Nigeria’s public health system: A narrative review of key indicators, systemic challenges, and community-based solutions

Background: Nigeria's rapidly growing and diverse population requires a resilient public health system capable of delivering equitable, high-quality healthcare. This review synthesized evidence on the current state of Nigeria's public health system and explored community-based initiatives as potential solutions to strengthen service delivery. Methods: We conducted a comprehensive search of bibliographic databases and grey literature sources. Studies published between 2000 and 2025 reporting on the status of Nigeria’s public health system, health indicators, systemic challenges, and community-based solutions were included. Results: Findings identified persistent system-level challenges, including a high burden of communicable diseases, recurrent epidemics, and a rising prevalence of non-communicable diseases. Maternal and child health outcomes remain suboptimal: only 43% of live births occur in health facilities, and 63% of women receive antenatal care from skilled providers. Mortality rates remain high, with under-five, infant, and neonatal deaths at 110, 63, and 41 per 1,000 live births. Child nutrition is suboptimal, with 40% of children under five stunted, 27% underweight, 8% wasted, and 1% overweight. These outcomes are linked to high out-of-pocket expenditures, health-worker shortages, inequitable infrastructure, inadequate policies, and limited public awareness. Evidence highlights community-based initiatives, including community needs assessments, community engagement, community-based health insurance (CBHI), and the local recruitment and training of health workers, as viable approaches to improve access, utilisation, and system performance. Conclusion: Strengthening and evaluating the feasibility and impact of diverse community-based health models may improve utilisation, equity, quality, and accountability within Nigeria’s public health system.