“The future of health is not in the health space alone,” says Professor Adaeze Oreh, family physician, public health strategist and immediate past Honourable Commissioner for Health, Rivers State,

In a recent Nigeria Health Watch Curated Conversations interview, Prof. Oreh traced that conviction to her medical training at the University of Nigeria Teaching Hospital (UNTH), Enugu. While still considering a career in cardiology, she began to notice stark differences in the care patients received before reaching the teaching hospital, particularly between people from rural communities and those from cities.

That experience moved her towards health systems strengthening and the broader question of what determines whether people can live healthy lives in the first place. Answering that question meant looking beyond hospitals and healthcare to the conditions that shape people’s health in the first place.

The World Health Organization (WHO)’s framework on the social determinants of healthdescribes health as shaped by the conditions in which people are born, grow, live, work, and age. Education, income, housing, safe water and the physical environment can influence health as much as, and sometimes more than, access to healthcare.

If health is shaped by more than healthcare, then improving it cannot be the job of the health sector alone. In policy terms, this is the thinking behind a Health in All Policies approach, where decisions made in finance, education, water, housing, transport and other sectors can have consequences for population health.

Everybody is a stakeholder in health

For Prof. Oreh, identifying the institutions responsible for a problem is only part of the answer. The people living with that problem must also be able to shape the response.

“Everybody should have a say in health,” she says. As commissioner, she recognised that the Ministry of Health’s stakeholders were not only health professionals, but the wider population.

That principle matters for Nigeria’s current restructuring agenda. The Nigeria Health Sector Renewal Investment Initiative (NHSRII), launched in 2023 and implemented through the Sector-Wide Approach(SWAp), is intended to align federal, state, and local governments, development partners, civil society, and the private sector around shared health priorities.

But alignment at the government level is not enough if communities remain outside policy design.

The Basic Health Care Provision Fund (BHCPF) provides a route to bring resources and accountability closer to primary care. The National Primary Health Care Development Agency (NPHCDA) reports that more than 8,300 validated PHCs currently receive quarterly Direct Facility Financing, while participating facilities are required to have functional Ward Development Committees.

The harder question is whether these community structures consistently have the voice, capacity and influence to support the co-creation Prof. Oreh is calling for.

Community orientation in practice

Other countries offer useful lessons, although their models cannot simply be transplanted into Nigeria.

Brazil’s Family Health Strategy organises multiprofessional primary-care teams around defined communities, including household-based care. A study of 1.2 million adults in Rio de Janeirofound that greater use of the strategy was associated with fewer emergency admissions for conditions that can often be managed through effective primary care, as well as fewer 30-day readmissions.

Rwanda has also invested heavily in community-based delivery. In July 2026, the Rwanda Ministry of Health reported that 58,298 community health workers provided doorstep care across the country, while the Rwanda Social Security Board currently reports 89.06% coverage under its Community-Based Health Insurance scheme.

The lesson for Nigeria is less about copying either system than about sustaining the institutions, workforce, financing and accountability that make community-oriented care work.

Communication is part of governance

Prof. Oreh also places communication at the centre of reform. Health professionals, she argues, are “used to talking to ourselves”, even though policies often depend on people outside the sector who authorise or finance them.

Health leaders, therefore, need to communicate value to “financiers, economists, education leaders, people in energy”, while maintaining dialogue with the communities they serve. “Where there’s no communication, there cannot be any trust,” she says.

In this framing, communication is not publicity after a policy has been designed. It helps build political support, mobilise resources, explain reform and bring lived experience back into policymaking. Communities, Prof. Oreh argues, should be able to “weigh in on the co-creation of health policies”.

The workforce crisis is a system-wide problem

The same argument applies to Nigeria’s health-worker migration challenge. “Retention is actually the least expensive form of recruitment,”Prof. Oreh says. However, she rejects the idea that “Japa” is purely a health-sector failure. “It is not a health sector problem. It is a system-wide problem.”

Insecurity, economic pressures, working conditions, and opportunities for professional growth all influence whether health workers stay or leave the country. Nigeria’s National Policy on Health Workforce Migration, approved in August 2024, includes measures on ethical recruitment, diaspora engagement, retention and rural deployment. However, without clear accountability, the policy risks remaining a statement of intent rather than translating into action,

Prof. Oreh’s argument raises the harder implementation question: can a workforce policy succeed if the wider pressures driving people out of the system remain unresolved?

She also points to what chronic underinvestment means for improvement within facilities. “When many facilities are just working to survive, innovation takes a back seat,” she said.

Making the business case for health

That is why Prof. Oreh argues that health spending should also be understood as an economic investment. “We should stop looking at healthcare investments as throwing money at social goods,” she says.

Her wider point is that functioning health services support employment, training, medicines, commodities, utilities and supply chains. The economic argument does not displace health as a public good or the goal of universal health coverage; it strengthens the case for sustained investment.

The Federal Government’s Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) is pursuing this approach through domestic manufacturing, job creation, and reduced dependence on imports. But implementation matters more than announcements.

A proposed joint venture for Vestergaard-Harvestfield mosquito-net manufacturingbroke ground in Ogun State in December 2025. In July 2026, however, Vestergaardannounced that the joint venture would not proceed and that it would instead establish Health Textiles Nigeria FZE in the Lagos Free Zone.

The change is a useful reminder that policy ambition must ultimately be judged by what becomes operational and delivers results.

Prof. Oreh’s broader argument is the same. Nigeria will not close its health gaps by asking the health sector to work harder in isolation. Progress towards universal health coverage will depend on leaders who can work across sectors, communities with a meaningful role in shaping policy, stronger systems for retaining and developing the workforce, and sustained investment in quality care closer to where people live.

“The future of health is not in the health space alone,” Prof. Oreh says. “It must be intersectoral and multidisciplinary.”