Long-term care is one of the most invisible yet consequential gaps in Nigeria’s health and social systems. It rarely features in policy debates, yet it shapes the daily reality of ageing for millions of families.
This is not a theoretical concern for me. It is personal.
My siblings and I recently spent two weeks with our parents in the village over the Christmas period. Like many older Nigerians, they rely on a live-in carer for everyday support. Just before our visit, their carer travelled to Northern Nigeria to spend the holidays with her family. There was no backup system. No formal replacement pathway. Just a sudden care vacuum.
As a stopgap, we have hired a “nurse” through an agency. She turned out to be a young woman with no formal training or experience in caring for older adults. We paid the agency well, yet I could not tell how much reached her, what standards guided her work, or who was accountable for the quality of care.
This experience is not unusual. It is how long-term care functions for most families in Nigeria.
An Informal System Carrying a Formal Responsibility
Nigeria does not have a structured long-term care system. What exists is an informal, family-based arrangement that operates largely outside regulation, training, or policy oversight.
Care is typically provided by:
- Family members, often women, balancing work, childcare, and caregiving
- Untrained paid carers sourced through informal networks or loosely regulated agencies
- Domestic workers who gradually assume caregiving roles without preparation or support
This model persists not because it is effective, but because it is the only option available.
Formal home-based care services are weak or absent. National standards are unclear or unenforced. Training pathways for caregivers are limited. Protection for caregivers and safeguards for older adults are minimal.
Ageing, Migration, and a Growing Care Gap
Nigeria’s population is ageing, even as the social structures that once absorbed care responsibilities are eroding. Migration, urbanisation, smaller households, and economic pressure mean fewer adult children are available to provide hands-on care.
We are moving away from traditional models of family care without replacing them with credible alternatives. The result is a widening gap where families improvise, older adults face inconsistent care, and caregivers work without dignity or security.
Why Long-Term Care Is a Systems Issue
Long-term care is often treated as a private family matter. In reality, it is central to healthy ageing, health system sustainability, and social protection.
When long-term care systems are weak:
- Preventable hospital admissions increase
- Functional decline accelerates
- Family caregivers burn out
- Older adults lose autonomy and dignity faster than they should
Well-designed home-based care is not a luxury. It is one of the most cost-effective responses to population ageing, if it is organised, regulated, and integrated into health systems.
What Strengthening Long-Term Care Should Mean
Nigeria does not need to replicate high-income country models wholesale. It needs context-sensitive system design.
Key priorities include:
- A national long-term care framework that recognises home-based care as an essential service
- Standardised training pathways for caregivers focused on older adult needs, safety, and dignity
- Regulation and accountability for care agencies, including transparency in pay and supervision
- Structured support for family caregivers, including education and respite
- Integration of long-term care with primary healthcare and rehabilitation services
This is a health issue, a labour issue, a gender issue, and a human rights issue.
Where Systems Fail Most Clearly
Long-term care happens behind closed doors, in villages and city homes, far from policy tables. That is where systems fail most quietly and where the consequences are most human.
If Nigeria and other African countries are serious about healthy ageing, long-term care can no longer be an afterthought. It must be deliberately designed, sustainably financed, and humanely regulated.
Our parents deserve more than improvisation. Caregivers deserve visibility and protection. And our future selves deserve a system we can trust.
The time to act is now. It is a problem we will all confront when we retire, between the ages of 60 and 70, after our working lives. So we all have an interest in building structures and policies that are robust enough to care for us post retirement.
