This article was co-authored by Africa Health Business and Nigeria Health Watch as part of our advocacy efforts to raise awareness and drive action on Universal Health Coverage.
In a rural clinic , a mother arrives with her feverish child, hoping for a diagnosis. The nurse on duty, overworked and lack of resources, does her best, but without a functioning diagnostic kit, she can only make a reasonable guess. The mother is referred to a larger facility miles away, where the cost of treatment will likely determine whether her child gets treatment or not.
In Nigeria, seeking healthcare means navigating a complex system that involves financial constraints, personnel shortages, and infrastructural gaps. Access to comprehensive healthcare services is very uneven, while urban centres may boast state-of-the-art hospitals, on the other end, many rural communities rely on under-resourced primary healthcare centres (PHCs) that do not meet their health needs.
Similarly, Kenya’s Primary Health Care (PHC) systems encounter significant hurdles, including inconsistent resource distribution, insufficient funding, and notable disparities in healthcare services across different counties.
In Nigeria and Kenya, PHCs are a crucial part of the healthcare system, serving as the primary point of contact for communities. Despite the potential, many PHCs are not fully functional, lacking essential resources like drugs, equipment, and infrastructure.
However, this is not just the story of Nigeria and Kenya, it reflects a broader challenge facing many countries across the African continent. Health systems are under severe strain, with chronic underfunding, shortage in the health workforce, and inadequate infrastructure preventing millions from accessing the care they need.
As both countries work toward strengthening PHCs and achieving universal health coverage (UHC), the distribution and availability of clinical health workers remains a persistent challenge.
Staffing realities on the ground
Health facilities across Kenya and Nigeria operate under varying levels of strain, yet the contrast between the two countries remains stark.
According to a 2024 study published in Health Policy and Planning, Nigeria’s primary health system remains alarmingly understaffed, especially at the community level. At health posts, often the first point of care in rural communities, 97% of staff in Nigeria are community health workers, assistants, or volunteers with limited clinical training. Only 0.7% are doctors or clinical officers, and just 2.3% are nurses or midwives.
In contrast, Kenya’s health posts show a more balanced staffing mix with 17.1% doctors/clinical officers, 47.1% nurses/midwives, and 35.7% community health workers and assistants.
The disparity continues at the level of health centres. In Nigeria Only 1.3% of staff are doctors/clinical officers resulting to a skilled health worker-to-patient ratio of 1:9,000 patients. Meanwhile, Kenya’s health centres are staffed with 18.9% doctors/clinical officers and 45.7% nurses/midwives, indicating a more skilled workforce.
The study also found that Nigerian facilities average just 0.58 clinical staff per facility, meaning many operate with only one clinician or none at all, while Kenyan facilities average 3.35 clinical staff per facility, over five times higher than Nigeria.
A facility staffed by a single, often under-trained worker cannot reliably deliver even the most basic preventive or curative services. The consequences are dire: delayed diagnoses, untreated conditions, and an overreliance on referral hospitals already stretched beyond capacity.
From Crisis to Commitment
Nigeria’s health sector has long reflected wider continental challenges: a disproportionate disease burden and reliance on external donors. However, with the launch of the Nigeria Health Sector Renewal Investment Initiative (NHSRII) operationalised through the Four-Point Agenda of the Federal Ministry of Health & Social Welfare (FMoH&SW), the country is signalling a decisive shift toward addressing decades of underinvestment and inertia.
In 2024, Professor Mohammad Ali Pate, Nigeria’s Coordinating Minister of Health & Social Welfare during a Ministerial Sectoral Briefings stated that, “N260 billion is currently available at the state level for the revitalisation of their primary healthcare centres. Our goal is to ensure that every Nigerian, regardless of their location, has access to quality healthcare services. By revitalising these primary health centres, we can provide essential health services closer to the people, thereby reducing the burden on tertiary healthcare facilities.”
The government is prioritising major improvements in healthcare infrastructure. A key example is the upgrade of General Hospital Kumo in Gombe State to a Federal Medical Centre, the second such facility in the state aimed at enhancing medical services across the Northeast.
This centre will also support medical education by serving as a teaching hospital for the Federal University of Kashere and Lincoln University, Kumo. In addition, the administration plans to more than double the number of functional Primary Healthcare Centres, expanding from 8,809 to over 17,600 by 2027
Similarly, Kenya’s World Bank backed $215 million Building Resilient and Responsive Health Systems Project which started in 2024 is being implemented to strengthen key institutions critical in achieving UHC.
The project aims to enhance the Kenya Medical Supplies Authority’s (KEMSA) capacity to ensure timely availability of essential health products at the PHC level, while promoting transparency and accountability.
It is also addressing geographical inequities to health outcomes, health financing and quality of care reforms, human resource shortages, and suboptimal use of quality data for decision-making, including challenges related to refugee health services, ultimately driving progress towards UHC.
Where there are shortages, there is a strategy
The Nigerian government is also tackling the issue of understaffed health facilities head-on, focused on expanding and retaining the health workforce. To mitigate this, the Nigerian government introduced the health workforce migration policy to retain medical workers.
A health workforce registry was developed to improve accountability and equitable deployment of staff. Achieving WHO’s call for all nations to pursue UHC and the Sustainable Development Goals (SDGs) by implementing the Global Strategy on Human Resources for Health (GSHRH) 2030.
In both Nigeria and Kenya, a Task Sharing Policy,(TSP) initiated by the Ministry of Health, aims to redistribute specific healthcare tasks from highly specialised professionals to those with less formal training, such as nurses, midwives, and community health workers.
While in Kenya, evidence indicates that task sharing has led to improved service delivery, particularly at lower-tier health facilities, with notable gains in HIV and maternal health services. The policy has contributed to the achievement of HIV targets and increased contraceptive use through nurse-led interventions, while also alleviating the burden on physicians, especially in rural areas.
In Nigeria, through the task sharing policy approved in 2014, community health workers (CHWs) and nurses have assumed a greater role in delivering routine care, thereby enhancing service availability. However, the effectiveness of the policy in Nigeria is constrained by challenges including limited funding, inconsistent training quality, and resistance from some professional associations.
A hopeful horizon
Despite visible gains in both countries, challenges remain. Some facilities still face drug stockouts, and data gaps continue to limit effective planning. However, the most important shift is that these issues are no longer being overlooked, they are being acknowledged, monitored, and actively addressed. That in itself is progress.
The journey to comprehensive, quality healthcare in Kenya and Nigeria is still unfolding. But it is no longer just a story of failure, it is becoming a story of intention, investment, and hope.
Policymakers must keep their promises. Communities must stay engaged. And funding, both public and private, must remain consistent. Because at its heart, healthcare is not just about survival. It’s about dignity, equity, and the right to thrive.