-Rural Nigeria’s Reliance on Community Health Workers and Unlicensed Doctors.
Nigeria’s northern states continue to grapple with a severe shortage of medical doctors and specialised health professionals, forcing primary health centres and rural communities to rely heavily on community health practitioners (CHPs) for day-to-day care, the Federal Ministry of Health and Social Welfare says in its 2025 State of Health of the Nation Report.
The report’s workforce analysis exposes stark regional imbalances. CHPs are now the largest single professional group in the country’s health workforce, with 223,802 registered and licensed practitioners as of 2024. Employment data show that 100 per cent of licensed CHPs are currently employed — a contrast with 51 per cent of licensed doctors and 62 per cent of licensed pharmacists who are in active practice.
Concentration and density
The concentration of CHPs is highest in northern states. Kaduna leads with 11,973 CHPs, followed by Benue (11,552) and Kano (11,382). By contrast, a heat map of doctors per 10,000 population included in the report highlights an uneven national distribution of physicians.
Lagos, the Federal Capital Territory (FCT), Edo and Enugu have the highest doctor densities, each recording five or more doctors per 10,000 people. Several states — including Ogun, Kwara, Plateau, Anambra, Rivers and Bayelsa — fall into a moderate category at around three doctors per 10,000.
Most northern states sit in the lowest band. Kebbi, Sokoto, Zamfara, Niger, Yobe, Borno and Adamawa register one doctor or fewer per 10,000 population. The report identifies Yobe, Kebbi, Zamfara and Jigawa as experiencing the lowest densities — 0.5 doctors per 10,000 — meaning a single doctor may be responsible for roughly 20,000 people. Adamawa, Bauchi, Taraba and Katsina register about 0.7 doctors per 10,000.
Scale of the gap
Nationwide, 95,456 doctors are registered but only 60,551 (about 63 per cent) are licensed to practise. Lagos accounts for the largest share of licensed doctors (8,741), followed by the FCT (5,505) and Rivers (3,001). At the other extreme, Taraba has only 256 doctors, while Zamfara and Kebbi report 298 and 312 doctors respectively.
Nursing and midwifery staffing follows a similar pattern of concentration. Lagos employs 13,071 nurses and midwives, the FCT 5,578 and Oyo 3,723. Yobe has the fewest with 522; Jigawa and Borno also report fewer than 1,000 in this category. For specialised roles, Lagos has 4,448 pharmacists compared with just 41 in Zamfara; dental services are likewise concentrated — Lagos has 896 dental professionals while Taraba has only eight.
Drivers of shortages
The report links shortages in the North to insecurity, poor infrastructure and the outward migration of trained health workers. External migration figures included in the analysis record 7,487 nurses and 3,919 doctors among those who have moved abroad.
Public and private sector employment of doctors also declined between 2023 and 2024. Licensed doctors engaged in the public sector fell from 24,681 to 23,435, while private sector engagement dropped from 9,213 to 8,392. Despite the fall, the public sector remains the dominant employer, accounting for roughly 74 per cent of engaged doctors.
Government response and remaining gaps
The report notes several workforce-strengthening efforts undertaken in 2025. Nursing school enrolment rose from 37,470 students in 2023 to 44,451 in 2025, a 19 per cent increase. The government recruited 1,155 skilled birth attendants across five states and hired 13,434 community-based health workers in 11 states. To support frontline staff, 60,000 midwives received workwear and personal protective equipment and an additional 37,000 kits were procured for distribution.
Yet the report stresses that maldistribution — not just absolute shortages — remains a major obstacle to equitable access to care. Northern states continue to report severe shortfalls of doctors and specialists such as radiographers, optometrists and physiotherapists, undermining the ability of primary health centres and rural clinics to provide comprehensive services.
What comes next
Addressing these imbalances will require a mix of actions: improving security and infrastructure in underserved areas, incentivising rural placements and retention, expanding training and career pathways for mid-level cadres, and tackling the drivers of external migration. Strengthening supervision, investing in telemedicine and formalising task-sharing practices with CHPs can also help expand access more quickly — but such measures must be paired with long-term investments to rebuild confidence among health professionals to work in hard-to-reach areas.
As Nigeria seeks to meet national and global health targets, the 2025 report makes clear that numbers alone will not suffice: where health workers live and practise will determine whether communities can get timely and quality care.
