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HRH Needs and Solutions in Nigeria’s Healthcare Sector

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By Dr Jennifer Anyanti and Grace Mmesomachukwu Oji.

The strength of the healthcare system is her human resources. However, as critical as this component is, human resources for health (HRH) in Nigeria is assailed by numerous related issues that limit the effectiveness of health service delivery, and there is a dire need to address these challenges, for it is vital for improving health outcomes. In this blog, the HRH needs in Nigeria’s healthcare sector, followed by potential solutions, will be discussed, with a focus on the role of the Pharma PHC system in the private sector in supporting HRH needs in Nigeria’s health sector.

Insufficient Health Workforce

According to the International Labor Organization (ILO) report in 2014, 10.3 million more health workers are needed worldwide to fill the existing shortages and guarantee the provision of universal healthcare. More concerning is the lack of HRH in developing nations, particularly in Africa, where 2.8 million are needed (ILO, 2014). Nigeria faces her own share of significant shortages of healthcare professionals. The doctor-patient ratio is considerably below the World Health Organization (WHO) recommendations of 1 doctor to 600-1000 patients. As of recent estimates, Nigeria has approximately 0.4 doctors per 1,000 people, far below the ideal of 1 doctor per 1,000 people. The March 2025 Primary Examination Report from the National Postgraduate Medical College of Nigeria gives a centre breakdown from Abuja, Enugu, and Lagos Colleges, showing that across these cardinal locations, there are a total of 825 doctors, with some faculties having as few as 0. These saddening statistics reflect the health workers’ famine that has crept up on the nation.

Inadequate Funding and Budget Allocation

The healthcare system grapples with chronic underfunding, leading to suboptimal health outcomes. Despite Nigeria’s commitment under the Abuja Declaration (2001) to allocate 15% of the national budget to health, Nigeria’s health budget allocation has only averaged 5.05% between 2001 and 2021, peaking at 6.23% in 2012. In 2024, the health sector was allocated NGN 1.38 trillion, constituting 5.03% of the national budget. This shortfall highlights the habitual underinvestment in health, bearing testament to underlying issues like governance and policy gaps.

Unequal Distribution of Healthcare Workers

In Nigeria, poverty, poor education, corruption, poor governance, geographic isolation, unfavourable environmental conditions, cultural norms, foreign influences and other factors are the main causes of health inequality, disparity, and inequity. Reversing these factors is the key to improving health outcomes. Healthcare professionals are often concentrated in urban areas, leaving rural and underserved regions with limited access to healthcare. While half of the country’s population is deemed rural, over 60% of healthcare workers are based in urban centres. This urban-rural disparity and rural HRH shortage in rural areas is brutal. Medical resources are continuously limited, resulting in inequitable access to services amidst heightened morbidity and mortality.

Limited Training and Capacity Building.

This silent crisis is championed by the tripartite issues of medical education in Nigeria – its system trains too little and produces too few, due to underfunded medical schools. The neglect of continuing medical education and the existing gap in specialist training are also unique problems. Nigeria’s medical and nursing schools produce far fewer graduates than the healthcare system needs. Imagine a young doctor posted to a rural community where he/she is the sole healthcare provider within a large mile radius. She experiences complex cases but has no guidance from senior colleagues, no access to specialised training, and outdated equipment that barely functions. The lived experiences of thousands of Nigerian healthcare workers are ones where the system demands more from them daily. Yet, investments in continuous training and capacity building remain alarmingly inadequate, leading to insufficient clinical and leadership capabilities.

Brain Drain and Migration of Healthcare Workers.

The Exodus of Nigeria’s best minds features the mass migration of HRH to greener pastures. Between 2015 and 2023, over 15,000 Nigerian doctors moved abroad- a trend that has only accelerated in more recent years. A significant number of healthcare professionals leave Nigeria for better working conditions and higher remuneration abroad, contributing to a “brain drain” that diminishes the country’s healthcare capacity. Several factors are liable for this: Poor remuneration, stunted career growth and development, insecurity and workplace violence, inadequate resources, and challenging work environments. This led to dissatisfaction and high turnover among healthcare workers, further exacerbating the shortage of skilled professionals.

