Nigeria ranks 14th of 18 countries with poor health system; trails Rwanda, as South Africa tops

by Amref Health Africa

By Chioma Obinna

Despite spirited attempts to improve the fortunes of the healthcare sector, Nigeria has been ranked among countries with the worst health system services in Africa.

In a first-of-its-kind Health System Sustainability index report released on Tuesday, Nigeria ranked 14th with a total of 41 scores out of 18 African countries, with South Africa ranking first with 63 scores.

Tunisia came second with 58, followed behind with Morocco 55 while the Democratic Republic of Congo came last with 33 scores.

The Africa Sustainability Index launched by the FutureProofing Healthcare initiative at the 2021 Africa Health Agenda International Conference, AHAIC, also revealed that Nigeria ranked last in maternal mortality, infant vaccination, and in neonatal mortality.

The country also came 17th on births attended by skilled health staff and access to effective treatment for tuberculosis.  However, the country ranked first in laboratory quality.

The Index report designed to enable data-driven decision making for health and revealed correlations between economic strength and health system sustainability showed that countries with good access to services do not always have similar scores for the quality of the health services provided.

This suggests holistic policies that prioritise access and quality are needed to meaningfully impact Universal Health Coverage, UHC, goals.

Specifically, the report notes that like Angola, Nigeria performed well in responding to emerging health threats, leading the continent in its COVID-19 response stringency and also in testing cases of tuberculosis for multiple drug resistance.

“Nigerians are also the most likely in Africa to describe accessing medical services as ‘easy’, which reflects a few barriers to treatment.

“Despite this, there is considerable room for improvement with respect to the health status of the Nigerian population; mortality rates from communicable diseases including water-borne illness and diarrhoea disease are high, and there is a high incidence of viral hepatitis and malaria.

The report recommended that health outcomes could also be improved by prioritising neonatal care, as Nigeria faces low rates of infant vaccination and high rates of maternal and neonatal mortality.

It also noted that there were considerable deficits in the availability of healthcare personnel combined with allied factors such as poor access to clean water, political instability and adult gender literacy gaps which accentuate the problems in the ecosystem.

Reacting to the report, the Chief Executive Officer of  Amref and Africa Sustainability Index panellist,  Githinji  Gitahi, said: “Sustainable healthcare is a key element on the journey towards UHC and will impact millions of lives in Africa.

“The Sustainability Index is a useful tool in guiding stakeholders in the healthcare ecosystem on where to focus efforts, make improvements and identify best practices from other countries.

“On behalf of my fellow panel members, it is our intention that this tool will spark a conversation about actions that are needed today to create more resilient, sustainable health systems in the future.”

The findings of the Africa Sustainability Index indicated that economic strength and political stability are key drivers behind overall performance in healthcare sustainability, with most of the countries that performed well in the Financing Vital Sign also doing well in the Index overall.

These countries include South Africa, Rwanda, Algeria and Ghana. The Index also reveals that all countries analysed have numerous areas of opportunity for improvement.

There are strong variations throughout the continent related to the Access and Quality Vital Signs, suggesting that targeted policies in these areas will make an impact in achieving UHC goals.

Supported by Roche, experts from organisations including Amref, the World Bank, United Nations Development Programme /(UNDP), the African Society for Laboratory Medicine and the Africa Centres for Disease Control and Prevention collaborated to develop the FutureProofing Healthcare Africa Sustainability Index.

Article first published on

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