Nigeria’s Healthcare Gaps Are Pushing Startups and Informal Providers Into Bigger Roles

Getting medical help in Nigeria can depend heavily on where a person lives, how much money they have and whether they know how to navigate a healthcare system spread across public hospitals, private facilities, pharmacies, medicine vendors and informal providers.
For emergencies, one of the biggest problems is not always the complete absence of ambulances or hospitals.
Sometimes, the resources exist but are not connected well enough to move a patient quickly from the place where an emergency happens to the facility capable of treating them.
That coordination problem is one of the gaps Nigerian health-technology companies are attempting to address.
Medwaka started with a different problem
Healthtech startup Medwaka originally focused on helping pregnant women obtain blood during medical emergencies.
Its founders began working around blood donation shortages in Ondo State but repeatedly encountered another problem: even when care was available, patients could struggle to reach it quickly.
The company eventually changed direction.
Instead of focusing mainly on blood donation, Medwaka began building an emergency-response platform connecting patients with hospitals, ambulances and first responders.
The service launched its first prototype and pilot in Ondo State in 2024.
The idea is relatively simple: rather than building every ambulance or hospital itself, Medwaka tries to coordinate resources that already exist.
That reflects a larger trend in Nigeria’s healthtech industry.
Many startups are not trying to replace hospitals.
They are building technology around weak connections between different parts of the existing health system.
Primary healthcare remains under pressure
The problems go much deeper than emergency transportation.
Nigeria has more than 30,000 primary healthcare facilities, but the Federal Ministry of Health has acknowledged that many are still not functioning at the level required to provide reliable basic care.
The ministry said its 2023 assessment found the country's primary health centres were still not optimally functional.
Staffing is another challenge.
Government figures presented in 2025 put Nigeria’s doctor-to-population ratio at approximately one doctor for every 5,000 people.
The distribution is also uneven.
According to the ministry, about 75% of health workers were concentrated in urban areas serving roughly 45% of the population.
That means having health workers nationally does not necessarily mean patients in every community can reach one.
Rural communities and poorer urban neighbourhoods can face significantly different healthcare options from people living close to major hospitals in cities.
Nigerians still pay heavily from their own pockets
Financing creates another major barrier.
WHO reported that household out-of-pocket payments accounted for around 72% of Nigeria’s current health expenditure in 2023.
In practical terms, that means patients and their families frequently pay directly when they need healthcare instead of having most of the cost covered through pooled government financing or health insurance.
This can affect when people seek treatment.
A family that knows a hospital visit will require an immediate cash payment may delay going to a facility until an illness becomes more serious.
For poorer households, a major medical emergency can also compete directly with spending on food, rent, school fees and other necessities.
WHO describes high out-of-pocket spending as one of the major obstacles to universal health coverage because it can cause people to delay care or suffer financial hardship after receiving treatment.
Health insurance is expanding, but coverage remains a challenge
Nigeria has been trying to reduce this burden through the National Health Insurance Authority, state health-insurance schemes and programmes supported by the Basic Health Care Provision Fund.
The NHIA Act signed in 2022 replaced the previous National Health Insurance Scheme framework and made health-insurance participation a central part of the country's universal-health-coverage strategy.
Every state now has a State Social Health Insurance Agency, although the programmes, benefits and levels of implementation vary.
The Federal Government and NHIA have also expanded targeted programmes for vulnerable patients.
In September 2026, the NHIA reported that more than 93,000 women and newborns had been reached through programmes providing emergency obstetric, newborn and fistula care, while more than 40,000 women had been enrolled through the Basic Health Care Provision Fund.
Those initiatives show that public-sector reforms are continuing.
But the scale of Nigeria's population means expanding financial protection to everyone remains a much larger challenge.
When formal healthcare is difficult to reach, people find alternatives
One result is the large role played by informal and semi-formal healthcare providers.
Across Nigeria, many patients first seek help from Patent and Proprietary Medicine Vendors, commonly known as PPMVs.
These shops are often easier to reach than hospitals and may offer medicines without the long waits or higher costs associated with formal facilities.
The 2024 Nigeria Demographic and Health Survey showed how important they have become.
Among children under five who had a fever and received medication, 66% obtained that medicine from a pharmacy or patent medicine vendor, compared with 21% from a health facility.
This does not mean those providers can replace trained doctors or hospitals.
PPMVs are legally limited in the medicines they are permitted to sell, and research has repeatedly raised concerns about differences in training and quality of care.
But they remain an important part of the reality of how Nigerians obtain treatment.