Gender Disparities

According to a study conducted by LSHTM and Resilient &Responsive Health Systems on Gender and Leadership in Nigeria, South Africa and Kenya, women constitute nearly 70% of the global health and social workforce. However, in many countries, they occupy only about 25% of senior leadership roles as they face systemic barriers to leadership roles and career advancement, contributing to gender inequality in healthcare management. The underrepresentation of women in leadership results in limited perspectives and skewed decision-making, which translates to marginalising policies, poor health outcomes, and a repressed cycle of underachievement and under-representation of the viable workforce.

PROPOSED SOLUTIONS TO ADDRESS HRH NEEDS

Increase Investment in Health Workforce Training and Development

Investment in human resources for health is one of the best buys in public health. The topmost choice towards reversing the damage is to invest in a smarter, more capable workforce. The focus should be tilted towards building stronger leadership skills within the healthcare system. This will improve service delivery and health outcomes and develop leadership and management training programmes for mid-level and senior healthcare professionals. And it can be achieved through partnerships with local universities and international organisations.

Improve Incentives and Working Conditions, Strengthen Healthcare Workforce Distribution Policies

The Nigerian health workforce crisis is not just about numbers – it’s about the creation of a system where healthcare professionals can thrive and deliver quality care. All feasible by improving the welfare of healthcare workers through competitive salaries, better work environments, and benefits commensurate with the hours they put in. Addressing these challenges will require bold policy reforms and intentional investments targeted towards retention strategies, including financial incentives for healthcare workers in rural areas and the provision of career development opportunities, medical supplies, and infrastructure improvements.

Create Sustainable Pathways to Retain Healthcare Workers

This involves political dialogue and coordinated actions in the field of international migration of medical workers. In Nigeria, policy initiatives have been proposed to address the migration of health workers, including retention programmes that include competitive salaries and benefits and incentive programmes such as professional development opportunities. This labour shortage in Nigeria from the brain drain can only be fixed by sustainable systemic progress. Addressing the “brain drain” should entail making health career paths more sustainable and attractive within Nigeria as the new norm.

Enhance Gender Equality in the Health Workforce

According to a 2024 article from Think Global Health, “A comprehensive assessment of the global health workforce unveils a stark reality: health is delivered by women but led by men.” The pursuit of gender equality in the global health workforce can help policymakers better address the obstacles faced by women in the health sector by taking a gender perspective. However, we can begin bridging these gaps, one step at a time, by promoting gender equality, ensuring women have equal opportunities for leadership and career progression within the health sector, addressing the existing gender pay gap, launching mentorship programmes for female healthcare workers, advocating for equal pay, and designing gender-sensitive policies that ensure a fair working environment for women.

Increase Government and Private Sector Funding

 

One way for governments to finance large infrastructure projects without putting too much pressure on public budgets is through Public-Private Partnerships (PPPs). Public-Private Partnerships (PPPs) offer significant advantages for infrastructure projects, enabling governments to manage risks more effectively. According to the Infrastructurist, these partnerships allow for optimal risk allocation between public and private sectors, enhancing project efficiency and sustainability. Infrastructure projects benefit greatly from public-private partnerships (PPPs), which help governments better control risks.

The Vital Role of Community Pharmacists and PPMVs in Africa’s Healthcare System: A Conclusion

As we reflect on the critical role of other providers in the health care systems, the contributions of Community Pharmacists and Patent and Proprietary Medicine Vendors (PPMVs) are indispensable, particularly in underserved and rural areas. In this final section, we highlight the potential for further empowering these healthcare workers to improve access to care across the continent.

1. A Crucial Role in Bridging Healthcare Gaps

Community Pharmacists and Patent and Proprietary Medicine Vendors (PPMVs) are filling an essential gap in healthcare delivery, especially in rural and underserved areas. In these regions, where access to formal healthcare services is limited, PPMVs and community pharmacists serve as the first point of contact for many individuals seeking medical assistance. By providing a wide range of services, from dispensing over-the-counter medications to offering health consultations, they are ensuring that healthcare is accessible even in the most remote areas. Their strong relationship with the community and the trust they’ve built make them invaluable in improving access to primary healthcare.

