Five years after COVID-19, Nigeria’s health system remains critically fragile — Report

A new SBM Intelligence report has revealed that Nigeria remains ill-prepared for a major health crisis, five years after the COVID-19 pandemic, with no state scoring even 30 per cent on preparedness.

Titled “The SBM Health Preparedness Index 2025”, the report assessed the capacity of all 36 states to respond to health emergencies.

Abia State ranked highest with 26.85 points, while Katsina (12.54), Kebbi (13.31), and Ebonyi (12.85) were among the lowest.

The study highlights persistent systemic weaknesses first exposed during COVID-19, including limited hospital infrastructure, inadequate testing capacity, and a shortage of critical health workers and supplies.

Nigeria’s healthcare workforce remains overstretched, averaging 15,361 patients per doctor nationwide, far below the WHO benchmark of 1 doctor per 1,000 people.

Southern states like Enugu, Edo, and Lagos have fewer than 3,200 patients per doctor, while northern states such as Bauchi and Zamfara face over 43,000 patients per doctor.

SBM Intelligence attributes this imbalance to the ongoing “Japa Syndrome”, which has driven thousands of Nigerian health professionals abroad.

The report warns that the workforce shortage is fueling long hospital queues, overworked doctors, and preventable deaths, particularly in rural areas. Budget performance across states is inconsistent.

While Lagos leads with N221 billion allocated to health, Akwa Ibom (4.3%) and Imo (3.5%) spend among the least of their total budgets.

Per capita spending shows Abia (N22,926) and Ogun (N21,051) as top performers, while Adamawa and Imo allocate under N4,500 per resident.

SBM Intelligence notes that political will, more than resources, drives health outcomes.

Southern states dominate the top half of preparedness rankings due to better investment and access to medical professionals.

However, for the first time, a southern state, Ebonyi, fell into the bottom five, showing fragility is no longer confined to the North.

Northern states continue to face poor infrastructure, high infant mortality, and large household sizes, with disparities expected to widen without targeted investment.

The report urges urgent reforms, including improving working conditions for health professionals to halt the ongoing brain drain, increasing transparency and equity in health budgeting, and establishing a national framework to redistribute medical personnel and resources across states.

SBM Intelligence warns that without immediate action, Nigeria risks facing the next health crisis in the same vulnerable state it was during COVID-19.

SBM Intelligence is an Africa-focused research and strategic communications firm, providing political, social, economic, and market data across multiple countries, including Nigeria, Ghana, Kenya, South Africa, and the UK.