At the Frontline of Survival: How Nigeria’s Primary Healthcare Lifeline Faces a Defining Test
Hussaini Ibrahim 
KANO, Nigeria – In a country where a woman’s chance of surviving childbirth can depend on her postcode, and where a child’s immunity to deadly diseases is often determined by distance, Nigeria’s primary healthcare system stands as both lifeline and last resort. In 2025, as the nation grapples with persistent inequality, insecurity and climate stress, the mandate of the National Primary Health Care Development Agency (NPHCDA) has become one of the most consequential in Nigeria’s public health history.
For millions of Nigerians living in rural, riverine and conflict-affected communities, primary healthcare centres (PHCs) are not simply the first point of care; they are often the only one. From antenatal clinics to vaccination posts, from malaria treatment to emergency referrals, the effectiveness of Nigeria’s health system rests heavily on how well the NPHCDA delivers on its core responsibilities: expanding access, reducing maternal and child deaths, and preventing disease outbreaks through routine immunisation. As experts assess the agency’s performance in 2025, a consensus is emerging: progress is visible, but fragile. And the choices made now will determine whether, by 2026, Nigeria moves closer to universal access to functional PHCs—or slips further behind. Hussaini Ibrahim, writes.
Reaching the unreached
One of the NPHCDA’s central mandates is to ensure that basic health services reach underserved populations, particularly in rural and hard-to-reach areas. In 2025, this task has grown more complex. Insecurity in parts of the North, flooding in riverine communities, and poor road infrastructure continue to isolate millions from essential care.
Public health experts argue that PHCs remain the backbone of health delivery outside major cities. Where they function, preventable deaths fall. Where they fail, families often resort to unsafe alternatives—or go without care entirely.
“Primary healthcare is the backbone of any functional health system,” said Dr. Amina Sadiq, a community health and development expert. “In rural and hard-to-reach areas, NPHCDA’s role in coordinating facility upgrades, deploying community health workers and supporting outreach services determines whether people live or die.”
She noted that in 2025, interventions such as mobile clinics, task-shifting to trained community health extension workers, and closer collaboration with state primary healthcare boards have helped bridge access gaps in several states. Yet she warned that these gains remain uneven.
Health analysts stress that sustaining rural outreach requires more than commissioning new buildings. It demands consistent funding, security support for health workers, reliable transport and robust monitoring systems to ensure facilities remain open, staffed and stocked long after ribbon-cutting ceremonies end.
Maternal health at the heart of the crisis
Few indicators expose Nigeria’s health inequities as starkly as maternal mortality. Despite global progress, Nigeria continues to record one of the highest maternal mortality ratios in the world, with deaths largely caused by preventable complications such as haemorrhage, infections and prolonged labour.
In 2025, the NPHCDA’s focus on strengthening antenatal care, skilled birth attendance and postnatal services at the PHC level have been widely identified as a critical strategy for reversing this trend.
“When primary health centres are functional, pregnant women do not need to travel long distances to access care,” said Prof. Tunde Alabi of the Resource Centre for Human Rights and Civic Education, a maternal and child health specialist. “The NPHCDA’s mandate to standardise and revitalise PHCs is directly linked to saving mothers’ lives.”
He explained that initiatives supporting midwife deployment, emergency referral systems and community sensitisation have shown measurable impact in states that align closely with national primary healthcare policies. In such areas, more women attend antenatal clinics, deliver with skilled attendants and seek postnatal care.
However, Prof. Alabi cautioned that progress remains vulnerable. “Without addressing staff shortages, inconsistent electricity supply and the availability of essential drugs, maternal health gains will be difficult to sustain,” he said.
For many women, a functional PHC can mean the difference between life and death. For the NPHCDA, maternal health remains both a moral obligation and a test of systemic effectiveness.
Immunisation: prevention at scale
Routine immunisation is perhaps the most visible expression of the NPHCDA’s work—and one of the most cost-effective public health interventions available. In 2025, experts say the agency’s coordination role is central to preventing outbreaks of measles, diphtheria, polio and other vaccine-preventable diseases.
Working with state governments, development partners and community leaders, the NPHCDA oversees vaccine procurement, cold chain management, health worker training and social mobilisation nationwide.
“Immunisation performance is a strong indicator of how well primary healthcare systems are functioning,” said epidemiologist Dr. Sadi Mohammed. “Where coverage is high, it means outreach systems are working, data is being used effectively, and communities trust the health system. NPHCDA’s leadership in this area is critical, especially in 2025 when misinformation remains a challenge.”
He pointed to targeted campaigns in underserved areas and improved routine immunisation services as drivers of better coverage in several high-risk states. Still, the persistence of “zero-dose” children—those who have never received a single vaccine—highlights enduring access and trust gaps.
Experts argue that strengthening PHCs is essential to closing these gaps, as immunisation thrives where facilities are accessible, trusted and adequately staffed.
A verdict in 2025—and targets for 2026
As Nigeria takes stock of its primary healthcare landscape, health experts broadly agree that the NPHCDA sits at the heart of the country’s quest for universal health coverage. In 2025, progress in facility revitalisation, service integration and disease prevention is evident—but insufficient to meet the scale of need.
Looking ahead to 2026, analysts identify clear targets if access to PHCs is to improve meaningfully. These include ensuring that every ward has at least one fully functional PHC, expanding the health workforce through sustained recruitment and retention, guaranteeing reliable electricity and water supply, and strengthening referral networks between primary, secondary and tertiary care.
Crucially, experts emphasise the need for stronger state-level ownership, increased domestic financing and transparent accountability mechanisms. Without these, gains risk remaining project-based rather than systemic.
Investing in primary healthcare, analysts argue, is not merely a health policy choice. It is a national development strategy—one that shapes productivity, educational outcomes and social stability.
For Nigeria, the frontline of survival runs through its primary healthcare centres. And as 2026 approaches, the question is no longer whether the country can afford to strengthen them—but whether it can afford not to.
About the Author
Oluwafunbi Bello 
Mirian Gom