Where Health Reform Becomes Real: Reflections from Nigeria’s Primary Healthcare Frontline

Nkata Chuku

On an ordinary morning in a primary healthcare centre, a mother may walk several kilometres with her baby on her back to have him immunised. Whether she returns home relieved or turned away often depends on small, but critical, details: whether the vaccines are available, whether the health worker is there, whether the doors are open at all.

Across Nigeria, these everyday moments are becoming increasingly important measures of whether health reforms are delivering on their promise. 

They remind us that while policies, financing and infrastructure create the conditions for change, the real test of reform is whether people experience better care when they need it most. 

And that experience is shaped at primary healthcare centres, where stronger systems and essential services covering malaria, family planning and immunisation come together in the care families rely on.

There are encouraging signs that this is beginning to happen. 

The Basic Health Care Provision Fund, ongoing primary healthcare revitalisation efforts and stronger fiscal commitments by many states are creating renewed momentum for primary healthcare. Across the country, facilities are being upgraded, equipment is improving and state governments are demonstrating greater commitment to strengthening services closer to communities.

Yet progress is rarely defined by infrastructure alone. A facility may look transformed, but if essential medicines are unavailable, routine immunisation is inconsistent or health workers lack the support they need, families continue to face uncertainty. 

The distance between policy commitments and a consistently functioning clinic is often bridged by factors that receive far less attention than the reforms themselves.

What Progress is Beginning to Look Like

One of the most encouraging developments in recent years is that, across different states, common patterns are beginning to emerge where reforms are translating into better services.

These are rarely places transformed by a single innovation. More often, they are places where leadership remains focused on implementation, where data is used to solve problems rather than simply report them, where frontline health workers receive regular support, and where different parts of the health system work towards shared priorities.

Yobe’s recognition in the 2025 Primary Healthcare Leadership Challenge reflects many of these characteristics.

 Improvements in the availability of essential medicines, stronger coordination across services and greater confidence in routine data did not happen overnight; they are the result of sustained attention to the fundamentals of primary healthcare.

Kaduna offers a similar perspective. 

The state’s efforts to strengthen selected primary healthcare centres and expand health insurance coverage have undoubtedly improved access for many families. But perhaps the more significant lesson lies beneath those visible investments. 

Conversations with state officials and frontline health workers consistently point to the value of regular performance reviews, closer coordination between partners and government, and sustained leadership attention to implementation.

These examples are different in many respects, yet they reinforce the same observation: reforms gain traction when implementation becomes everyone’s daily business, not just a policy ambition.

The Work that Often Goes Unseen

Some of the most important improvements in primary healthcare rarely attract headlines.

They happen when community health workers identify pregnant women early and continue supporting them throughout pregnancy. They happen when facility teams use routine data to identify children who have missed vaccinations and bring them back into care. 

They happen when referral systems function as intended, reducing delays during obstetric emergencies, or when supervisors address supply challenges before they become stock-outs.

None of these actions is new. 

What is changing in many places is the consistency with which they are being applied.

That consistency matters because it builds confidence – not only within the health system but among communities themselves. When people know that services will be available, and also believe in the responsiveness of the system as it shows up in health worker attitudes and quality of care, they are more likely to seek care early, return for follow-up visits and recommend those services to others.

Development partners also have an important role to play, but experience increasingly shows that the greatest impact comes when support strengthens government priorities rather than creating parallel systems. 

Lasting progress depends on national and subnational leadership, with partners helping to reinforce the systems already being built.

Building on the Momentum

There is every reason to recognise the progress Nigeria has made in strengthening primary healthcare. Equally, there is every reason to recognise that this progress remains fragile. Workforce shortages, supply chain interruptions and fiscal pressures continue to test even the strongest systems.

Across government, frontline health workers, development partners and communities, there is an opportunity to keep learning from states where reforms are beginning to translate into better experiences for families – not to replicate one model, but to understand the conditions that allow progress to endure.

Ultimately, health reform is not measured by the number of policies adopted or facilities renovated. It is measured by whether a mother arriving at her local clinic finds the care she came for.

That is both the promise of Nigeria’s primary healthcare reforms and the challenge ahead: ensuring that the encouraging progress already visible in many states becomes the everyday experience of families in every community across the country. 

*Nkata Chuku is Deputy Director Health Systems Strengthening & Primary Healthcare, Gates Foundation

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There is every reason to recognise the progress Nigeria has made in strengthening primary healthcare. Equally, there is every reason to recognise that this progress remains fragile. Workforce shortages, supply chain interruptions and fiscal pressures continue to test even the strongest systems. Across government, frontline health workers, development partners and communities, there is an opportunity to keep learning from states where reforms are beginning to translate into better experiences for families