The Federal Government has called for an overhaul of general hospitals across the states to close gaps in Nigeria’s healthcare system and reduce the pressure on tertiary health facilities.
The Director, Reproductive Health Division, Federal Ministry of Health and Social Welfare, Dr Samuel Oyeniyi, made the call on Thursday at a special webinar, organised by the Doctors Medical Aid Foundation (DMAF), with the theme, “Nigeria’s Health Workforce at a Crossroads: Rethinking How We Deliver Care.”
Oyeniyi identified weak state-level general hospitals as a major gap in the country’s healthcare delivery system, noting that many patients bypass secondary healthcare facilities and travel long distances to tertiary hospitals in state capitals.
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He said the situation had placed additional pressure on tertiary facilities, with some patients travelling between 120 and 300 kilometres in search of care that could have been provided at general hospitals closer to their communities.
According to him, state governments must take greater responsibility for strengthening general hospitals, particularly in areas of infrastructure, staffing, equipment and service delivery.
“We have a challenge with our general hospitals in the states. That is one area where we need to look at what we can do differently because people bypass these hospitals and go straight to the tertiary centres,” he said.
Oyeniyi said the Federal Government was considering ways of supporting the strengthening of secondary healthcare, while also engaging state governments and relevant stakeholders to address the gaps.
He said the issue had been raised in a memorandum to the National Council on Health, stressing that improving healthcare delivery required a holistic approach to workforce planning, infrastructure, commodities, coordination and partnerships.
The director also disclosed that the government was expanding the health workforce through the recruitment of 4,000 nurses and midwives under the National Primary Health Care Development Agency and Basic Health Care Provision Fund arrangements, particularly for facilities with significant workforce gaps and high disease burden.
He added that the government was expanding medical training capacity, with universities increasing admission capacity, while infrastructure was being supported through the Tertiary Education Trust Fund.
Oyeniyi said simulation and training centres were also being developed in Kano and Ekiti to strengthen practical training for health workers.
He further disclosed that the government was reviewing its task-shifting and task-sharing policy in collaboration with professional bodies, including the Society of Gynaecology and Obstetrics of Nigeria, the National Association of Nigeria Nurses and Midwives, community health workers and local government authorities.
On the role of private healthcare providers, Oyeniyi said private facilities remained an important component of the health system but noted that their regulation largely fell under state governments, while the Federal Government provided policy direction and oversight.
Also speaking, a health systems and financing expert, Dapo Odulana, said addressing Nigeria’s health workforce challenges required looking beyond the number of health workers to the broader health system.
Odulana identified medicines and human resources as two critical inputs in healthcare delivery, warning that innovations such as task shifting would have limited impact where health workers lacked adequate infrastructure, medicines and other essential commodities.
He called for greater investment across the health workforce value chain, covering production, deployment, welfare and retention, while urging stronger engagement with the private sector.
The Health Systems Strengthening Expert at the Clinton Health Access Initiative, Ruth Adetokunbo, identified four critical areas requiring attention: production, absorption, deployment and retention of health workers.
Adetokunbo said workforce distribution remained heavily skewed towards urban areas, citing an assessment which found that fewer than four per cent of doctors were practising in rural areas, with similar patterns observed among pharmacists and laboratory scientists.
She also raised concerns about the capacity of training institutions, noting that more than 80 per cent of qualified nursing candidates were being directed to other courses because of limited training capacity.
Adetokunbo said efforts to address health workforce shortages must therefore go beyond recruitment to include equitable deployment, retention and provision of the equipment and infrastructure required for health workers to function effectively.
The Head of Training, Primary Healthcare Division, NPHCDA, Dr Gilbert Uwadia, said a functional primary healthcare system required not only the right number and mix of health workers but also adequate infrastructure, medicines and essential commodities.
He said the minimum workforce team for a functional primary healthcare facility should comprise four to five appropriately skilled frontline workers, adding that the agency had revitalised 3,504 primary healthcare centres since 2023.
Uwadia said the agency was also providing job aids and standard operating procedures to improve service delivery, while introducing incentives aimed at encouraging health workers to serve in rural areas.
He listed rural allowances, flexible duty rosters, accommodation, solarisation and other non-financial incentives among measures being used to improve rural deployment and retention.
He stressed that task shifting must be properly supervised and supported with essential commodities, clear referral pathways and appropriate regulation.
Chairman, Board of Trustees, DMAF, Prof Bala Audu, said the webinar provided an opportunity for stakeholders to examine the interconnected challenges of training, deployment and retention of health workers.
Audu said the foundation would sustain conversations around health workforce development and support efforts aimed at improving the country’s healthcare system.
In its closing remarks, DMAF said Nigeria’s health workforce challenge could not be resolved through numbers alone, stressing the need for equitable distribution, retention, conducive working environments and deliberate utilisation of available skills.
The foundation also cautioned that task shifting should complement, rather than substitute, investment in health workforce development and must be based on competence, clear roles, collaboration, supervision, referral systems, regulation and accountability.
The Country Director, Doctors Medical Aid, Dr Hameed Adediran, said an earlier poll among participants showed that 66 per cent identified poor remuneration as the biggest health workforce challenge.
Adediran said 23 per cent cited poor working conditions, while 21 per cent identified inadequate workforce numbers.
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