Nigeria, an oil-rich nation, and Africa’s most populous country with over 200million people, grapples with a healthcare system facing numerous challenges, which is hindering its ability to provide equitable access and quality care. With lots of the country’s healthcare problems being not only clinical but mostly economic, this has led to a confidence crisis in the healthcare sector. Even though we talk a lot about the issues, it’s crucial to shine more light on the big problems and suggest ways we can make things better.
Home to a vast and underserved population, Nigeria is faced with a significant disease burden, making the demand for healthcare services exceed the available resources (from manpower to facilities). This has resulted in challenges related to accessibility, quality of care, and overall health outcomes. According to World Poverty Clock 2023 data, about 83 million Nigerians representing approximately 40% of the population live in extreme poverty. In addition to this, people face social conditions that contribute to ill health which includes poor sanitation, air pollution, non-access to clean water, and food insecurity, especially amongst children. Also, the reliance on out-of-pocket spending has placed healthcare services beyond the financial reach of many poor Nigerians. Again, despite being the largest economy by GDP in Africa, Nigeria contends with a paradox of a low per capita income of about US$2,140 and highly inequitable distribution of wealth and health. This presents a visible contrast of wealth and poverty, thus creating a complex socioeconomic backdrop for healthcare delivery. This financial barrier compounds the challenges faced by the nation’s most economically disadvantaged people, limiting their access to essential medical care.
Furthermore, the other issues in the healthcare sector include the not too effective utilization of available resources which has led to increased medical tourism by Nigerians and its leaders abroad. Similarly, the lack of robust population health data, insufficient government health financing which falls short of even the Sub-Saharan regional average in healthcare expenditure, and sub-optimal deployment of funds to purchase health services has contributed to systemic inefficiencies and hinder the provision of quality care. Despite an increase from 4.76% in the 2022 healthcare allocation, only 5.75% of the total budget is allocated to the health sector in the 2023 proposed budget. This inadequacy reflects a critical gap in the government’s fiscal commitment to the health and well-being of its citizens.
Hence, it is imperative therefore that the government considers the strategic channeling of resources towards building and upgrading healthcare infrastructure including hospitals, clinics and medical facilities, expansion of primary healthcare, particularly in underserved regions. Moreover, the government should prioritize training and recruitment of more healthcare professionals to address the shortage of skilled personnel. With only about 24,000 doctors currently available in the country, the current doctor-patient ratio of approximately 1:10,000, which is in contrast with WHO’s recommendation of one doctor to 600 patients. It is imperative that the government provides incentives to available healthcare personnels towards curtailing brain-drain in the sector and ensuring a well-motivated competent workforce.
In developing a centralized and digitized health information systems, Nigeria can streamline its data collection, analysis, and reporting. This can be achieved by collaborating with international organizations and leveraging technology for real-time data sharing which will allow for evidence-based decision making and interventions.
Furthermore, by encouraging more Public-Private Partnerships (PPP) the government can leverage additional funding and expertise for healthcare projects. This model has proven to be successful in Lagos University Teaching Hospital (LUTH) NSIA Cancer center and Synlab diagnostic center.
In addition, expanding and promoting health insurance programs would reduce the burden of out-of-pocket spending and provide financial protection for individuals and families. Implementing the new National Health Insurance Act (NHIA) 2022 which aims to secure mandatory health insurance for every Nigerian and legal resident and establishing subsidized health insurance coverage for vulnerable persons through payment of health insurance premiums for indigent population is imperative at this stage to achieving universal health coverage.
It is also worth noting that involving local communities in the design and implementation of healthcare policies will ensure cultural relevance and responsiveness to community needs. The emphasis of these policies should be on redirecting resources towards key social determinants by prioritizing adequate sanitation, access to clean air and water, and food security especially for children. Likewise, by implementing the existing policies that promote public health, the government can improve healthcare infrastructure and services particularly in rural areas leading to equitable access to quality care regardless of location. With these, we can lay the foundation for a healthier and more resilient society.
In conclusion, the country stands at a critical juncture in its healthcare journey, where addressing the complex challenges requires a multi-faceted approach. Through strategic resource allocation, improved data collection, innovative financing models, and equity-centered policies, Nigeria can pave the way for a healthcare system that offers equitable access and quality care for all its citizens. It is worth saying that the paradox of poverty amidst wealth underscores the urgency of transformative actions. Hence, collaboration between government agencies, international organizations, and local communities is paramount to effecting lasting change. I believe that through strong political will and concerted efforts towards addressing these challenges, Nigeria can build a resilient healthcare system capable of meeting the diverse needs of its population and ensuring a healthier future for all.
Dr. Oluwaseyi Atoyebi is a Health Sector Management (HSM) Fellow at the Fuqua School of Business, Duke University, North Carolina, USA.
