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For over two decades, Nigeria’s health sector has leaned heavily on the support of international development partners. These partners, particularly USAID, US President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’s Malaria Initiative (PMI), have played a central role in helping Nigeria respond to public health emergencies, reduce maternal deaths, treat millions living with HIV/AIDS, and scale up malaria prevention. But that scaffolding is beginning to unravel.
In 2023, USAID’s health portfolio in Nigeria was valued at about $600 million. By 2024, that figure had dropped to $464 million, a decline of more than $135 million in just one year. This is about lives: pregnant women with bleak hope for antenatal care, under 5’s who won’t get access to care, fewer HIV treatment packs, reduced access to family spacing commodities, stalled malaria programmes, and a growing threat to maternal and child health services.
PEPFAR, the U.S. government’s flagship HIV/AIDS initiative, has invested over $7.8 billion in Nigeria since inception, supporting more than 1.3 million Nigerians living with HIV. With funding from PEPFAR, Nigeria has made commendable progress in HIV testing, treatment access, and prevention campaigns.
Read also:USAID funding freeze and Nigeria’s buffer measures
But uncertainties in the U.S. domestic policy space are casting long shadows over PEPFAR’s future. The Nigerian government allocated ₦4.8 billion (about $10 million) to procure HIV treatment packs to cushion the impact, but this barely begins to replace what is being lost. The implications include a possible surge in new infections and higher mortality.
The implications for maternal health are equally alarming. Nigeria still has one of the highest maternal mortality rates in the world—545 deaths per 100,000 live births in 2022. While we have seen some progress, particularly in increased use of modern contraceptives, which rose from 16.6 percent in 2018 to roughly 20 percent in 2024, the unmet need remains high. Around 21 percent of Nigerian women still have unmet needs for family spacing.
Child spacing programmes, skilled birth attendance, emergency obstetric care, and antenatal services will all be affected, especially in rural areas, where service delivery was already fragile before the funding cuts.
In the battle against malaria, the story is no different. Reductions in PMI funding have slowed or halted the distribution of insecticide-treated nets, community-level interventions, and access to antimalarial drugs. In a country with one of the highest malaria burdens globally, this is a serious setback.
Nowhere are the consequences more devastating than in northeastern Nigeria, where ongoing conflict has crippled health service delivery. In this fragile region, 60 to 70 percent of healthcare is sustained by donor funding. Across rural communities and internally displaced persons (IDP) camps, many health facilities are stretched to breaking point, and over 70 percent face critical service disruptions.
When aid funding declines, it hits the most vulnerable the hardest. Women, children, and low-income communities are pushed further to the margins. As resources shrink, so does access to life-saving services, widening health inequities and reversing hard-won gains.
Yet amid this healthcare crisis lies a powerful opportunity. The private sector in Nigeria is already a dominant force—more than many realise. As of 2019, private domestic spending made up over 71 percent of the country’s total health expenditure, with nearly 90 percent of that burden falling directly on individuals through out-of-pocket payments. In urban centers like Lagos, an estimated 75 percent of healthcare services are provided by private actors, much of it informally, without integration into broader public health strategies.
Read also: USAID’s Power Africa: Counting wins, losses as funding vanishes
At the Private Sector Health Alliance of Nigeria (PSHAN), we believe this moment calls for a new kind of partnership; one that reimagines the role of the private sector not just as a provider or payer, but as a key stakeholder in Nigeria’s health system.
Through our flagship initiative, the Adopt-A-Healthcare-Facility Programme (ADHFP), we are mobilising private capital and institutional resources to strengthen at least one PHC in each of the country’s 774 local government areas. Through our partners, we have demonstrated that well-structured corporate engagement can yield tangible, scalable impact.
We’re also encouraged by the growing wave of innovation. Between 2019 and 2022, Nigeria attracted over $18 million in private capital to health-tech ventures. The digital health market in Nigeria is projected to grow to €278 million by 2025 and to €374 million by 2029. Telemedicine alone is expected to more than double its revenue from $315 million in 2022 to $704 million by 2027. Our pharmaceutical sector is also on a strong growth path.
Still, these gains are fragile. Health insurance coverage remains low, rising only slightly from 5.1 percent in 2018 to 8.8 percent by 2021. Without legislation to expand microinsurance or policies that incentivise employer-based schemes, coverage will remain confined to formal sectors and urban elites. Workforce shortages, poor infrastructure, and regulatory bottlenecks continue to limit the sector’s ability to scale. Nigeria’s largest hospitals average only about 250 beds.
Some states are leading the way. Kano allocated 16.46 percent of its ₦437.3 billion budget to health in 2024. Kaduna followed with 15.63 percent. Lagos, although lower proportionally at 8.5 percent, allocated the highest absolute amount of ₦149.4 billion. But the facility counts alone are not enough. Across Nigeria, about 85 percent of PHCs are publicly owned, yet only 20 percent are fully functional.
There are bright spots. MTN Foundation adopted 52 PHCs nationwide, equipping them with essential drugs, solar-powered electricity, clean water, and trained medical staff. The Aig-Imoukhuede Foundation is renovating 23 PHCs, with four already active in Edo State.
Other notable contributions include those of the Aliko Dangote Foundation, the HOW Foundation in Rivers, and the Jim Ovia Foundation in Delta. In Lagos, private sector players like Zenith Bank and Access Corporation continue to invest in health through corporate initiatives.
Read also: How USAID shutdown will impact Nigeria
But if we are to replicate and scale these successes, we need to act on several fronts. Nigeria must enact laws that institutionalise blended finance and de-risk private capital. We must enable pooled risk insurance schemes, including tax incentives for employers and subsidies for vulnerable populations.
Workforce retention strategies—such as incentivised rural placements, postgraduate training, and performance-based incentives—are critical. As digital tools become more central to health delivery, we need harmonised frameworks for data governance, digital health regulation, and private provider accreditation.
If you are a policymaker, push for legislation that unlocks private investment in health. If you’re a private sector player, explore partnerships that go beyond CSR; invest in sustainable models like ADHFP. If you are a philanthropist, not-for-profit, or concerned citizen, identify and support functional PHCs in underserved communities. The future of Nigeria’s health system will not be shaped by external aid alone but by the choices we make, the priorities we set, and the collective will we bring to building a healthier nation.
.Egbomead is head of corporate communications, Private Sector Health Alliance of Nigeria (PSHAN);
Adah-Ogoh is the director of policy, PSHAN
