Nigeria at 66: A Look at Our Health Sector Today

…for the Tinubu administration to turn this year’s anniversary theme of “Consolidating Nigeria’s Renewed Hope for Shared Prosperity” into action in the health sector, it must focus on financial protection as the main priority… This means quickly expanding publicly funded health insurance for poor and vulnerable families instead of relying on people to pay for themselves.

Every year since 1960, Nigeria has marked its independence from British colonial rule on 1 October. This year, we celebrate the 66th anniversary. The current government has planned a modest ceremony for Thursday. They chose the theme “From Reforms to Stability: Consolidating Nigeria’s Renewed Hope for Shared Prosperity” to highlight some results from the president’s economic reforms across the nation.

Such celebrations have allowed other groups and stakeholders to reflect on how Nigeria has progressed over time. The health sector is one of these key areas because a healthy population supports economic growth, social stability, and education. This article offers a fair assessment of the health sector under the current administration from a medical practitioner’s viewpoint.

Looking at the past three years, the Tinubu administration has made some significant strides in health. Key among these is a clearer national health reform program, including the Nigeria Health Sector Renewal Investment Initiative (NHSRII), Health Sector Strategic Blueprint 2024, 2027, and the National Suicide Prevention Strategic Framework (NSPSF) 2023, 2030, which I helped develop.

These initiatives have unified federal and state health programs into a stronger framework. They offer a guide for reshaping health governance, healthcare delivery, and funding. This is a big step forward since Nigeria's health policy has often been fragmented between federal, state, and local government efforts. There have also been weak policy tools to support existing laws and international commitments that could improve Nigeria's health system.

Another major win has been the expansion and upgrading of primary healthcare facilities nationwide. This is a vital investment as primary healthcare is the foundation of our health system. In Nigeria, about 70 percent of people depend on primary healthcare, with these facilities making up over 80 percent of all medical centers. The past lack of funding has left many Nigerians without proper access to healthcare.

So, investing in primary care, as this administration has started to do, means providing better healthcare closer to where people live and work. This reduces barriers to access. Also, initiatives like the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) focus on boosting local production of medicines and medical equipment. This aims to lessen our reliance on imports.

But we cannot ignore that the recent fiscal policies, such as removing fuel subsidies and devaluing the naira, have caused a significant strain on healthcare.

Still, the negative effects of these fiscal reforms on healthcare access have not led to a corresponding increase in government health spending. While not trying to blame any government, comparing the federal health budgets from the last years of Buhari’s administration to Tinubu’s shows a surprising contrast.

Since 2023, the naira has lost about 60 percent of its value due to ongoing inflation. This drop has come from an inflation cycle that peaked under the current administration after major policy changes like the removal of fuel subsidies and floating the currency.

The cost of accessing healthcare has shot up. This includes the rising costs of medicines, medical equipment, energy to run health facilities, salaries for healthcare workers, health insurance, and transport to hospitals.

Yet, the negative impact of the administration’s fiscal changes on healthcare access has not resulted in higher health spending by the government. Comparing the federal health budgets between the end of Buhari’s term and Tinubu’s reveals a surprising situation.

Although the naira amounts have nearly doubled under Tinubu, their real value in dollars has dropped sharply because of currency devaluation. For example, in 2022, the health budget of ₦826.9 billion was worth about $1.84 billion. In contrast, the ₦2.48 trillion allocated for health in 2026 under Tinubu is only valued at about $1.77 billion at the current exchange rate.

This inflation has also put a lot of pressure on public secondary and tertiary hospitals. Many teaching hospitals are struggling with high overhead costs that exceed their revenue.

Much of this cost goes towards energy generation, especially after the removal of energy subsidies. The fiscal changes have also hurt the pay of healthcare workers compared to their international peers. This has led to many professionals leaving the sector.

While there have been some efforts to improve pay, Nigerian doctors still earn much less than their peers in other countries, including some in Africa. Studies show that doctors in Nigeria rank towards the bottom globally in terms of salary.

The ongoing Collective Bargaining Agreement (CBA) being discussed between the federal government and health worker unions, including the Nigerian Medical Association, could be a fair way to settle ongoing labor disputes, prevent hospital strikes, and tackle the brain drain. The Tinubu administration should prioritize its quick resolution.

Doctors in countries like South Africa and Botswana earn up to ten times what a Nigerian doctor makes today because of better healthcare budgets and economic support.

For the Tinubu administration to move beyond the anniversary theme of “Consolidating Nigeria’s Renewed Hope for Shared Prosperity,” it needs to prioritize financial protection in healthcare.

This means quickly expanding public health insurance for the poor and vulnerable instead of relying on individuals to enroll and pay. The government must view the health worker crisis not just as a recruitment issue but as a retention challenge.

Experienced healthcare workers will continue to leave if wages are not fair. There needs to be an active plan to keep health workers in Nigeria with salaries that adjust for inflation and reflect current economic realities.

The Collective Bargaining Agreement (CBA) being worked out between the federal government and health worker unions is a fair and legally binding way to solve deep-seated labor issues. It can help avoid nationwide hospital strikes and address the brain drain issue. The Tinubu administration should aim for a quick conclusion.

Beyond salaries, offering tax incentives and special health insurance packages for doctors and health workers who have served for years will encourage commitment to the system and help reduce the outflow of doctors from public service and the country.

To cover these extra costs, the government needs to increase health spending in real terms. They should aim for at least 7.5 percent of the total budget next year and increase it by 20 percent each year for the next five years until they reach the 15 percent target set in the Abuja Declaration.

Happy Independence Day, Nigeria!