…for the Tinubu administration to translate this year’s anniversary theme of “Consolidating Nigeria’s Renewed Hope for Shared Prosperity” beyond the slogan in the health sector at least, it must focus on financial protection as the immediate health-sector priority… This means rapidly expanding publicly financed health insurance for poor and vulnerable households rather than relying predominantly on people to enrol and pay themselves.
Every year since 1960, the Nigerian state has celebrated the anniversary of its independence from the British colonialists on 1 October. This year marks the 66th of such celebrations. The present government has planned a ceremony, however low-key, to commemorate the day on Thursday. The government has chosen the theme “From Reforms to Stability: Consolidating Nigeria’s Renewed Hope for Shared Prosperity”, conceivably to showcase some of the fruits of the president’s signature economic reforms on different aspects of the economy and national development.
Historically, such commemorations have provided opportunities for non-state actors and stakeholders to also reflect on how the nation has fared, from more objective perspectives, in critical sectors of relevance to them. The health sector is one of such cornerstone sectors in view of the fact that a healthy population drives economic growth, social stability, and educational advancement. This brief narrative provides an objective, non-partisan appraisal of the health sector under the present administration from the eye of a medical practitioner and public health enthusiast.
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Objectively speaking, the past three years of the Tinubu administration have ushered in some landmark achievements in the health sector. Notable among them is a more coherent national health-sector reform programme such as 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 was personally involved in the theoretical development and finalisation of.
These policy initiatives brought the resources of the federal and state health programmes under a more coordinated framework and provided a template for restructuring the health sector governance, healthcare delivery, and funding mechanisms. These are significant steps because Nigerian health policy has historically suffered from fragmentation between federal, state and local government programmes. In addition, there have also been historically weak policy instruments to support existing legislative architecture and international normative commitments, with potentials for transforming the Nigerian health system.
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The ongoing major expansion and revitalisation of primary healthcare facilities across the country is another notable achievement of this administration. The revitalisation of primary healthcare facilities in Nigeria is arguably the most strategic investment in the healthcare sector because they form the bedrock of the national health systems. In a country where roughly 70 per cent of the population relies on primary healthcare, with primary care facilities accounting for over 80 per cent of all medical facilities, the historical under-funding of primary healthcare has left many Nigerians without meaningful access.
Therefore, investment in the primary care sector, as the present administration has more distinctly embarked upon, yields higher returns as functionality directly translates to bringing healthcare closer to where people live and work, reducing geographic barriers to access. Furthermore, through well-thought-out initiatives such as the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC), the present administration has placed greater emphasis on local pharmaceutical and medical-product production to reduce dependency on imported medicines, medical equipment, and diagnostics.
However, it is also noteworthy that the fiscal policy reforms embarked upon by the administration, including the fuel-subsidy removal, the devaluation of the naira, and the attendant inflation and high interest rates, have conspired together to create a sustained major healthcare shock in the country.
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Yet, the stark reality of the negative impact of the administration’s fiscal reforms on healthcare access in the country has not translated into proportionately higher health spending by government. While not trying to praise or blame any government, comparing the federal health budget allocations between the final years of the Buhari administration and the current Tinubu administration reveals a stark paradox.
Between the year 2023 to date, the Nigerian currency has lost almost 60 per cent of its domestic value due to compounding inflation. The rapid erosion of the naira’s value was driven by an intense inflationary cycle that peaked during the present administration following major macroeconomic policy shifts such as the fuel subsidy removal and the floating of the currency, among others.
As a result, the overall cost of healthcare access has risen astronomically under this administration through higher costs of medicines and medical equipment, higher energy costs to run healthcare infrastructure, higher personnel costs for healthcare workers, higher health insurance premiums, and the rising cost of transportation to the physical location of hospitals.
Yet, the stark reality of the negative impact of the administration’s fiscal reforms on healthcare access in the country has not translated into proportionately higher health spending by government. While not trying to praise or blame any government, comparing the federal health budget allocations between the final years of the Buhari administration and the current Tinubu administration reveals a stark paradox.
While the naira amounts have nearly doubled under Tinubu, the actual value in dollar terms has significantly declined due to the massive devaluation of the currency. For instance, in relative dollar terms, a smaller health budget of ₦826.9 billion in 2022 in the last year of Buhari was worth roughly $1.84 billion compared with a humongous ₦2.48 trillion allocation to health in 2026 under Tinubu but with a lower real-world value of about $1.77 billion at present exchange rate.
The inflationary trend has also led to major strain on the operations and infrastructure of public secondary and tertiary hospitals across the country. Most teaching hospitals in Nigeria are labouring under the weight of heavy overheads that have stretched their revenue (both internally generated and subventions) beyond healthy limits.
A sizeable chunk of the costs goes to energy generation and financing in the era of forgone energy subsidy. The fiscal reforms have also led to a severe erosion of the purchasing power of the healthcare workforce relative to international peers, with attendant mass exodus of critical manpower in the sector.
Though there has been some undeniable attempt to improve remuneration, the comparative wage gap between Nigerian doctors and their counterparts in other countries, including some African countries, is still atrocious. Virtually all analyses that have compared wages of doctors in Nigeria with those of their counterparts have placed them at the bottom tier globally.
The ongoing Collective Bargaining Agreement (CBA) being worked out between the federal government and the health worker unions — including the Nigerian Medical Association — is a potential fair, data-driven, and legally binding framework that resolves deep-seated labour disputes, prevents nationwide hospital strikes, and directly addresses the systemic brain drain affecting the country. The Tinubu administration will do well to see this to a rapid conclusion.
Doctors working in other African countries such as South Africa, where strong provincial healthcare budgets ensure strong health-worker wages, and Botswana, where the economy is heavily subsidised by diamond/mineral wealth, can boast of earning up to ten times the average wage of the Nigerian doctor right now.
Therefore, for the Tinubu administration to translate this year’s anniversary theme of “Consolidating Nigeria’s Renewed Hope for Shared Prosperity” beyond the slogan in the health sector at least, it must focus on financial protection as the immediate health-sector priority.
This means rapidly expanding publicly financed health insurance for poor and vulnerable households rather than relying predominantly on people to enrol and pay themselves. Government must also stop treating the human-resource crisis in the health sector as a recruitment problem but as a retention problem.
Experienced health workers will continue to leave, creating critical shortages, in as long as wages are not equitable. There must be an aggressive and deliberate strategy to retain health workers in the country through competitive, inflation-adjusted salaries, and wage packages that reflect modern economic realities.
The ongoing Collective Bargaining Agreement (CBA) being worked out between the federal government and the health worker unions — including the Nigerian Medical Association — is a potential fair, data-driven, and legally binding framework that resolves deep-seated labour disputes, prevents nationwide hospital strikes, and directly addresses the systemic brain drain affecting the country. The Tinubu administration will do well to see this to a rapid conclusion.
Beyond wages, special tax incentives and special health insurance packages for doctors and health workers who have served the public sector for a number of years in the country will incentivise commitment to the system and mitigate one of the pull factors for the mass exodus of doctors from the public sector and indeed the country.
To finance the extra burden, government must increase health spending in real terms by increasing the budgetary allocation to the health sector to at least 7.5 per cent of the total budget in the next year, increasing by 20 per cent annually for the next five years until the target 15 per cent of annual budget as committed to in the Abuja Declaration is achieved.
Happy Independence Day, Nigeria!
Olayinka Atilola is the National Publicity Secretary of the Nigerian Medical Association (NMA).
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