Nigeria's Health System Gaps: How Founders and Families Fill the Void
In Lagos, getting emergency medical assistance often follows a familiar pattern: a phone number that may ring endlessly, multiple attempts to connect, and finally a fortunate individual with a vehicle or a contact who can help. Ambulances are present in the city, yet no central mechanism brings them together.
Medwaka's founders approached this challenge from a different angle. Their initial goal was to tackle blood donation shortages affecting pregnant women in Ondo State, but they kept confronting the same obstacle: patients could not move from the point of distress to the point of care. As a result, they restructured their company to address that issue by building a dispatch and coordination layer that operates on top of hospitals, ambulances, and first responders, all of which already existed separately.
That detail is easily overlooked in a founder's narrative. The company was not merely addressing a shortage of ambulances; it was repairing a coordination breakdown that a working public system ought to have resolved long ago.
A similar dynamic applies to funding. Primary healthcare centres across Nigeria suffer from chronic underfunding, and any solution must begin by acknowledging how poorly fiscal policy serves the people who need it most. Funds are allocated in budgets but not always disbursed. Even when they are, the money may not reach the facility level in a manner that translates into patient care. An investigation into where people turn when this happens uncovered a vast informal healthcare economy: patent medicine vendors, unlicensed clinics, and community caregivers quietly absorbing patients the formal system was meant to serve.
Donor funding follows a comparable pattern, though it moves faster and is more visible. Over the past twenty years, the bulk of Nigeria's health financing has come from external partners. With government health spending far below the African regional range of 2–12%, this dependency is not being treated as a problem to fix.
The withdrawal of USAID in 2025 demonstrated to the healthtech sector how much of its credibility and connective tissue relied on a single external source. The impact of USAID's departure was not just financial; it also severed partnerships that lent startups legitimacy with public health programmes. A follow-up investigation found that disease surveillance systems went dark when the funding line closed, as no alternative infrastructure had been built that did not depend on donor money.
Matters such as sex education, which even policy meetings avoid despite evidence of its importance, are central to understanding healthcare in Nigeria. Access to contraceptives is still limited more by stigma than by supply, sex education is virtually absent in Nigerian schools, and the question of who decides what happens to a woman's body is still, in practice, not the woman. Whispa, a Nigerian digital platform offering young people confidential and affordable sexual and reproductive healthcare, built its entire product around this gap years ago: anonymous, judgment-free access to sexual health information for girls who would otherwise have nowhere to ask. But fundamental problems persist.
Founders have worked around these issues, but they are not to blame, as it is nearly impossible to innovate around a gap the government cannot address without foreign funds. A dispatch app does not give Nigeria a functioning national emergency number. A femtech platform does not get comprehensive sex education into the curriculum. What they have done collectively is leave a paper trail pointing to moments founders hit a wall the state should have removed, and that is a more specific indictment than most policy critiques manage.
That paper trail forms the core argument of the health edition of The Nigerian Life Compendium, an initiative by Zikoko Citizen that is less interested in health statistics for their own sake and more interested in naming, essay by essay, where the system hands its responsibilities to whoever is left standing; usually families, sometimes founders, occasionally no one at all.
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