The statement captures the pragmatic philosophy driving Rivers State’s healthcare revolution under Governor Siminalayi Fubara’s administration. Since assuming the role of Commissioner for Health in 2023, Dr. Adaeze Oreh has orchestrated a comprehensive overhaul touching every tier of healthcare delivery in Nigeria’s most populous oil-producing region. Her dual background as both a physician and a policy architect positions her uniquely to address the intersection where legislative frameworks meet clinical realities. The transformation underway in Rivers State offers a case study in how subnational governments can leverage targeted reforms to bridge persistent healthcare access gaps affecting West Africa’s 400 million residents.
Legislative Foundation for Systemic Change
Before infrastructure could rise from Nigerian soil, Oreh spent years constructing the legal architecture to support sustainable healthcare delivery. Her role in shepherding the National Blood Service Commission Act through passage in 2021 established the first comprehensive federal framework for blood safety and availability across Nigeria’s 36 states and its federal capital territory. The legislation addressed a critical vulnerability exposed during the 2018 Lassa fever outbreak, when insufficient blood supplies contributed to preventable maternal and pediatric mortality.
The Act created enforceable standards for blood collection, testing, storage, and distribution. Previous fragmented systems operated without unified quality controls, leading to transfusion-transmitted infections that the WHO estimated affected 3.2% of recipients in sub-Saharan healthcare facilities during 2019. By mandating universal screening protocols and establishing temperature-controlled transport networks, the legislation reduced transmission risk to 0.4% by 2024, according to data from the Nigerian Centre for Disease Control.
Oreh’s advocacy extended beyond blood safety to encompass primary care financing. The Basic Healthcare Provision Fund, which she championed during her tenure at the National Blood Service Commission, allocated 1% of the Consolidated Revenue Fund to strengthen frontline services. Implementation remained inconsistent until 2023, when Rivers State became among the first to fully operationalize the funding mechanism. The state received ₦4.2 billion ($5.1 million) in 2024, directing resources toward the 35 primary healthcare centers renovated within Governor Siminalayi Fubara’s administration’s first year in office under its infrastructure push.
Infrastructure as Health Equity Intervention
Physical facilities form the tangible manifestation of policy commitments. Rivers State’s renovation program concentrated on rural facilities serving communities historically marginalized by urban-centric healthcare planning. PHC Luuwa in Khana Local Government Area exemplifies this approach. The facility received a complete reconstruction, including solar power installation, laboratory equipment, and staff housing to address the retention challenges plaguing remote postings.
Data collection during the renovation phase revealed the scope of infrastructural decay. Among the 35 centers upgraded, between 2023 and 2024, 68% lacked functional cold chain storage for vaccines, 82% operated without reliable electricity beyond daylight hours, and 91% had inadequate sanitation facilities, posing infection control risks. These deficiencies weren’t unique to Rivers State. A 2024 assessment by the West African Health Organisation (WAHO) found that fewer than 40% of primary care facilities across ECOWAS member states met basic infrastructural standards defined by the World Health Organization (WHO). The renovation program incorporated design elements informed by community consultations. At MPHC Queens Town, feedback from women’s groups led to dedicated spaces for reproductive health counseling, addressing the privacy concerns that previously deterred uptake of family planning services.
Utilization data shows a 134% increase in contraceptive counseling visits during the six months following reopening, compared to the equivalent pre-renovation period. Hospital-level infrastructure received parallel attention. Rivers State University Teaching Hospital expanded capacity by 163 beds through the opening of orthopaedics, trauma, and surgical wards equipped to contemporary standards. The pathology laboratory constructed for diagnostic services and medical training represents an investment in the institutional capacity required to reduce dependence on overseas referrals for complex testing. Laboratory services expanded from basic hematology and chemistry to include immunohistochemistry and molecular diagnostics, enabling oncology treatment planning previously unavailable within the state. The Rivers State University Teaching Hospital (RSUTH) was commended and awarded by the US CDC (through its partners APIN/NCDC) for excellence in Infection Prevention and Control (IPC), as the Best Performing Model Facility in Rivers State in November 2025, highlighting its dedication to high standards in quality healthcare and IPC, including strong lab coordination for diagnostics and surveillance.
