Overcoming the Challenges to Primary Healthcare and Universal Health Coverage in Nigeria: The Pivotal Role of the Family Physician

Abstract

Background
Nigeria, the most populous country in Africa and the leading nation in sub-Saharan Africa, is facing a severe healthcare crisis. Its life expectancy of 62.2 years and other worsening health indicators, such as a maternal mortality rate of 814 maternal deaths per 100,000 live births, highlight a weakened health system. Although Family Physicians are the largest group of physicians in developed countries and have transformed primary healthcare, their role and involvement in Nigeria's health system are not yet fully realised. This review examines the main barriers to effective primary healthcare (PHC) and universal health coverage (UHC), and the role Family Physicians could play in achieving a strengthened PHC system.

Methodology
We conducted a systematic review of the literature across multiple electronic databases, including AJOL, PubMed, Scopus, and ResearchGate. The findings from the literature review were compiled into a comprehensive report, designed to provide clear and actionable insights.

Result
The main cause of PHC failure in Nigeria is the shortage of healthcare professionals, especially doctors, to provide necessary care, further worsened by the emigration of professionals seeking better pay and opportunities. Other significant challenges include chronic underfunding, with health expenditure consistently below the 15% target set by the Abuja Declaration, and out-of-pocket expenses making up to 70% of health costs. Infrastructure gaps are extensive, as only about 20% of PHC facilities are fully operational, further strained by critical shortages of water, sanitation, and reliable electricity. A lack of policy direction, poor coordination and implementation among the three tiers of government, insurgency, and banditry in some areas are key factors limiting access.

Conclusion
Nigeria's progress towards establishing robust PHC and UHC faces a complex journey that requires expanding the insurance scheme to enrol all Nigerians. Increased budgetary allocation to develop and maintain infrastructure, alongside competitive salaries and allowances, will motivate staff and enhance the quality of services. Aligning donor agencies' vertical programmes and reporting systems with the National Health Plan and a unified electronic record system (EMR) will produce better results. Investing in the training and deployment of Family Physicians to lead the PHC team will significantly improve primary healthcare and ultimately help the country achieve UHC.