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Probatio Africa

Health systems

Are health gains reaching the poorest households, or only improving the average?

Independent research for governments, development partners and health programmes in Nigeria, on how health systems are financed, staffed, supplied and governed, and whether reforms are reaching the people they are meant to serve. We draw on evidence from across Africa.

What the evidence says

Every figure carries its source, its date and a label for how much weight it can bear.

Official statistic2022

About 76%

of health spending in Nigeria was paid by households out of pocket in 2022. Across 192 countries, the average was about 30%.

WHO Global Health Expenditure Database, via the World Bank

How we know this

Out-of-pocket payments as a share of health spending, compiled from national health accounts. The 30% comparison is the simple average across countries, not weighted by population.

Survey estimatePublished 2024

16.2%

of public primary health care facilities met the minimum standard for laboratory equipment. Clinical equipment scored highest (76.4%), and the median for essential medicines was 43.8%.

Sampson et al., Health Research Policy and Systems, 2024

How we know this

An assessment of 25,736 public primary health care facilities against Nigeria’s minimum standards, covering infrastructure, staffing, equipment, essential medicines and services. Median overall compliance was 40.7%.

Survey estimate2023–24

110

deaths of children under five per 1,000 live births, down from 132 in 2018. Skilled attendance at birth rose from 43% to 46%. Both remain well short of global targets.

Nigeria Demographic and Health Survey 2023–24

How we know this

From the national household survey whose final report was launched in October 2025. The same survey shows total fertility falling from 5.3 to 4.8 children per woman since 2018. An earlier preprint reported 102 deaths and 52% skilled attendance; this page uses the official report.

Official statistic2025

4.3%

of the final approved 2025 federal budget went to health: ₦2.38 trillion of ₦54.9 trillion. The budget proposal had put it at 5.18%. The African Union’s Abuja target is 15%.

2025 federal budget, analysed by Dataphyte

How we know this

A budget allocation, not money released or spent. Whether budgeted funds reach facilities is one of the questions governments ask.

Official statistic2025

60,551

doctors were licensed to practise, out of 95,456 registered: about 63%. Yobe, Kebbi, Zamfara and Jigawa have 0.5 doctors per 10,000 people.

Federal Ministry of Health and Social Welfare, State of Health of the Nation report, 2025

How we know this

The gap between registered, licensed and working staff is one of the questions governments ask about the workforce.

What we don't know

Questions our review of published sources found were not yet well answered.

Non-communicable disease burden

Little evidence yet

Only three longitudinal cohorts exist in Nigeria, rural northern data are sparse, and incidence data are almost absent.

The effect of insurance expansion

Asked widely

Enrolment figures cannot show whether insured Nigerians use more care, whether household costs have fallen, or which groups are being left behind.

The scale of substandard and falsified medicines

Asked widely

Estimates from national agencies differ widely, from 13–15% to about 70%.

Independent verification of reform progress

Asked widely

The Federal Ministry reports that 37 of 41 sector indicators under the Presidential Bond had been achieved by the third quarter of 2025. Independent verification would strengthen confidence in results reported by implementing institutions.

Brief a study on one of these

How we can help

The research services most often used on questions in this sector. Each service page sets out the methods, the standards we follow and typical timelines.

Surveys and measurement

We count and measure. Surveys of households, facilities, schools and providers tell you how many people are affected, where they are, and how far a service reaches them.

See the service

Evaluation

We test whether something worked. An evaluation asks whether people are better off than they would have been without the programme, who gained most, and what it cost.

See the service

Economics and financing

We follow the money and cost the options. Budget analysis and costing show what something takes to run at scale, who benefits, and what happens when outside funding ends.

See the service

Data systems and M&E

We help you trust your own data. We assess the data you already collect, design what you should measure, and train your teams to use it.

See the service

Policy and systems analysis

We look at why a sound policy isn’t working. We map who decides, who has to act, and where things stall between federal, state and local levels.

See the service

Have a health systems question the evidence should answer?

Tell us the decision it will inform. We will say whether the evidence can answer it and, if not, who is better placed to.

Brief a study