migration continues to affect retention.

Strengthening efforts

Also speaking at the webinar, the Head of Training, Primary Healthcare Division of the National Primary Health Care Development Agency (NPHCDA), Gilbert Uwadia, said strengthening primary healthcare facilities remains central to improving health outcomes across the country.

Mr Uwadia said a functional PHC should have the right personnel, infrastructure, equipment and essential commodities required to provide quality services.

According to him, NPHCDA promotes a minimum multidisciplinary team comprising community health officers, nurses or midwives and junior community health extension workers.

He said the agency prioritises integrated training programmes to ensure frontline healthcare workers possess the skills needed to provide multiple services and appropriately refer complicated cases.

“It is in PHCs that you find health workers who are expected to provide a wide range of services. They need the competencies to manage different health needs and know when referrals are necessary,” he said.

Mr Uwadia added that the agency has implemented community-based health worker programmes aimed at linking households to health facilities and improving healthcare utilisation at the grassroots level.

Reforms

The Director of Reproductive Health at the Federal Ministry of Health and Social Welfare, Samuel Oyeniyi, said all levels of government have a role to play in addressing workforce shortages and inequitable distribution of health professionals.

Mr Oyeniyi said the ministry maintains a national health workforce registry that provides evidence on the availability and distribution of doctors, nurses, community health officers and other cadres across healthcare facilities.

According to him, the database helps policymakers identify workforce gaps and design appropriate interventions.

“In some local government areas, you may not even have one specialist obstetrician and gynaecologist, not to mention other specialists,” he said.

Mr Oyeniyi said the government continues to implement task-shifting and task-sharing policies to help bridge service delivery gaps, particularly in underserved areas.

He acknowledged resistance from some professional groups but stressed the need for reforms.

Uneven distribution persists

Also speaking, a Health Systems Strengthening Expert with the Clinton Health Access Initiative (CHAI), Ruth Adetokunbo, said Nigeria’s health workforce challenge revolves around four critical areas: production, absorption, deployment and retention.

Ms Adetokunbo said assessments conducted by CHAI showed significant differences in workforce challenges across professional cadres.

For some categories of health workers, she said, the problem is inadequate production, while for others it is poor distribution or limited capacity within training institutions.

She noted that although many Nigerians are interested in studying health-related courses, training institutions often face infrastructure and faculty limitations that restrict student intake.

On deployment, she highlighted stark inequalities in the distribution of healthcare personnel across the country.

According to her, less than four per cent of doctors are located in rural areas, while approximately 96 per cent practice in urban centres.

She added that similar trends exist among pharmacists and medical laboratory scientists, with Abuja and Lagos accounting for a substantial proportion of the country’s health workforce.

Ms Adetokunbo stressed that improving workforce retention would require better funding, fair remuneration, safer working environments and clearer pathways for professional advancement.