BACKGROUND:
Nigeria, with over 200 million people, faces one of the largest surgical care deficits in Africa. Despite longstanding universal health coverage (UHC) policies, less than 5% of Nigerians are enrolled in the National Health Insurance Scheme, leaving most to pay out-of-pocket. Surgical services remain largely centralized at tertiary hospitals, sidelining the primary healthcare system. This study advocates integrating essential surgical and anaesthetic care into Nigeria’s primary healthcare framework to achieve equitable, timely, and affordable access for all citizens.

METHODS:
A narrative policy analysis was conducted using data from national statistics, and literature [PubMed, AJOL, Scopus, Web of Science, Embase] published from databases inception till September 2025 on surgical access, workforce distribution, and financing. Key barriers and evidence-based policy pathways were identified.

RESULTS:
Nigeria performs only 166 surgeries per 100,000 people annually [ below the global benchmark of 5,000 per 100,000]. Workforce density stands at one surgeon, obstetrician, and anaesthetist per 100,000 population, compared to the recommended 20. Over 70% of health expenditure is out-of-pocket, resulting in catastrophic financial hardship for surgical patients. Geographic inequities persist, with rural populations living beyond two hours’ access to essential surgical facilities. Despite the NSOANP providing a national roadmap, implementation remains slow due to inadequate funding, weak political commitment, and limited decentralization.

CONCLUSIONS:
Universal access to safe, timely, and affordable surgical care is essential for achieving UHC in Nigeria. Expanding surgical capacity within primary healthcare through workforce strengthening, equitable financing, and consistent policy execution will be key to reducing preventable surgical deaths and improving national health outcomes.