It is a great privilege to be invited by the Ondo State University of Medical Sciences (UNIMED) to deliver its 3rd Distinguished Lecture. I would like to extend my appreciation to His Excellency Governor of Ondo State, Vice-Chancellor and entire UNIMED leadership, Ondo State Government and its people for the warm welcome and the gracious opportunity of this lecture. The lecture aims to share a perspective on the future of health and the promise of primary health care in Nigeria. I intend to place Nigeria’s health situation within the context of important trends that are occurring globally, as well as in our mother continent, Africa. Within that context, I will attempt to link health and economic development, share some observations on Nigeria’s demographic dynamics linked to its health status, aspects from recent history of its health system’s evolution, identify the underlying reasons for the key challenges and present a few ideas on the way forward. There are several major transitions happening gradually in our world today, and particularly in Africa and Nigeria, which can easily escape notice. These transitions range from demographic transitions in terms of population structures and ageing, urbanization, political transitions until recently in democratic directions, climatic shifts, economic transitions into the fourth industrial revolution and including technological changes from big mechanical machines, towards miniaturization, mobile, biotechnology, nanotechnology, genomics to proteomics and metabolomics. All these transitions can be interconnected and have potential implications for individual, population and planetary health. More immediately, they may have implications for future of health systems and the ongoing epidemiologic transitions. In May 2012, The Lancet medical journal convened a specific Commission on the future of health in sub-Saharan Africa. The Commission comprising diverse African experts, academics, policy makers and practitioners, decided to take a medium to longer term perspective on the issues, opportunities and challenges facing African health systems. We recognized the region’s potential to improve health on its own terms, and largely within its own resources in the long-term.  Recognizing the substantial inter-country as well as intra-country variabilities in health systems and outcomes, the commission concluded its work with justified evidence for optimism in Africa’s health future. But that optimism is not guaranteed, it will depend on how national and sub-national leaders exercise their role to invest appropriately in people-centered systems with solid primary health care foundations. In this era of the Sustainable Development Goals, and move toward Universal Health Coverage, bold new ideas must be explored and executed upon, thinking ahead, learning from global experiences but pursuing sometimes uniquely African paths, and deliver results for everyone. The Commission’s vision and aspiration is that by 2030 Africans should have the same opportunities for long and healthy lives that new technologies, well- functioning health systems, and good governance offer people living everywhere.  It laid out a clear agenda for action. I was very honored to join some brilliant minds on health in the African continent and globally to contribute in the commission’s work, led by Peter Piot and Nelson Sewankanbo. The Commission’s report was officially launched on September 14th in Nairobi, Kenya, but given this gracious invitation by UNIMED I thought to also bring copies of the report as a way of disseminating the results within Nigeria (1). Demographic Dynamics Nigeria has a large and fast-growing, youthful population. By the year 2050, it is likely that its population, based on current growth rates, will be near 400 million, making Nigeria the 3rd or 4th most populous country in the world. There are economic benefits for a nation from having a youthful population when they are gainfully employed. This potential benefit, also called the demographic dividend, results when the share of the working-age population is larger relative to the non-working-age, dependent population. For a country to realize the demographic dividend, it must first undergo a demographic transition (change in the population structure), which means a shift from higher fertility and child mortality to relatively lower fertility and child mortality. During the early stages, mortality rates among children fall because of improvements in sanitation, hygiene, nutrition and reduction in preventable diseases. When child survival improves, parents are likely to feel more confident about reducing desired fertility rates and women become better able to participate in the broader labor force. The critical stage is when the labor force grows more rapidly than the population dependent on it (the dependency ratio starts to fall). This frees up resources for investment in economic development and an opportunity for rapid economic growth, provided the right social and economic policies and investments are in place. The period during which a demographic dividend (economic benefits of a youthful population) may be realized can be up to five decades or more. (2). Later, when the older ones also invest their savings or through pensions, further extension of the dividend occurs. In 2013, shortly after voluntarily resigning from Government and went back to a University, I approached Professor David Bloom at Harvard University to explore Nigeria’s demographic dynamics. With data supplied by the National Bureau of Statistics, we modeled the country’s population dynamics, based on various explicit assumptions and linked with future economic growth scenarios. There are a few relevant insights worth mentioning at this stage: Nigeria’s north-east, north-west and north-central zones have remained with stable population structure in the last 5 decades, with continued high child mortality, higher fertility and dependency ratios.  The south-east, south-west and south-south zones are already undergoing demographic transition with ageing becoming prominent particularly in the south-east, potentially raising the dependency ratio in that zone as well. There are real prospects for demographic dividend in Nigeria’s future, but those prospects are not guaranteed. Policy makers at Federal and State levels ought to understand various implications and take adapted actions for their contexts (3). These would include reproductive health services as well as educating girls, empowering young women in society. Given diversity of performance across various zones, the implications are more serious for some zones than others. Population Health Status Nigeria’s population health is still sub-optimal, despite huge investments by households,