The Nigerian Emergency Care System: Structural Challenges, Workforce Constraints, and Financing Gaps

Emergency Medical Services (EMS) are a critical component of resilient health systems, enabling timely response to trauma, acute medical conditions, and obstetric emergencies. Despite Nigeria's substantial burden of preventable emergency-related morbidity and mortality, the development of a coherent and fully functional EMS system remains incomplete. Existing initiatives, including the National Emergency Medical Service and Ambulance System (NEMSAS), have demonstrated policy intent but continue to face persistent structural constraints. This narrative review synthesised peer-reviewed literature, national policy documents, and international agency reports to examine governance structures, workforce capacity, and financing mechanisms within Nigeria's emergency care system. Comparative analysis with selected high- and middle-income country EMS models was undertaken to identify contextually relevant system-level lessons. Findings indicate that EMS limitations in Nigeria reflect interdependent structural weaknesses rather than isolated operational failures. Governance fragmentation within a federal health system has hindered standardisation, coordination, and accountability, while workforce shortages, exacerbated by limited professionalisation and high rates of migration, restrict both prehospital capacity and clinical leadership. Financing remains inconsistent and heavily reliant on public budget allocations and out-of-pocket payments, limiting sustainability and equitable access. These domains interact in a reinforcing cycle that constrains system performance and the implementation of national reforms. Strengthening EMS in Nigeria will therefore require coordinated cross-domain reform that aligns governance authority, workforce professionalization, and sustainable financing within a unified national framework. Recognising emergency care as a public good and prioritising effective policy implementation are essential to improving health system resilience and advancing progress toward universal health coverage.