Essential Health Reforms Cannot Be Compromised

Nigeria’s Struggle for a Robust Healthcare System

Nigeria, Africa’s most populous country, continues to face significant challenges in its public health system. The nation’s healthcare infrastructure is burdened by long-standing issues that have hindered the delivery of quality care to its citizens. Ensuring access to healthcare and building trust in health institutions have become critical national priorities.

On June 30, during the Ministerial Oversight Committee meeting held in Abuja, the Minister of Health and Social Welfare, Mohammed Pate, announced that the Federal Government’s tax reform would significantly boost health funding. He highlighted that the recent tax law signed by President Bola Tinubu would increase government revenue, which could be used to finance essential services such as healthcare. While these promises are not new, they mark an important shift in Nigeria’s approach to healthcare financing.

Historically, Nigeria has depended heavily on external funding for its health programs. However, the government is now determined to change this narrative. This effort is crucial, especially considering that Nigerians, particularly the elite, spend between $1.1 billion and $2 billion annually on medical tourism. This trend drains the economy and highlights the urgent need for improved domestic healthcare services.

As part of these efforts, Pate announced the planned disbursement of N32 billion—approximately N140 per citizen—over six months to improve access to quality healthcare nationwide. This allocation, covering the period from April to June 2025, is expected to be released by the end of August. While this injection of funds represents a positive step forward, it falls short of addressing the deeper systemic issues within the health sector.

Chronic underfunding has left many hospitals ill-equipped, with shortages of essential medicines and inadequate infrastructure. Since 2001, when Nigeria set a target of allocating 15% of its budget to the health sector, the country has consistently failed to meet this goal. As a result, the vision of Universal Health Coverage remains unfulfilled.

The health sector also faces a critical shortage of professionals. Many doctors and nurses seek better opportunities abroad due to poor working conditions and low pay. According to reports, over 16,000 doctors have reportedly emigrated in the last five to seven years. This brain drain exacerbates existing challenges, particularly in rural areas where access to medical facilities is limited. Even in urban centers, hospitals often suffer from understaffing, partly due to deep-seated corruption that has monetized internship slots for medical graduates, keeping qualified professionals out of the system.

The sector also struggles with weak policy implementation, fragmented health insurance systems, and insecurity, leaving millions without basic care and limited access to medical facilities. Only about 20% of the over 30,000 Primary Health Centres (PHCs) across Nigeria are fully functional, according to the National Primary Health Care Development Agency. The rest cannot provide essential primary healthcare services.

Another pressing issue is the systematic casualisation of medical labor. Originally introduced as a temporary solution to address staff shortages, locum employment has become a trap for many doctors whose salaries are significantly lower than those of full-time colleagues, even when performing identical duties. These temporary workers are excluded from standard entitlements such as pension contributions, health insurance, paid leave, residency or specialist training slots, hazard and call duty allowances, and promotion or official recognition.

To address these challenges, Nigeria must adopt a strategic and holistic approach. Prioritizing healthcare, increasing budgetary allocations, raising health workers’ pay, and improving their general welfare are essential steps. The government needs to develop a clear locum policy that guides how healthcare professionals are recruited, managed, and fairly compensated.

Upgrading and equipping PHCs, ensuring adequate funding for healthcare, and expanding access to health insurance are also critical. Effective health reforms can reduce the disease burden, lower mortality rates, and ensure that more Nigerians—regardless of income or location—can access the care needed for healthier, more productive lives.