Why Nigeria’s healthcare can’t survive on promises

If we want to be truthful as long as this matter lasts, Nigeria, the most populous country on the African continent, is still caught in the grip of a healthcare system that is weighed down by decades of structural inefficiencies and policy missteps.

In a country where even the basic right to access quality healthcare remains elusive for many, trust in public health institutions is fast eroding. Rebuilding that trust has now become a matter of national urgency.

At a recent Ministerial Oversight Committee meeting in Abuja on June 30, the Minister of Health and Social Welfare, Dr. Mohammed Pate, revealed that the Federal Government’s ongoing tax reforms could offer a fresh pathway to increased health sector funding. According to him, the newly signed tax law by President Bola Ahmed Tinubu is expected to ramp up government revenue, a portion of which will be used to finance public services, including health. While this might sound reassuring, Nigeria’s citizens have grown wary of lofty promises that rarely translate into meaningful change.

For far too long, the country’s health system has depended heavily on donor funding, often leaving it vulnerable to shifts in foreign policy and aid fatigue. Now, with the government voicing its commitment to domestic resource mobilisation, expectations are cautiously optimistic. But words will not heal hospitals.

One of the most glaring ironies remains the staggering amount spent by Nigerians, particularly the elite, on medical treatment abroad. Estimates put that figure between $1.1 billion and $2 billion every year. It’s a bleeding wound on the economy and a testament to the lack of confidence in the country’s own medical infrastructure.

Part of the government’s immediate plan includes the release of ₦32 billion, which, when spread across the population, equates to roughly ₦140 per person. This fund, aimed at improving healthcare access, is expected to be disbursed between April and June 2025, with actual releases anticipated by the end of August. It’s a gesture that, while symbolically important, is woefully insufficient to plug the gaping holes in the system.

The rot in Nigeria’s health sector runs deep. Years of budgetary neglect have left hospitals scrambling to function with outdated equipment, constant drug shortages, and dilapidated infrastructure. The 2001 Abuja Declaration, in which Nigeria committed to allocating at least 15% of its national budget to health, remains more of a forgotten aspiration than a working reality. Year after year, the health sector receives a pittance, making Universal Health Coverage a distant dream.

A worsening brain drain compounds the crisis. Thousands of Nigerian doctors, nurses, and allied health workers have packed their bags for countries offering better pay, better working conditions, and the professional respect that is often lacking at home. In the past five to seven years alone, over 16,000 doctors are reported to have left the country, with more on their way out each month. Those who stay behind are stretched thin and frequently disillusioned.

In rural communities, access to medical care is severely limited. Urban hospitals, meanwhile, grapple with personnel shortages, not always because the professionals don’t exist, but because the system that ought to employ them is bogged down in corruption and inefficiency. Internships, once the gateway to a medical career have become monetised, locking out capable hands unless they can pay their way in.

Policy fragmentation and poor coordination have only made things worse. Health insurance remains patchy, with many citizens still having to pay out of pocket for even the most basic services. Out of over 30,000 Primary Health Centres scattered across Nigeria, only about 20% are considered functional. Most others cannot even manage simple medical needs.

One of the most alarming developments has been the unchecked rise of casual medical labour. Initially conceived as a temporary measure to plug short-term staff shortages, the locum system has turned into a trap. Doctors on short-term or rolling contracts are denied the benefits of permanent employment, no pensions, no leave, no residency training, no hazard pay. Yet, they perform the same tasks as their full-time colleagues, sometimes in even more hazardous conditions. Their job security is practically nonexistent, renewed month after month with no clear path to career growth or permanence.

This systemic exploitation is not only unjust, it is also detrimental to the delivery of healthcare. When frontline workers feel disposable, the quality of care inevitably suffers.

There’s a critical need for a national locum policy, one that standardises how casual health workers are hired, paid, and protected. At the very least, they deserve a pathway to permanence, or at minimum, fair compensation and benefits commensurate with their labour.

What Nigeria needs now is not another round of bureaucratic lip service but a complete overhaul of its health sector priorities. The government must take deliberate steps to increase health funding, improve infrastructure, offer competitive salaries to stop the brain drain, and revive the confidence of health workers. Primary Health Centres, particularly in underserved areas, must be upgraded, staffed, and equipped to meet real needs.

Equally important is expanding access to health insurance. When people cannot afford to fall sick, they stop seeking care until it’s too late. Financial protection in health is not a luxury, it’s a necessity for development.

If the country truly wishes to reduce preventable deaths, control disease outbreaks, and build a productive population, then its health system must work for everyone, not just for those who can afford to fly to London for a check-up. Until then, medical tourism will thrive, hospitals will decay, and citizens will continue to pay the ultimate price for the government’s healthcare negligence.

Nigeria has been here before, but perhaps this time with the right policies and political will, it won’t just be another page in the endless story of broken promises. Perhaps this time, we’ll start writing a new script where health is no longer treated as charity, but as the basic right it has always been.