Strengthening Nigeria’s Health System: A Scoping Review of Recent Reforms, Implementation Outcomes, and Systemic Challenges (2015–2025)
DOI:
https://doi.org/10.63950/gshh.2025.1.2.19Keywords:
Health system strengthening, Nigeria, Universal Health Coverage, Health reform, Digital health, Patient satisfaction, Community-based health insuranceAbstract
Introduction: Nigeria’s health system continues to face systemic challenges, including underfunding, fragmented governance, workforce shortages, and inequitable access to services, despite repeated reforms. While numerous initiatives have been implemented to strengthen the health system in line with Universal Health Coverage (UHC) goals, existing evidence remains fragmented and lacks a comprehensive synthesis. This review aimed to map, synthesise, and critically assess health system strengthening initiatives in Nigeria from 2015 to 2025, highlighting their outcomes, implementation barriers, and policy implications.
Methods: A scoping review was conducted per the PRISMA-ScR (2020) guidelines and the Arksey and O’Malley framework, as enhanced by Levac et al. A mixed-methods approach was employed to incorporate both qualitative and quantitative studies. Four major databases, PubMed, Scopus, ScienceDirect, and Google Scholar, were systematically searched between April 21 and May 13, 2025, for studies published from January 2015 to May 2025. Eligibility criteria were defined using the Population–Concept–Context (PCC) framework. Eleven studies met the inclusion criteria.
Synthesis: Five thematic domains emerged: national policy reforms, digital health innovations, community-based interventions, infrastructure and service delivery, and governance and financing. Key initiatives included the National Health Act, NHIA Act, Basic Health Care Provision Fund (BHCPF), digital tools such as ClinPak and mHealth apps, and community models like Community-Based Health Insurance (CBHI). While many initiatives led to improved healthcare access, patient satisfaction, and service delivery, especially in underserved areas, most faced sustainability challenges due to political instability, poor infrastructure, fragmented implementation, and insufficient financing. Innovative Nigerian solutions, such as a decentralised offline patient ID system, showed promise for improving health information systems and coverage.
Conclusion: Although Nigeria has introduced significant health reforms over the past decade, their success remains uneven. Future efforts must prioritise policy continuity, systems integration, equitable financing, and scaling of context-specific innovations. This review underscores the need for coordinated, evidence-informed strategies to build a resilient health system and achieve UHC. Longitudinal research is needed to assess the sustainability, impact, and scalability of these interventions across diverse geopolitical contexts.
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Data Availability Statement
All data analysed during this study are included in the published articles and reports referenced. Extracted data tables can be made available by the corresponding author upon reasonable request.
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Copyright (c) 2025 Adewoye AA, Lawal SA, Obadina AO, Ibor GO (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
