Nigeria’s Uneven Healthcare Progress: A Geopolitical Commentary on Findings from the Nigeria Demographic and Health Survey
Introduction The Nigeria Demographic and Health Survey (NDHS) remains the most authoritative data source on health and demographic trends in the country. Its latest findings highlight both progress and persistent inequities in healthcare access and outcomes. While national averages show modest improvements in maternal care, childhood nutrition, and immunization coverage, a geopolitical breakdown reveals sharp disparities between the northern and southern regions. These inequities are not only statistical curiosities, they reflect structural differences in health infrastructure, literacy, poverty, cultural practices, and governance. Image 1 This commentary explores Nigeria’s health system performance across the six geopolitical zones, highlighting progress made, areas lagging behind, and policy priorities for achieving universal health coverage (UHC). Maternal and Child Health Maternal healthcare utilization remains one of the starkest divides. Nationally, just over 60% of women receive antenatal care from skilled providers, but the South East and South West report coverage above 80%, compared to less than 50% in the North West and North East. Similarly, while more than two-thirds of women in the South deliver in health facilities, fewer than one in three do so in the northern zones. This gap contributes directly to higher maternal and neonatal mortality in the North. Image 2 Postnatal care follows the same trend, southern zones record significantly higher uptake than northern ones, where many women never return to health facilities after delivery. These disparities are strongly associated with differences in literacy rates, cultural norms around childbirth, and access to functional primary health centers (PHCs). Child mortality rates mirror maternal care disparities. Nationally, one in nine children dies before age five, but the North East and North West account for the bulk of these deaths. Southern zones, especially the South West, report considerably lower child mortality, reflecting better immunization coverage, access to care, and nutrition outcomes. Childhood Vaccination Vaccination remains one of the most unequal indicators across Nigeria. National coverage for full immunization among children 12–23 months stands at 39%. However: South East: Around 60–65% of children fully immunized. South West: Approximately 55%. North West: Less than 20%. North East: Around 25%. Image 3 Worse, the North West and North East also report the highest proportions of children with zero vaccinations, perpetuating cycles of preventable diseases. These figures underscore the failure of routine immunization programs in conflict-affected and underserved northern states. Nutrition and Childhood Illness Child nutrition shows modest national improvement, with stunting falling slightly to 37%. Yet, malnutrition remains a predominantly northern problem: North East: Stunting >45%, wasting >10%. North West: Stunting >40%, underweight rates remain among the highest nationally. South East & South West: Stunting <25%, wasting <5%. Image 4 This disparity is tied to food insecurity, conflict-driven displacement in the North, and weak integration of nutrition into primary healthcare services. When children fall ill, the probability of receiving appropriate care also varies by zone. Children in the South are more likely to receive oral rehydration salts (ORS) for diarrhea or ACTs for malaria compared to their northern counterparts. In many northern communities, reliance on patent medicine vendors (chemists) remains high, raising concerns about inappropriate treatment. Malaria Prevention and Treatment Malaria prevention is another area of uneven progress. Despite mass distribution campaigns, fewer than half of children under five and pregnant women nationally slept under an insecticide-treated net (ITN) the night before the survey. Regional disparities are evident: North Central and South South: ITN usage lowest. North East and North West: Higher ownership of nets but poor utilization, partly due to cultural practices and heat discomfort. Image 5 Treatment disparities persist. While more than 60% of febrile children in the South received ACTs, the rate falls below 50% in the North, where stockouts and distance to facilities are common. HIV and Chronic Disease Services HIV testing remains worryingly low, with more than 60% of women and nearly 70% of men never tested. The South East and South West record higher testing rates compared to the North West and North East, where stigma, weak health infrastructure, and lower health literacy undermine uptake. Chronic disease care tells a similar story. Few Nigerians have ever had their blood pressure or blood sugar checked, and among those diagnosed, medication adherence is poor. Yet again, southern zones report higher screening and treatment adherence compared to the northern zones, reflecting both greater facility availability and higher literacy levels. Cross-Cutting Determinants of Regional Disparities The north-south divide in health outcomes is shaped by several cross-cutting factors: Education: Literacy among women is above 70% in the South but below 40% in rural northern zones. Education strongly predicts maternal care utilization and child vaccination. Poverty: The North accounts for most of Nigeria’s poor, limiting affordability of healthcare. Security: Armed conflict and insurgency in the North East disrupts service delivery. Cultural practices: Strong reliance on traditional medicine and home births in the North slows adoption of facility-based care. Health system distribution: Health facilities and skilled personnel are disproportionately concentrated in urban and southern areas. Image 6 Conclusion: Bridging the Regional Divide The NDHS data make it clear: Nigeria is making progress, but it is progress divided. The South East and South West are advancing in maternal care, vaccination, and chronic disease management, while the North West and North East remain trapped in cycles of high mortality, malnutrition, and poor service utilization. Closing this gap requires a deliberate strategy: Invest in PHCs in the North with infrastructure, personnel, and commodities. Expand financial protection through the NHIA, targeting rural and poor households. Prioritize female education and health literacy as long-term levers of change. Strengthen immunization and malaria programs with culturally sensitive community engagement. Address conflict and insecurity, which remains a major barrier in the North East. Nigeria cannot achieve universal health coverage or meet SDG health targets without tackling these regional inequities head-on. Progress is real, but unless it is inclusive, national averages will continue to mask the fact that millions particularly in the North are still left behind.