2. Empowering Communities and Alleviating Healthcare Pressure

PPMVs and community pharmacists are also playing a key role in alleviating pressure on formal healthcare systems. With the growing strain on hospitals and clinics, these health workers are stepping in to provide essential services, such as minor consultations and referrals to more specialised care when necessary. In line with Task Shifting and Task Sharing policies, which are gaining traction across many African countries, these healthcare providers help reduce the burden on formal healthcare facilities. They also serve as crucial sources of health education, empowering communities with the knowledge they need to prevent illness and maintain good health.

3. Training, Regulation, and a Stronger Healthcare Future

To fully harness the potential of PPMVs and community pharmacists, proper training and regulation are necessary. Equipping these healthcare workers with the skills to administer medications, prevent diseases, and respond to medical emergencies will elevate the quality of care they provide. In collaboration with regulatory bodies (like the Pharmacy Council of Nigeria), frameworks are being developed to ensure that PPMVs and pharmacists operate within legal and ethical boundaries, thereby increasing public trust in their services. By empowering this cadre of healthcare workers, we can build a stronger, more accessible healthcare system across Africa.

References

1.     A., & Sulaimon, O. (2019). “The Role of PPMVs in Strengthening Healthcare Access in Rural Nigeria.” African Journal of Primary Health Care & Family Medicine.

2.     Abuja Declaration (2001). African Health Financing Commitments.

3.     Aluttis, Christoph & Bishaw, Tewabech & Frank, Martina. (2014). The workforce for health in a globalized context – global shortages and international migration. Global health action. 7. 23611. 10.3402/gha.v7.23611.

4.     Baruwa, S., Tobey, E., Okafor, E., Afolabi, K., Akomolafe, T. O., Ubuane, I., Anyanti, J., & Jain, A. (2022). The role of Kolo, job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria. BMC Health Services Research, 22(1), 981. https://doi.org/10.1186/s12913-022-08360-0

5.     FMOH (2018). Nigeria Health Sector Infrastructure Report.

Health Policy and Research Group. (2018). Gender stereotypes and inequities in health care leadership: Perceptions and experiences of senior managers in Nigeria. Gender stereotypes and inequities in health care leadership: Perceptions and experiences of senior managers in Nigeria | resyst.lshtm.ac.uk

6.      Ignacio, A., Kim, S., Tamayo, R., Think Global Health: Seeking Gender Equality in the Global Health Workforce Seeking Gender Equality in the Global Health Workforce | Think Global Health

1.      Ignacio, A., Kim, S., Tamayo, R., Think Global Health: Seeking Gender Equality in the Global Health Workforce Seeking Gender Equality in the Global Health Workforce | Think Global Health

2.     National Institute of Health (2017). Strengthening Health Systems Leadership and Management in Nigeria.

3.     Ogo, I. F. (2020). “Gender Disparities in Nigeria’s Health Workforce.” African Journal of Gender Studies and Public Health.

4.     Okafor, E., Idogho, O., Anyanti, J. et al. Scaling training facilities for patent and proprietary medicine vendors in Nigeria: insights and lessons learned for policy implication and future partnerships. Health Res Policy Sys 22, 97 (2024). https://doi.org/10.1186/s12961-024-01186-8

5.      The Infracturist. (2025). Understanding Infrastructure Financing Through Public-Private Partnerships. Understanding Infrastructure Financing Through Public-Private Partnerships – Infrastructurist

6.     WHO. (2018). A Policy Framework for Strengthening PPMVs in Nigeria.

7.     WHO. (2019). Health Leadership and Management in Low-Resource Settings.

8.     WHO. (2021). State of Health Infrastructure and Workforce in Nigeria.

 

9.     World Health Organization. (2019). Gender Equality and Human Resources in Health.

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