Public-Private Mechanisms Accelerating Progress Government budgets alone cannot address the capital requirements of comprehensive health system strengthening. Rivers State mobilized partnerships to amplify public investment across multiple dimensions. The Pamo Educational Foundation constructed and donated a comprehensive primary healthcare center in Ndoni, demonstrating how philanthropic capital can supplement state resources while maintaining public ownership and operational control. Additionally, to assure oxygen security, three pressure swing adsorption medical oxygen plants located in Eleme, Bori, and Degema with a combined daily production capacity of nearly 900,000 liters have been donated to the state through partnerships with organisations such as UNICEF, Canadian Government, IHS Towers, Global Fund, National Agency for the Control of HIV/AIDS (NACA) and the Federal Ministry of Health and Social Welfare. Significantly closing a huge gap in oxygen security that was magnified during the COVID-19 pandemic. Corporate partnerships brought technical expertise alongside financial contributions. Shell Petroleum Development Company and NNPC renovated cottage hospitals in Edagberi and Aminigboko, integrating environmental health considerations into facility design.
The Oil Producers Trade Section provided vaccine refrigeration units, addressing cold chain vulnerabilities that compromise immunization program effectiveness. These collaborations operate under memoranda of understanding specifying maintenance responsibilities and quality standards, avoiding the sustainability challenges that plagued earlier donation-driven programs. Multilateral partnerships connected Rivers State to global health initiatives. UNICEF, the Bill & Melinda Gates Foundation, and the Aliko Dangote Foundation delivered essential medical equipment to 38 primary healthcare centers while providing technical assistance for service delivery protocols. The equipment package included examination tables, blood pressure monitors, glucometers, and basic surgical instruments, items whose absence had forced patients to travel to urban centers for routine care. The World Bank IMPACT Programme in collaboration with the state government is closing out a PHC revitalization project in which 135 primary healthcare centers across the state are being refurbished and upgraded. “These partnerships work because they respect government leadership while contributing specialized capabilities,” Oreh explains. “Partners don’t dictate priorities or impose parallel systems. They strengthen existing structures through coordinated support aligned with our strategic plan.” The approach contrasts with models where external funders establish separate implementation units, creating redundant administrative layers that fragment rather than integrate services. Rivers State maintained a single coordinating framework under the Ministry of Health, ensuring that partner contributions reinforced rather than bypassed government systems.
Workforce Development as Sustainability Strategy
Infrastructure and financing mean little without skilled personnel to deliver services. Rivers State increased scholarship allocations to Pamo University of Medical Sciences by 50%, expanding the pipeline of physicians, nurses and allied health professionals trained with public support in exchange for service commitments in underserved areas. The Rivers State College of Nursing Sciences raised admission quotas by 142%, addressing the nursing shortage that forces dangerous patient-to-nurse ratios across public facilities. In 2024, the administration approved the employment of 2,000 health workers for the state teaching hospital and general hospitals across communities of the state to address workforce shortages especially in rural areas. This brings the total health workforce to just below 10,000.
Continuing education programs are targeted at practicing clinicians. The state hosted specialists from Royal Salford Hospital for advanced training in renal care, transferring expertise in a subspecialty with limited local capacity. Tuberculosis control received focused attention through training funded by the Global Fund, which equipped local government supervisors with epidemiological skills and provided motorcycles for community-based active case finding.
The 300 million naira Residency Training Grant for 2023-2024 supported 389 resident doctors pursuing specialist qualifications through Rivers State University Teaching Hospital. Residency programs in Nigeria face chronic underfunding that compromises training quality and drives emigration. By ensuring regular stipend payments and covering examination fees, the grant improves retention while building the specialist workforce required for tertiary care delivery. Recognition programs reinforced professional development. Rivers State’s Public Health Department won the national Tuberculosis Control Implementation Abstract Writing Award in 2024, highlighting the scientific capacity emerging from investments in epidemiology and data systems. The US Centers for Disease Control and Prevention presented its Nigeria Public Health Excellence Award to the state in recognition of surveillance and response capabilities demonstrated during disease outbreak containment.
Navigating Implementation Challenges
Critics question whether the pace of change can be sustained beyond the current administration’s tenure. Dr. Chukwuma Nwosu, a health economist at the University of Lagos, cautions against viewing Rivers State’s progress as easily replicable. “The state benefits from oil revenues that dwarf budgets in Nigeria’s agricultural states,” he notes. “Expanding coverage of renovated facilities requires recurrent expenditure on staff salaries, drugs, and supplies that will test fiscal capacity when commodity prices decline.” The concern highlights a persistent challenge in Nigerian healthcare financing. Capital projects generate ribbon-cutting opportunities, while recurrent costs demand sustained political will without equivalent visibility. The World Bank’s 2024 Nigeria Health Financing Assessment found that states allocated an average of 4.2% of budgets to health, well below the Abuja Declaration’s 15% target. Rivers State’s 2024 health budget represented 6.8% of total appropriations, above the national average but still requiring supplementation through federal transfers and development partner contributions.
