Towards Health System Strengthening: A Review of the Nigerian Health System From 1960 to 2019

The Nigerian health system is weak and has been evolving over the years with misplaced priorities and the focus on health inputs rather than outputs. The design and adoption of several policies have contributed little to strengthening the health system towards improvement in health outcomes. Available evidence on the Nigerian health system from 1960 to 2019 was reviewed. Decentralization and fragmentation of the health system with duplication of responsibilities among the three tiers of government have affected effective health service delivery and accountability. The national health insurance scheme has provided health insurance coverage to less than five per cent of the population. Nigeria is also faced with health workforce crisis with no end in sight. While some modest gains and improvements have been recorded over the decades, maternal mortality, child mortality, immunization coverage, access to basic health services and life expectancy remain poor. Nigeria needs to strengthen its health system.