Nigeria fails health readiness test for second year as no state scores 30%

Five years after the COVID-19 pandemic exposed the weaknesses in Nigeria’s healthcare system, the country remains alarmingly unready for another health emergency.

According to the 2025 Health Preparedness Index (HPI) by the risk consultancy SBM Intelligence, not a single state in Nigeria reached 30% readiness – for the second year in a row. The independent report, which measures how well states can respond to disease outbreaks and other health shocks, paints a grim picture of systemic decay and neglect.

Abia State ranked highest with a modest 26.85 points, while Katsina (12.54), Kebbi (13.31), and Ebonyi (12.85) sat at the bottom. The results show that vulnerability cuts across regions, making health fragility a national, not merely a local, problem.

“This finding is a stark metric of Nigeria’s overall vulnerability,” the report said. “The country’s healthcare system faces an extreme deficit in basic capacity, reflecting years of neglect and underinvestment.”

The human cost is staggering. Nigeria now has an average of 15,361 patients per doctor, far below the World Health Organization’s standard. States like Bauchi and Zamfara have over 43,000 people per doctor, compared to fewer than 3,200 in Lagos, Edo, and Enugu.

That imbalance has been worsened by the “Japa Syndrome” – the mass migration of doctors and nurses seeking better pay and safety abroad. Hospitals across the country remain overburdened, with long queues, inadequate facilities, and rising preventable deaths.

Budgeting trends reveal the same contradictions. While Lagos leads nominally with ₦221 billion, Bauchi, Kaduna, and Kano devote more than 15% of their budgets to health, showing stronger commitment than wealthier southern states. By contrast, Akwa Ibom (4.3%) and Imo (3.5%) spend the least, proof that political will, not money, drives health outcomes.

Per capita spending tells a similar story. Abia (₦22,926) and Ogun (₦21,051) spend relatively more on citizens’ health, while Adamawa and Imo spend less than ₦4,500 per person.

Regional differences remain stark: southern states dominate the top ranks, but for the first time, Ebonyi joined the bottom five – evidence, analysts say, that the crisis is spreading southward.

“Without sustained and equitable investment in health,” the report warns, “Nigeria’s preparedness for future crises will remain critically low.”

The 2025 HPI scores were based on six indicators: doctor-to-population ratio (30%), infant and child mortality rate (25%), Human Development Index (20%), per capita health budget (10%), share of health in total state budget (10%), and average household size (5%).

The index is expected to pressure governments into closing the preparedness gap that COVID-19 laid bare.

Policy experts say the fix is straightforward but politically difficult: stem the brain drain, reform health infrastructure, increase transparency in spending, and rebalance medical resources across states.