Strengthening Nigeria’s Primary Health System with Lessons from Ethiopia

Precious Ajayi (Lead writer)

On 22 October 2025, Nigeria’s Federal Ministry of Health and Social Welfare approved and released 32.9 billion Naira under the Basic Health Care Provision Fund (BHCPF), the third disbursement this year.
In 2023, under the Renewed Hope Agenda, the Federal Government launched the Primary Health Care Revitalisation Plan as part of the Nigeria Health Sector Renewal Investment Initiative (NHSRII). The goal was to revitalise about 17,600 primary health care centres (PHCs) by 2027, ensuring at least one fully functional PHC in every ward. However, as of September 2025, more than two years after, only 1,295 PHCs had reached the required standard.

As Nigeria works to accelerate progress towards its PHC revitalisation goals, valuable lessons can be drawn from other African countries that have built resilient and people-centred primary health systems. At the 2nd International Conference on Primary Health Care (ICPHC) themed “Advancing Healthcare in the 21st Century: Putting People First” held in Addis Ababa, the capital city of Ethiopia, dignitaries embarked on a field visit to the Kolfe Health Centre, a modern PHC facility in Addis Ababa built in 1973. This visit aimed to highlight the effectiveness of Ethiopia’s PHC system, where community engagement and data come together to bring services closer to the people.

Ethiopia operates a mixed financing system for its PHCs;

1. The government treasury is the main source of funding, covering about 32.2 % of total health expenditure, generated from taxes and national revenue. Through this, the government provides exempted services for free, including maternal health, delivery, child immunisation, Tuberculosis, HIV, family planning, and epidemic response care, so that no one is turned away due to cost.
2. The second source is external donor support, which complements public spending and strengthens national programmes. This includes funds from partners working with the Ministry of Health and non-governmental organisation (NGO) to improve infrastructure, maternal health and disease control.
3. The third source is out-of-pocket payments, where individuals pay directly for certain services, drugs, or diagnostics not covered by government programmes.

Additionally, to reduce direct household spending, Ethiopia introduced the Community-Based Health Insurance (CBHI) scheme which pools small premiums so rural dwellers can access PHC services. Since 2022, joining CBHI has been compulsory, gradually phasing in universal coverage. Enrolment is done per household, not per individual, and payment is made annually.

Leveraging community nutrition and maternal care

A feature of Ethiopia’s PHC system is how it actively reaches into communities rather than waiting for people to come. Through the Health Extension Programme, the country trained and deployed more than 30,000 female Health Extension Workers (HEWs) to work in rural health posts and partner with local volunteers, linking clinics to everyday community life.

These HEWs spend up to 70% of their time in homes and communities teaching nutrition, hygiene, maternal-child care and outreach for pregnant women via health posts, community meetings and group sessions.

At the facility level, nutrition is not an afterthought. Health centres run biweekly nutrition classes where mothers learn how to prepare nutrient-dense meals with local ingredients through cooking demonstrations. This builds an understanding of healthy feeding habits. Meanwhile, maternal services are offered free of charge in public PHCs, including antenatal checks, facility delivery, and emergency obstetric care, ensuring access when it matters most.

The impact of these initiatives is visible. According to official data, Ethiopia’s maternal mortality ratio dropped from about 953 deaths per 100,000 live births in 2000, to 267 by 2020, a decrease of about 72%. Neonatal mortality has also fallen from around 60 deaths per 1,000 live births to about 33 per 1,000. Chronic child stunting reduced from 58 % in 2000 to 37 % by 2019.

Digital records and dashboards play a key role

In Ethiopia, digital technology plays a central role in how PHC services are delivered. For example, the HEWs use the Electronic Community Health Information System (eCHIS) app on tablets to record household visits, growth monitoring results, and referrals. The app links data from health posts up to health centres and feeds into the national DHIS2 system — an open-source system implemented nationwide.

At the facility level, the Electronic Medical Record (EMR) system has been adopted in health centres and hospitals to replace paper-based records.

Together, these systems allow the Federal Ministry of Health and regional health bureaus to monitor crucial indicators from primary care units through to hospitals. It also gives managers and policymakers real-time visualised performance data.

A recent study found that about 87% of health facilities in Ethiopia used DHIS2 for budgeting and resource allocation and 96% used it for programme monitoring.

Lessons for Nigeria

While the Red Letter calls on WDCs, traditional leaders, women’s and youth groups, faith-based organisations, and civil society to sit together, decide together, and act together to strengthen and secure their health facilities, Ethiopia’s PHC experience shows that such collaboration succeeds when it is supported by financing that protects the poor, skilled health workers who live within the community, reliable data systems, and genuine partnerships with citizens.

For Nigeria, turning this kind of collaboration into measurable progress will depend on how effectively financing, community participation, and data are leveraged to strengthen primary health care delivery.

1. Utilise domestic financing effectively. Nigeria should use the BHCPF and state PHC funds strategically to fully subsidise key services of high priority such as maternal care, family planning, nutrition and outbreak control.
2. Strengthen community engagement. Ethiopia’s Health Extension Programme and its volunteer ground PHC model make community action central to local health. In Nigeria, structures like Ward Development Committees (WDCs), health fellows exist, but they now need amplified authority, resources and accountability. For example, in Nasarawa State, WDC’s efforts helped raise awareness and mobilise support.
3. Prioritise data use in healthcare delivery. Although Nigeria currently has a PHC Monitoring Dashboard, the next step is building an administrative culture that actually uses the data, where facility managers and community committees are trained to read dashboards and demand fixes.
4. Political commitment matters. Ethiopia’s PHC reforms have borne fruit in part because successive governments upheld the agenda. Nigerians have made big pledges for PHC but sustaining them will require the same consistent leadership. PHC revitalisation should not be a short-term project but needs to be embedded into national strategy and institutional memory, so that progresses survive leadership changes.

The fact that Ethiopia’s Health Extension Programmes spans over 22 years, and is a source of national pride, is no accident of fate, but of determination.