Recent research in informal settlements in Anambra and Enugu found strong support among both patients and informal providers for connecting them more formally with the wider health system through training, supervision and proper referral arrangements. Oxford Academic
The referral problem matters
A healthcare system works best when a patient can move from one level of care to another.
Someone with a minor illness might begin at a local primary health centre.
A more complicated condition could then be referred to a general or specialist hospital.
But research in Nigerian urban settlements suggests those links can be weak.
A 2025 study involving more than 1,000 people in informal communities in Enugu and Anambra found that only 7.4% of patients received a referral from their original healthcare provider.
Most referrals were verbal rather than supported by a more structured system.
This becomes particularly serious during emergencies, when delays can mean the difference between successful treatment and a much worse outcome. Frontiers
Startups are increasingly building the connections
That is where companies such as Medwaka see an opportunity.
Instead of building another hospital, technology can potentially help answer basic but important questions:
Which nearby hospital can handle this emergency?
Is an ambulance available?
How quickly can it reach the patient?
Does the receiving hospital know the patient is coming?
Can the patient be transferred to a specialist facility if necessary?
A functioning emergency system should answer those questions quickly.
Digital platforms can help connect the organisations already responsible for different parts of the process.
Similar models are appearing elsewhere in healthtech.
Some startups focus on telemedicine.
Others manage electronic medical records, medicine delivery, diagnostics, health insurance or payments.
The common theme is that technology is being used to connect parts of healthcare that traditionally operate separately.
Technology cannot solve everything
There are limits to what startups can do.
An app cannot replace a missing doctor.
Software cannot create hospital beds that do not exist.
A dispatch platform cannot send an ambulance that is unavailable or unable to reach a patient because of poor roads.
And digital insurance cannot provide high-quality treatment if the facility itself lacks medicines, equipment or trained staff.
That means healthtech can help address coordination and access problems, but it cannot substitute for sustained investment in the underlying healthcare system.
Nigeria's health challenges involve financing, infrastructure, staffing, regulation, procurement, transportation and governance as well as technology.
Health workers remain one of the biggest constraints
The shortage and distribution of healthcare workers remains particularly difficult.
Nigeria has trained large numbers of doctors, nurses and other health professionals, but migration has reduced the number available locally.
The Federal Ministry of Health says more than 37,000 additional health workers were employed between 2023 and 2025, with over three-quarters in clinical roles.
Government has also introduced a national health-workforce migration policy and expanded training quotas.
At the same time, officials acknowledge that migration and unequal distribution continue to affect staffing.
This creates another important distinction.
Nigeria can increase the total number of health professionals while still having individual communities where patients struggle to find one.
Donors remain important — but households carry the largest direct burden
International organisations and development partners also play an important role in Nigerian healthcare.
Donor financing supports programmes covering areas such as malaria, HIV, tuberculosis, maternal health, vaccination and disease surveillance.
But describing donor organisations as funding most of Nigeria's entire healthcare system would be misleading.
WHO data show that the much larger structural problem is the high share paid directly by Nigerian households.
That means any long-term attempt to improve access will also have to reduce the amount families are expected to pay themselves at the moment they become sick.
Government reforms are trying to change the structure
Nigeria’s current health reforms include efforts to strengthen primary healthcare, expand insurance and improve coordination between federal, state and local health institutions.
The government’s Health Sector Renewal Investment Initiative is intended to improve healthcare infrastructure, expand the workforce and strengthen financial protection.
The NHIA is also developing better health-financing data systems.
On September 30, it launched the Nigeria Health Financing Observatory, intended to bring together information from government agencies, WHO, the World Bank and private organisations so that policymakers can better track where health money goes and what outcomes it produces.
Whether these reforms substantially improve access will depend on implementation across thousands of facilities and dozens of state health systems.
The people filling the gaps are already part of the system
Nigeria’s healthcare reality therefore cannot be divided neatly into public and private care.
A patient may begin with a neighbourhood medicine vendor, speak to a doctor through a digital platform, take a privately operated ambulance to a public hospital and pay partly through insurance while purchasing some medicines out of pocket.
All of those pieces can be involved in a single treatment journey.
The challenge is getting them to work together safely.
Startups can build useful technology.
Informal providers can offer proximity to underserved communities.
Private hospitals can provide additional capacity.
Donors can finance important programmes.
And families will continue finding ways to get relatives to treatment when formal arrangements fail.
But none of those actors can individually provide a national health system.
The longer-term question for Nigeria is therefore not simply who fills the gaps.
It is whether the gaps can become smaller in the first place — and whether the different public, private and community providers already delivering care can be connected into a system that patients can depend on regardless of their location or income.