PHCs in crisis as japa shrinks public health physicians to 3,000

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Nigeria, with a population of over 230 million, is facing a severe shortage of public health physicians, while many Primary Healthcare Centres across the country continue to operate without doctors due to the japa syndrome.

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Experts said the shortage of public health physicians is a broader symptom of a critical manpower deficit in the country’s healthcare sector.

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The deficit, the public health physicians said, has been impacting their roles, which include disease surveillance, disease outbreak response, epidemiology, primary healthcare management, health policy formulation and implementation, and occupational and environmental health.

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PUNCH Healthwise recently reported that the number of licensed doctors in Nigeria dropped to about 40,000, far below the estimated 300,000 needed to serve the country’s population.

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The drop in the figure to 40,000, which was 55,000 licensed doctors in 2024, was being fuelled by the continued migration of doctors abroad in search of greener pastures.

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Worryingly, the President of the Association of Public Health Physicians of Nigeria, Dr Terfa Kene, recently said the country lacks sufficient public health physicians.

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Kene said the deficit of medical professionals continues to limit the country’s capacity to produce the specialists required for effective public health practice.

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He explained that public health physicians operate at the community level, working across sectors to deliver essential health services, strengthen preventive care, and improve health outcomes.

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According to him, the exact number of public health physicians in Nigeria remains unclear due to registration gaps and varying qualifications, limiting accurate workforce data for planning and policy.

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He, however, noted that the association has over 3,000 registered members, though the figure does not represent the total number of practitioners in the country.

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“This still brings me to how many public health physicians we have in Nigeria. I don’t have that record, but we have more than 3,000 members registered with the association,” Kene said in an interview with NAN.

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Kene’s revelation is coming at a time when Nigeria is still actively managing several critical outbreaks of diseases of public health concerns while maintaining long-term surveillance on endemic conditions.

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These include Lassa fever, diphtheria, measles, meningitis, cholera, among others.

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These diseases are categorized by the Nigeria Centre for Disease Control and Prevention based on their potential for rapid spread, high mortality rates, and social or economic disruption.

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However, experts who spoke with PUNCH Healthwise expressed concern that the shortage of public health physicians was impacting the the mangement of these diseases.

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Aside from the diseases, they also noted that the deficits of public health physicians is affecting access to quality care across Nigeria’s rural areas, with PHCs operating without doctors, who are primarily experts with a public health background.

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Nigeria has an estimated over 30,000 PHCs across its 774 local government areas, but despite this number, only about 20 per cent, roughly 6,815, are considered functional, with the majority facing challenges like poor infrastructure, lack of equipment, and inadequate manpower.

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Investigations by PUNCH Healthwise revealed that several PHCs across the country operate without doctors, leaving patients to navigate care in unsafe conditions.

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Aside from that, investigations by our reporters in Akwa Ibom, Ebonyi, Ogun, and other states showed that many of the PHCs are plagued by filthy conditions, crumbling buildings, empty drug shelves, the absence of equipment, water, electricity, and trained personnel.

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This is despite the disclosure by President Bola Tinubu that over N98bn was disbursed in 2025 to strengthen primary healthcare delivery across the country.

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We’re concerned about population – Experts

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Speaking exclusively with PUNCH Healthwise, the APHPN Secretary General, Dr Austine Ajogwu, said public health physicians are concerned about adequately serving the population.

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“We have about 3,000 public health physicians in Nigeria. For every 500 to 1,000 patients, there should be a public health physician — a doctor with an advanced degree in public health. We deal with population health. Every primary healthcare centre serving a population of 500 to 1,000 patients should have a public health physician to manage it.

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“If we are to have a functional PHC in every ward, as recommended by the WHO, and we have over 10,000 wards in Nigeria, each functional PHC must have a medical officer of health who will manage it and understand the population,” he said.

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He stated that primary healthcare remains the foundation of healthcare globally, affirming that if the foundation is weak, everything built on it will collapse.

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“The WHO says primary healthcare is the foundation of healthcare, but our healthcare system is very weak. Just like when you are building a house, if the foundation is faulty, the house will collapse. Our healthcare system is weak in Nigeria because the foundation is faulty,” he added.

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He disclosed that despite the Federal Government’s upgrade of PHCs, many of them remain non-functional, describing them as merely beautiful structures without equipment and trained health workers.

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“A building does not make a hospital. A building alone does not make a good primary healthcare facility without the necessary equipment and personnel inside it. How many health workers are in those buildings? How many of these hospitals have accurate data that can be used to make decisions? I don’t think we can improve the healthcare system in the country if we continue like this,” he said.

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He urged the federal and state governments to focus on the key components that make a PHC functional, according to the WHO.

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He listed leadership, funding, health insurance, medical products, infrastructure, and human resources as critical factors needed to build a strong health system, lamenting that Nigeria is lagging behind based on available data.

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He maintained that unless these factors are holistically addressed, Nigerians may never enjoy a quality healthcare system, especially at the grassroots level.

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On his part, a former president of APHPN, Prof Tanimola Akande, said the shortage of public health physicians is a broader symptom of manpower deficit in the health sector.

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“The number of public health physicians, just like the number of doctors in Nigeria, is grossly inadequate. It is commonly estimated that 1 public health physician is required per 50,000 – 100,000 population. This is in view of the need to have a Medical Officer of Health (a trained public health physician) in each of the 774 LGAs in Nigeria and each public hospital in the country,” he said.

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Akande said there are several implications of public health physician shortages in managing diseases of public health concern, particularly in a country like Nigeria.

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“The shortage of public health physicians contributes significantly to the weak health system in Nigeria. The shortage affects the effective delivery of primary health services, disease prevention and control, as well as various other aspects of public health like occupational and environmental health care.

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“The shortage of public health physicians is a challenge to effective control of disease outbreaks and implementation of public health policies in Nigeria,” he said.

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Speaking on PHCs, the seasoned public health physician said the manpower shortage had made any health centre with doctors to be seen as a luxury in several communities in Nigeria.

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“There is a severe shortage of doctors in Primary Health Centres in Nigeria. A very low proportion of PHCs in Nigeria have medical doctors. This is primarily because of a shortage of doctors, which also translates to a shortage of public health physicians.

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“The situation is so bad that PHCs being manned by medical doctors are often considered a luxury in most parts of Nigeria,” he said.

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