Critical Care in Nigeria: Evolution, Current Status, and Future Directions

Introduction: Critical care medicine in Nigeria has evolved from a single postoperative recovery unit in 1973 to a recognised subspecialty, yet it remains severely under-resourced relative to population need. This systematic review synthesises evidence on the evolution, current capacity, workforce challenges, and financing of critical care in Nigeria and proposes evidence-informed strategies for sustainable system strengthening. Methods: We systematically searched PubMed/MEDLINE, African Journals Online, Scopus, and Web of Science from inception to March 2025, supplemented by reference list screening and grey literature from Nigerian Ministry of Health and professional society sources. Studies reporting on critical care capacity, workforce training, clinical outcomes, policy development, or financing in Nigerian settings were included. Two reviewers independently screened records and extracted data. Risk of bias was assessed using the JBI critical appraisal tools. Due to heterogeneity in study designs and outcome measures, data were synthesised thematically. Certainty of evidence was evaluated using the GRADE framework. This review is reported according to the PRISMA 2020 statement. Results: Of 254 unique records screened, 40 studies were included in the thematic synthesis. Nigeria has approximately 30 intensive care units (ICUs), yielding an estimated 0.1–0.2 beds per 100,000 population. Most ICUs are in tertiary public hospitals and are led by consultant anaesthetists rather than dedicated intensivists. Mortality rates in Nigerian ICUs are reported between 38% and 74% depending on diagnosis and case mix. The National Postgraduate Medical College of Nigeria approved a fellowship and MD curriculum in Intensive Care Medicine in December 2024, formalising the specialty. Paediatric ICUs exist in only 12.1% of training institutions. Out-of-pocket payments dominate financing, and the National Health Insurance Scheme excludes critical care. The certainty of evidence was very low to low across all key outcomes, primarily due to risk of bias, inconsistency, and indirectness. Conclusion: Critical care in Nigeria has progressed from an anaesthesia-led recovery service to an independent specialty with a formal curriculum, but structural deficits persist. Targeted investment in bed capacity, workforce retention, NHIS reform, tele-ICU platforms, and national registry development are essential for building a resilient, equitable critical care system.