The public health system of Nigeria has been in a state of near-collapse in many parts of the country for decades. Lack of clarity regarding the roles and responsibilities of the three different tiers of government (Federal, State, and Local Government Authority levels), and of parastatals, has led to duplication and fragmentation of services and lack of accountability for providing them.

Available data suggests total expenditure on health is inadequate to provide an essential package of care for common health problems. Policy and planning processes are poorly developed and are rarely linked to the budget cycle. The absence of effective management systems also contributes to inefficiencies in public service delivery. Development aid from both multi and bi-lateral donors overtime has implemented strategies to mitigate the effects of the decline of the systems. The UK Department for International Development (DfID) has continuously scaled up its work in the sector in the last decades. Through its programme; the Partnership for Transforming Health Systems (PATHS), the department has aimed to address service delivery in the sector through initiatives in systems strengthening.