Rebuilding Nigeria’s Primary Care System to Reduce Preventive Deaths

Nigeria is confronting a preventable public health crisis. Despite medical progress and expanded health investments, the country continues to experience some of the world’s highest burdens of avoidable disease and premature mortality. When I returned home in late 2018 after completing medical training in the United States, I anticipated reconnecting with family and deepening my clinical understanding of healthcare delivery in Nigeria. What I encountered instead was a vivid reminder that the foundation of our health system, primary care, requires urgent reform.

During my stay in Lagos, one image was impossible to ignore. Obituary posters appeared on walls, storefronts, and community boards, often featuring individuals in their 50s and early 60s. Equally striking was the limited presence of older adults in public life. Men and women in their 70s were notably absent from markets, parks, businesses, and social spaces. Even within hospitals, patients who appeared elderly were often only in their early 60s. This lived experience reflects a well-documented population health challenge. According to the World Bank, Nigeria’s life expectancy in 2018 was approximately 52.7 years, compared with 78.6 years in the United States. This gap is driven less by rare diseases and more by conditions that are manageable with functioning primary care.

Preventable Diseases Continue to Drive Early Deaths

Data from the World Health Organization show that Nigeria’s leading causes of death in 2018 included malaria, lower respiratory infections, diarrheal diseases, tuberculosis, hypertensive heart disease, and stroke. Nigeria accounted for roughly 25 per cent of global malaria cases and an estimated 20 per cent of global malaria deaths in 2017 – 2018. These conditions are treatable and often preventable when early diagnosis, routine surveillance, and timely follow up care are accessible.

However, in many Nigerian communities, the first encounter with the health system occurs only when illness becomes severe. The absence of reliable, community based primary care limits opportunities for early intervention and contributes to a cycle of avoidable morbidity and mortality.

Four Structural Gaps Undermining Nigeria’s Primary Care System

Limited Availability of Functional Primary Care Facilities: According to the National Primary Health Care Development Agency, fewer than 20 percent of Nigeria’s primary health centers are fully operational. Many lack essential medicines, basic diagnostic capacity, or trained clinical staff. Without accessible first-line care, patients often present late or rely on informal treatment options that delay effective therapy.

Lack of Continuity of Care: Chronic conditions such as hypertension and diabetes require long-term monitoring, yet most patients navigate a fragmented system where each visit occurs in isolation. The absence of standardized medical records leads to repeated tests, inconsistent treatment plans, and missed opportunities for early intervention. In 2018, WHO estimated that over 50 percent of adults with hypertension in Nigeria remained undiagnosed.

Underinvestment in Preventive Health Services: Preventive services, including routine blood pressure checks, immunizations, nutritional counseling, and infectious disease screening, remain limited. This gap allows high burden conditions to progress unnoticed. For example, only 33 per cent of Nigerian children were fully immunised in 2018 according to UNICEF, revealing a missed opportunity to protect families from preventable illness.

Overreliance on Secondary and Tertiary Hospitals: Hospitals designed for specialised care often manage illnesses that primary care clinics could address earlier and more efficiently. This strain limits the availability of specialty services and increases the costs borne by families and the health system.

A Strategic Path Forward: Strengthening the Foundation

International evidence clearly demonstrates that robust primary care is the most cost effective method for improving population health. Countries that prioritise primary care achieve higher life expectancy, better chronic disease control, and reduced emergency care burden. Nigeria can achieve similar gains through targeted reforms.

Modernise and Equip Primary Health Centers: Investing in essential diagnostics, medications, and staffing can convert existing facilities into true centers of first contact. Rwanda’s experience with community-based health systems demonstrates that consistent investment in primary care can significantly reduce mortality.

Expand Training Pipelines for Primary Care and Geriatrics: Nigeria’s evolving population health needs require more family physicians, general practitioners, community health workers, and geriatric specialists. Structured professional development programs and training incentives would support workforce expansion.

Scale Preventive Screening Across Communities: Mobile clinics, school-based health initiatives, and workplace screening programs can help detect hypertension, diabetes, malaria, HIV, and respiratory diseases early. Screening integrated into everyday environments reduces barriers to access.

Strengthen Digital Health Infrastructure for Continuity: Introducing standardised digital tools, even simple mobile-based patient tracking, can improve follow-up and chronic disease management. Digital continuity has been shown across multiple countries to reduce hospitalisation rates for preventable conditions.

Implement Public Education Programs That Build Health Literacy: Health education campaigns focused on early care-seeking, healthy aging, infectious disease prevention, and chronic disease management can improve population-level outcomes. Countries with strong health literacy programs consistently report lower preventable mortality.

Conclusion

Nigeria has the clinical talent and institutional expertise to improve population health outcomes significantly, yet the frontline of the health system remains underdeveloped. Strengthening primary care is not only a health strategy. It is a national economic and social investment that protects families, improves life expectancy, and builds healthier communities.

Preventable mortality is not an inevitability. It reflects a system that is not yet designed to meet its people’s needs. By rebuilding the nation’s primary care foundation, Nigeria can shift from reactive care to proactive health, ensuring that more citizens live long, healthy, and productive lives.

Sources: World Bank (2018), WHO Global Health Observatory (2018), UNICEF Nigeria Immunization Data (2018), NPHCDA Reports (2018).

About the Author
Dr. Oyindamola Ajumobi Writes from the US.
She recently completed her Doctor of Medicine degree at St. George’s University, Grenada, where she developed a strong interest in population health, primary care, and the clinical management of chronic diseases in low and middle-income settings. She also holds a Master of Science degree in Biomedical Sciences from Barry University in Florida, where her graduate work strengthened her understanding of the biological and community-level factors that influence health outcomes across diverse populations. She is passionate about improving access to high-quality, community-based primary care in Nigeria and other resource-constrained settings. Her clinical training exposed her to the challenges of preventable diseases, health inequities, and the gaps in early diagnosis that shorten life expectancy in many West African communities. These experiences continue to shape her commitment to strengthening frontline healthcare services, advancing preventive care, and supporting healthier aging for underserved populations. She plans to pursue further training in primary care and geriatric medicine, with the long-term goal of contributing to health system reforms, developing scalable care models, and supporting the next generation of clinicians dedicated to improving public health outcomes.