Nigeria’s health system may be facing its biggest constraint not in policy but in the ability to sustain investment, infrastructure and manpower, as the Federal Government said it had doubled the annual intake of medical students from about 5,000 to 10,800.

Coordinating Minister of Health and Social Welfare, Prof. Muhammad Pate made the disclosure in Abuja, while outlining some of the Federal Government’s interventions in the health sector.

He said the government was also expanding emergency care, infrastructure and ambulance services, while working with states and local governments to close critical gaps in healthcare delivery.

Pate’s disclosure came as civil society organisations in the sector warned that Nigeria’s ongoing health reforms would amount to little unless they produced lasting improvements in health outcomes and made the health system resilient enough to withstand future shocks.

Speaking at a mid-year review of the health-sector reforms organised by the Health Sector Reform Coalition (HSRC), the minister said the Federal Government was deliberately prioritising investments on the supply side of the health system while giving states greater resources to address demand-side gaps.

He said: “We had no illusions that it was going to be easy or that all the problems will go and disappear within a year or two or three or four.

“We are committed to start building the current system that Nigerians deserve and we respected Nigerian people’s voices. You cannot have health care system that you want when you are not spending the money.”

He pointed to the expansion of emergency care for women as one of the interventions, saying it had reached almost 60,000 women in two years and helped remove financial barriers to emergency caesarean sections.

According to him, the government had approved new ambulances to strengthen emergency response, while efforts were ongoing to improve the health workforce.

On medical education, Pate said the increase from about 5,000 to 10,800 medical-student intakes annually was part of a broader attempt to address Nigeria’s manpower shortage.

He also pointed to increased training capacity at state level, saying the expansion was possible because resources were being made available to states to invest in the infrastructure required to train more health professionals.

Co-convener of the Nigeria Universal Health Coverage (UHC) Forum, Moji Makanjuola, said the focus should shift from counting programmes and activities to determining whether reforms were actually changing the health system.

Makanjuola urged the media to go beyond reporting policy announcements and track whether reforms were improving financing, service delivery, equity and access across the country.

She said: “Importantly, this midterm review should move beyond asking whether reforms are producing activities and any results to asking whether the system is becoming sufficiently resilient to sustain those gains.”

The warning puts pressure on the government to demonstrate that its growing investment in medical training and healthcare infrastructure will translate into improved access and outcomes, particularly in states where health indicators remain stagnant or have deteriorated.

Makanjuola said the review found pockets of improvement but stressed that the uneven nature of progress across states raised questions about what was driving success in some areas and why similar results were not being replicated elsewhere.

“We must ask not only what is working, but also why it is working, and where it is working, whether it can be replicated, and what is required to sustain it.”

Makanjuola however pointed out that financing alone would not guarantee sustainable reform, as she identified leadership, governance, institutional capacity, community ownership, accountability and sustainable financing as critical to whether the reforms endure.

She said the UHC Forum and other non-state actors would use the 2027 electoral cycle to push health higher on the political agenda and demand stronger commitments from political actors.

The forum, she said, would review its citizen-led health agenda and develop an action plan covering the period before, during and after the 2027 elections.

Director-General of the National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, said access to quality medicines and other health commodities remained fundamental to UHC.

“We cannot have UHC without commodities. We cannot have universal health coverage without leadership.”

Adeyeye said NAFDAC had strengthened its systems, workforce and regulatory processes, adding that the agency had progressed from maturity level one to level three following global assessment of its regulatory capacity.

Also speaking, UNFPA Representative in Nigeria, Muriel Mafico, described the reforms as some of the most ambitious witnessed by the organisation, but stressed that government could not deliver the transformation alone.

“The reforms we are seeing in Nigeria are the boldest, most courageous health reforms we have seen at least in our time.

“It takes courage; it takes leadership to accept that the changes we want to see cannot be done by the Ministry of Health alone.”

Mafico said government, civil society, development partners and UN agencies all had roles to play in ensuring that the reforms produce sustainable improvements saying, “We are not here as spectators. We all have a role to play.”