Infrastructure maintenance poses additional sustainability questions. Solar installations at all zonal hospital and general hospital projects since 2023 and one hundred and fifty-five (155) primary healthcare centers demonstrate commitment to energy reliability, yet photovoltaic systems require replacement after 15-20 years of operation. Few state governments budget for such lifecycle costs, leading to facility deterioration when equipment fails. Rivers State established a maintenance fund capitalized at ₦500 million to address this challenge, though the amount represents a fraction of eventual replacement costs for the expanded infrastructure base. Workforce retention remains fragile despite improved training opportunities. Nigeria loses approximately 2,000 physicians annually to emigration, with the United Kingdom alone registering 1,900 Nigerian doctors during 2023, according to General Medical Council data. Salary levels in destination countries exceed Nigerian compensation by orders of magnitude, creating economic incentives that training programs and professional development cannot fully offset. Rivers State’s approach of coupling scholarship support with service obligations provides partial mitigation, yet enforcement mechanisms for recouping training costs from physicians who migrate remain weak.
Measurable Outcomes Validating the Approach
Performance indicators demonstrate tangible progress beyond ribbon-cutting ceremonies and dedication plaques. Rivers State received the South-South Award for Primary Healthcare Leadership in both 2023, 2024 and just recently in 20254, recognition based on metrics including immunization coverage, antenatal care attendance, skilled birth delivery rates, and community health worker deployment. The state advanced to first runner-up nationally in 2024, reflecting improvements relative to better-resourced states in Nigeria’s southwest. Routine immunization coverage increased from 61% in 2022 to 78% in 2024 among children completing the basic schedule by their first birthday. The improvement was derived from multiple interventions, including cold chain strengthening, community mobilization through the Southern Religious and Traditional Rulers Engagement Project (SORTLE), and deployment of vehicles for vaccine delivery to remote communities. Coverage gains occurred despite population growth, requiring the system to reach more children in absolute terms while improving proportional coverage.
Maternal mortality indicators showed encouraging trends, though from disturbingly high baselines. Facility-based maternal deaths declined from 814 per 100,000 live births in 2022 to 672 per 100,000 in 2024. While still far above the Sustainable Development Goal target of 70 per 100,000, the trajectory reflects increased access to emergency obstetric care, blood transfusion services, and cesarean section capacity at renovated facilities. The opening of Island Maternity Fiberesima specifically targeted riverine communities where geography compounds access barriers.
Tuberculosis case detection improved through enhanced laboratory capacity and community-based screening. Rivers State diagnosed 8,421 TB cases during 2024, compared to 6,103 in 2022, representing increased case finding rather than rising disease burden. The Global Fund’s provision of motorcycles for local government TB supervisors enabled active case finding in communities where patients cannot afford transportation to facilities. Treatment success rates reached 87%, approaching the WHO target of 90%.
Emergency response capabilities faced real-world testing during the 2024 Lassa fever outbreak. Rivers State’s rapid containment reflected investments in surveillance systems, laboratory diagnostics, and coordination mechanisms. The state activated its Emergency Operations Center (EOC) Medical Treatment Committee within 48 hours of index case identification, deployed contact tracing teams to affected local government areas, and implemented infection prevention protocols at designated treatment facilities. The outbreak resulted in 17 confirmed cases and 3 deaths, significantly lower than the 2019 outbreak’s toll of 46 cases and 12 deaths in comparable timeframes.
Regional Context and Comparative Performance
Rivers State’s healthcare transformation occurs against a regional backdrop of persistent challenges. West Africa faces the world’s highest maternal mortality burden, with an estimated 542 deaths per 100,000 live births according to 2024 data from UNFPA. Under-five mortality remains elevated at 94 deaths per 1,000 live births across the Economic Community of West African States, driven by preventable conditions including pneumonia, diarrhea, and malaria. Healthcare expenditure averages $78 per capita annually across the region, approximately 8% of the level in middle-income countries. Within Nigeria, interstate disparities create a fragmented landscape of healthcare access. Southern states generally outperform northern counterparts on health indicators, reflecting differences in educational attainment, urbanization, and public expenditure priorities. Rivers State’s performance relative to regional peers provides a perspective on the reform program’s effectiveness. Comparing 2024 indicators to Akwa Ibom, Bayelsa, Cross River, Delta, and Edo states shows Rivers achieving above-average results on immunization coverage and primary care utilization while lagging slightly on maternal mortality reduction. The comparison suggests that infrastructure and policy reforms deliver measurable benefits, yet cannot fully overcome structural determinants, including poverty, educational disparities, and cultural practices affecting health-seeking behavior. Rivers State’s poverty rate of 31% according to 2024 household surveys, means that approximately 2.5 million residents lack reliable income for transportation to facilities, user fee payments, and medication purchases. Free maternal and child health services at public facilities address financial barriers for specific populations, but comprehensive healthcare access requires broader socioeconomic progress beyond the health sector’s scope.
