Health system resilience in Nigeria after Ebola and COVID-19: impacts, improvements, and strategic directions

Abstract

Nigeria's healthcare system was severely challenged by the 2014 Ebola Virus Disease (EVD) outbreak and the 2020 COVID-19 pandemic. These events exposed systemic weaknesses in infrastructure, emergency preparedness, and health service delivery, while also prompting improvements in diagnostics, surveillance, and public health coordination. This paper analyzes the impacts of the COVID-19 and EVD outbreaks on Nigeria’s health system, as well as the advancements achieved during and after the crises. This review utilizes publicly available articles from sources such as Google Scholar, PubMed, and other grey literature from NCDC and WHO, among others. The search was focused on the Nigerian healthcare system, Ebola and COVID-19 outbreaks. The Ebola and COVID-19 outbreaks led to major disruptions in Nigeria’s healthcare system, including declines in antenatal care, immunization coverage, tuberculosis and HIV services, and in-facility deliveries. During the Ebola outbreak, emergency operations centers and digital surveillance systems like SORMAS were implemented to strengthen outbreak response. The COVID-19 pandemic prompted the adoption of telemedicine, expanded molecular diagnostic capacity, and large-scale investments in health infrastructure, enhancing service delivery beyond pandemic-specific needs. Both outbreaks disrupted essential healthcare services but also spurred critical investments and innovations. Strengthening health system resilience requires sustained funding, institutional reforms, and the integration of emergency gains into routine healthcare. The paper recommends that the healthcare system capacity and surveillance system should be strengthened, and there should be full adoption of telemedicine.