Bridging the gap: Nigeria’s health crisis demands urgent, coordinated reform

For millions of Nigerians, affordable and quality healthcare remains more a distant hope than a right, especially as illness can often lead to financial ruin, with even basic treatment often out of reach. The country’s health system is failing to deliver, weighed down by decades of underinvestment, policy paralysis, and institutional fragmentation.

Despite a flurry of policy frameworks and reforms that look impressive on paper, Nigeria’s healthcare sector continues to underperform.

Hospitals are overwhelmed, the remaining health workers—those who haven’t joined the growing wave of emigration (japa)—are underpaid, and critical infrastructure is steadily deteriorating.

Insurance schemes, meant to protect the most vulnerable, are poorly implemented and offer little protection. As the population surges past 200 million, the urgency for reform has never been more acute.

These issues were the focus of discussions at a recent BusinessDay Media health conference in Abuja convened under the theme “Bridging the Gap: Advancing Equitable and Affordable Access to Healthcare in Nigeria”, where experts, government officials, investors, and development partners issued a common warning: unless bold, coordinated reforms are enacted—especially in financing and policy enforcement—millions more Nigerians will remain locked out of lifesaving care.

Brian Deaver, CEO of the newly opened Afreximbank-backed Abuja Medical Centre for Excellence, opened the summit with a blunt assessment: “The pursuit of redefining healthcare delivery could not be more timely or more urgent. If we want to lead, we must demand more of ourselves. Not someday—today.”

Deaver argued that system reform must begin with people—not technology or brick-and-mortar. Frontline health workers, he said, are the beating heart of any healthcare system. Yet in Nigeria, they are chronically underappreciated, inadequately trained, and overwhelmed.

“Unsupported and underappreciated workers will not innovate and cannot deliver care,” Deaver said. He called on the government to invest in workforce training, provide supportive environments, and use health data to guide decision-making. “We too often accept mediocrity under the guise of pragmatism. Healthcare should not be an exercise in lowered expectations.”

He pressed for equal access across all demographics, citing the need to eliminate systemic inequities that leave women, people with disabilities, and rural dwellers behind. For Deaver, excellence is a choice, not a luxury. “Let history say that this was the generation that turned the tide for Nigerian healthcare,” he concluded.

Among the biggest pain points is healthcare financing. Nigeria spends well below the global average on health, and out-of-pocket payments, often catastrophic, account for more than 70 percent of total health expenditure. Public funding is thin, donor contributions are declining, and private investment is slow to scale due to perceived risk and a lack of regulatory clarity.

The government spending on health remains shockingly low, at just 0.5 percent of GDP (about $14 per person annually), and even less is directed toward primary care.

The 2024 national budget, for instance, allocated N1.34 trillion to health, representing 4.64 percent of the total N28.78 trillion budget.

In per capita terms, this works out to N6,289 per person annually, or N524 per month, assuming an estimated population of 212 million.

Only about 9.5 percent of Nigerians are covered under any form of health insurance as of 2024.

Mustapha Zakari, Executive Vice Chairman of Masslife Healthcare Ltd., painted a bleak picture of affordability. “More than half of the Nigerian population is multidimensionally poor and cannot afford healthcare when needed,” he said. He advocated for direct financial incentives to increase household purchasing power and reduce the burden on families.

For Zakari and others, breaking this cycle requires innovation in how health is financed, not just how it is delivered. Proposals floated included expanding social health insurance, introducing targeted subsidies for low-income earners, and leveraging technology to track and deliver entitlements efficiently.

Adetolu Ademujimi, Technical Adviser at APIN Public Health Initiatives, emphasised the role of local industry and the need to de-risk health sector investments. While commending government efforts to stimulate local pharmaceutical manufacturing, he noted that investor appetite is still held back by high interest rates, lack of concessional loans, and poor infrastructure.

“We need investments that are not just supply-driven but based on real-time data and national priorities,” he said, stressing the importance of aligning private capital with public health goals.

Chineye Ajayi, Legal Counsel at Olaniwun Ajayi LP, speaking on behalf of partner Ibi Ogunbiyi, took aim at poor policy follow-through. “Policy without implementation is paper,” she said. Despite legal frameworks like the 2022 National Health Insurance Authority (NHIA) Act, actual enforcement remains uneven, and millions remain uninsured.

Ajayi urged the government to move beyond draughting legislation to ensuring real compliance. She said implementation lags, loopholes, and weak governance structures continue to deter serious private investment.

The shortcomings of health insurance were a recurring theme. Lekan Ewenla, Managing Director of Ultimate Health Management Services, said the failure to fully implement mandatory insurance enrollment had undermined what could have been a transformative reform. “We are losing an opportunity to change the direction of poor health services,” he said.

He argued that Nigeria must develop enforcement frameworks that ensure every citizen is enrolled, particularly in the informal sector, where coverage is weakest. Without universal participation, the economics of risk pooling simply do not work, and the cost burden remains unsustainable.

Weibe Boer, Chief Growth Officer at JIPA Network, drew comparisons with health systems in the Caribbean, where risk-pooling and unified funding models have been effective in lowering per capita costs. “When you take 200 million people together, the cost per person becomes quite low,” he said. Boer urged Nigeria to fully leverage its scale and create a single national funding pool.

Boer advocated for consolidating federal, state, donor, and private funds under a unified structure led by the NHIA, which he said would enable better oversight, coordination, and return on investment. But he cautioned against relying solely on legal mandates to drive insurance adoption.

“In the Caribbean, mandates don’t always work as expected. Nigeria should consider strategies that attract citizens into the system rather than just punish non-compliance,” he said. Boer proposed incentive structures, such as discounts, rewards, or bundled benefits, to increase enrollment and participation.

He also stressed the importance of integrating care delivery across public, private, and faith-based institutions, creating a national provider network that offers quality assurance, economies of scale, and a consistent patient experience regardless of location.

Boer warned that failure to act will only deepen economic losses. Nigeria currently loses an estimated $2 billion annually to medical tourism, a figure stakeholders say could be drastically reduced with targeted investment and reform. That capital flight, they argue, represents missed opportunities to build world-class facilities, create jobs, and establish Nigeria as a regional health hub.
“This isn’t just a moral imperative; it’s an economic strategy,” Boer said.

Iziaq Salako, Minister of State for Health and Social Welfare, acknowledged the concerns and outlined the administration’s ongoing efforts to scale investment, expand insurance coverage, and upgrade primary healthcare infrastructure. He stressed that the government was not solely focused on building supply but also on creating demand.

“I want to assure you that the government is not just thinking about the supply side but also the demand side,” Salako said. “We look forward to deeper partnership with the private sector.”

Still, many in the room noted that Nigerians have heard such promises before. Scepticism runs deep after years of unfulfilled policy announcements, underfunded programmes, and revolving-door leadership.

Yet for all the challenges, there is also cautious optimism. The tools for reform are within reach, and the consensus among stakeholders, rare in Nigeria’s fragmented health landscape, offers a potential turning point. What remains is political will and the courage to disrupt vested interests that benefit from the system’s dysfunction.

If Nigeria is to escape its healthcare crisis, it must move beyond rhetoric and begin the difficult work of building a health system that serves everyone, not just those who can afford it.

The opportunity to rewrite the story exists, analysts say. However, their concern is whether it will be taken before the costs of inaction become irreversible.

COURTESY: businessday