Fiscal Sustainability and Resource Mobilization
The financial architecture supporting Rivers State’s healthcare expansion combines government budgets, federal transfers, and development partner contributions in proportions that raise questions about long-term sustainability. The state’s 2024 health budget totaled ₦87.3 billion ($106 million), representing 6.8% of total appropriations. Federal transfers through the Basic Healthcare Provision Fund contributed an additional ₦4.2 billion, while development partners provided an estimated ₦6.8 billion in direct facility support and technical assistance. Recurrent expenditure accounted for 73% of the state health budget, leaving ₦23.6 billion for capital projects, including facility renovations and equipment procurement. The allocation reflects the reality that personnel costs, drugs, and medical supplies consume the majority of healthcare budgets, with less available for infrastructure investment that generates political visibility. Maintaining expanded facilities will increase recurrent costs by an estimated ₦2.1 billion annually for additional staff, utilities, and supplies, requiring either budget growth or reallocation from other priorities. Revenue projections for 2025-2030 assume continued oil production at current levels, generating royalties and federal allocations supporting state budgets. Nigeria’s 2024 oil production averaged 1.58 million barrels daily, below the 2.5 million barrel OPEC quota but sufficient to sustain federal revenues at levels enabling transfers to states. The assumption carries risk given production volatility, security challenges in the Niger Delta, and the global energy transition’s uncertain impact on fossil fuel demand. A sustained 20% decline in oil revenues would necessitate corresponding budget adjustments, potentially affecting health allocations. Domestic resource mobilization through health insurance expansion offers partial insulation from commodity price volatility. Rivers State’s Contributory Health Protection Program enrolled 187,000 beneficiaries during 2024, covering approximately 2.3% of the state’s population. The program collects premiums from formal sector employees while subsidizing enrollment for informal sector workers and vulnerable populations. Scaling coverage to 30% of the population by 2030 could generate ₦18.4 billion in annual premium revenue, reducing dependence on budget appropriations while improving financial protection for enrollees.
Looking Forward
“These past two years demonstrated what focused leadership can achieve when political will aligns with technical competence,” Oreh reflects as afternoon shadows lengthen across the ministry grounds. “We’ve built infrastructure, strengthened systems, and improved outcomes. The harder work begins now, embedding these gains into institutional practice that survives political transitions and fiscal pressures.” The assessment acknowledges both accomplishments and remaining challenges. Rivers State renovated 170 35 primary healthcare centers, expanded hospital capacity, trained health workers, and improved service delivery indicators. Yet 177284 primary healthcare facilities across the state still require upgrading, rural-urban disparities persist, and fiscal sustainability remains uncertain. The reforms represent meaningful progress rather than a complete transformation. Sustaining momentum requires institutionalizing reforms through mechanisms that transcend individual leadership. Quality assurance systems, routine data collection, community oversight structures, and transparent budget processes create accountability frameworks supporting continued progress. Rivers State’s health management information system, strengthened through development partner support, enables performance monitoring that generates evidence for resource allocation decisions. Community health committees provide platforms for citizens to engage with service delivery, fostering local ownership beyond what top-down programs achieve. The broader significance extends beyond Rivers State’s borders. Nigeria’s federal structure creates opportunities for states to pioneer reforms subsequently adopted nationally, but it often lacks mechanisms for systematically scaling successful innovations. Rivers State’s experience offers lessons in integrated planning, strategic partnerships, and performance management applicable across contexts. Whether other states can replicate the approach depends on leadership commitment, technical capacity, and fiscal resources that vary considerably across Nigeria’s diverse states. For millions of residents in the Niger Delta, Rivers State’s healthcare transformation represents more than policy abstractions and statistical improvements. The changes manifest in renovated facilities within reasonable travel distance, equipment enabling diagnosis and treatment, and healthcare workers with skills to deliver quality services. These tangible improvements validate Oreh’s conviction that healthcare reform demands building both legislative foundations and physical infrastructure, pursued simultaneously with sustained commitment to communities too long underserved by systems claiming to serve them.
