The Most Efficient States for Healthcare in Nigeria

The current coronavirus pandemic brought to fore the importance of having a strong health system, as many countries were faced with a unique challenge on how to best handle a novel disease which was killing people around the world at a rapid rate. This has brought about the reassignment of  resources in fighting the disease, affecting other health services available to patients.  

Some countries, such as Nigeria were caught in a unique situation where we already had an underfunded and poorly resourced national health system, which saw a scrambling by the various state governments in the country to put in place temporary health facilities to deal with the lack of resources needed should the disease get a firm footing in the country.

Fortunately, it seems that has been avoided, but it did expose the geographical disparity in healthcare service availability and delivery across the country. Healthcare in Nigeria is largely influenced by different local and regional factors that impacts the quality or quantity of care received by its citizens, and largely denotes the efficiency of the health system in each state.

Health care efficiency is a comparison of delivery system outputs, such as health outcomes, with inputs like cost, time, or material. Efficiency can be reported then as a ratio of outputs to inputs or a comparison to optimal productivity using stochastic frontier analysis or data envelopment analysis. This is sometimes difficult to do, especially in a country where data is hard to come by.

To rank the most efficient states for healthcare in Nigeria we used a modified version of the model used by New York based Common Wealth Fund, a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, young children, and elderly adults.

We used 27 indicators that measure performance in four domains important to policymakers, providers, patients, and the public: Care Process, Access, Equity, and Health Care Outcomes. Our data come from a variety of sources including the National Bureau of Statistics, The Demographic and Health Surveys (DHS) Program, The World Health Organization (WHO), Oxford Poverty & Human Development Initiative (OPHI) and Except where stated, most of the data was from the year 2018. 

Performances of the States

Care Process

This was primarily covered by three subdomains which closely looked at the standardised interventions in care delivery.

Patient Engagement: The role of the patient is no longer as a passive recipient of care. These days patients are expected to engage in their own health, care and treatment. We took a look at initiatives to encourage patient involvement in being more active in the health care by examining the following: 

  • The percentage of mothers with the knowledge of using ORS to treat diarrhoea in children
  • The percentage of adults with knowledge of HIV preventive methods
  • The percentage of adults with exposure to family planning messages
  • The percentage of adults with the knowledge of female genital mutilation


Coordinated Care: This involves deliberately organizing patient care activities and sharing information among all the participants concerned with a patient’s care to achieve safer and more effective care. This means that the patient’s needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient. We used rates of

  • antenatal visits,
  • assisted delivery,
  • and postnatal visits that were handled by a health professional.