Background: : Health sector reform is a government-guided sustained process of structural change in programs and institutions of the health sector. Many developing countries like Nigeria have instituted various reforms in the health sector. However, issues in provision of quality healthcare persist. Hence this study explored high level stakeholders' perspectives on health reform in Nigeria. Methods: : The study was a descriptive case study using qualitative key informant interviews with purposively selected high-level government stakeholders in the Nigerian healthcare system comprising the Federal Ministry of Health and its agencies and institutes. Key aspects of health reform as identified by the World Health Orga-nization were captured and used to develop a semi-structured interview guide. Seven Key Informant Interviews were carried out and recordings were transcribed verbatim and manually analyzed using standard techniques of thematic content analysis. Results: : The emerging themes showing why reform has not led to improvement in the quality of healthcare include maladministration of the healthcare system, lack of an evidence-based engagement process and situation analysis involving all stakeholders, human resource shortages, weak health insurance, neglected primary healthcare system, poor financing, and weak political will. Conclusions: : The study assessed policy and governance stakeholders' views and perspectives on health sector reform in Nigeria. Findings showed various reasons why reform has not worked in Nigeria including poor stakeholder engagement and not following an evidence-based approach. Addressing these challenges by implementing some stakeholder perspectives including decentralizing the reform process and capturing the opinion of the people the reform is meant for can improve current and ongoing health reform policies. This could lead to an improved health system which can drive the attainment of Universal Health Coverage in Nigeria.