By Michael Owhoko, Ph.D
The quality of a country’s healthcare system is a mirror image of its leaders’ commitment to
citizens’ health. Countries like Singapore, Japan, South Korea and Switzerland are among the
world’s top countries with best healthcare for citizens, driven majorly by robust funding and
well-structured policy programme. Leaders in these countries do not go to foreign countries for
medical tourism, as they have absolute confidence in the delivery capacity of the healthcare
system.
But in Nigeria, the healthcare system is fraught with dysfunctionality, forcing elasticity of
reliability southward. Poor health facilities, unprofessionalism, unethical standards, weak
regulatory agencies, bad personnel attitude, questionable health insurance schemes, unreliable
health management organisations (HMOs), mismanagement, corruption, fake drugs and
obsolete equipment are incidental to lack of commitment by Nigerian leaders to efficient and
quality healthcare system.
Though, this is a symptom of greater disorders in Nigeria, poor funding and non-utilisation of
health facilities by the ruling elites undermine efficiency, quality and delivery capacity of the
healthcare system. Why will leaders not trust and utilize the healthcare system they have built,
equipped and made available to the people through funding? When food is served to public by
a provider who has no intention of eating, there is high probability that quality and hygiene
may be compromised.
In the 2025 federal government budget, only N2.56 trillion was budgeted for the health sector,
representing 5.15 percent of the country’s total budget of N49.7 trillion, which is far below the
15 percent recommended by the Abuja Declaration, to which Nigeria is a signatory. Though, the
N2.56 trillion is an increase of about 58.53 percent of the 2024 budget of N1.62 trillion,
however, when viewed in dollar terms, the amount decreased by 15.45 percent, dropping to
$1.7 billion from $2.02 billion.
Since the famous coup speech of Late General Sanni Abacha on December 31, 1983 that the
country’s health services were in shambles, and hospitals had been reduced to mere consulting
clinics without drugs, water and equipment, the health sector has not shown promises of
improvement. Even 34 years after, the wife of Late President Muhammadu Buhari, Aisha,
confirmed this in 2017 when she resorted to use of a private hospital wholly owned and run by
foreigners due to dysfunctional x-ray machine and lack of syringes in the Villa Clinic.
Unfortunately, 42 years after these observations were made by the powers that were, the
healthcare sector is still defined by lack of government’s commitment. This is particularly
worrisome when viewed against the background of Nigeria’s growing population, currently
characterized by low life expectancy, high maternal and child mortality rates. This means that
dependable and quality healthcare provision is not a priority for government, and therefore, a
mirage for Nigeria to achieve high quality healthcare in line with World Health Organisation
(WHO)’s standard.
Globally, Nigeria is ranked 157th out of 191 countries by WHO in the areas of quality health
delivery performance. As the largest oil producer in Africa and 16th largest in the world, it is
untenable for Nigeria not to provide robust funding for the health sector, given the country’s
huge earnings from crude oil sales.
Even among African countries, Nigeria is rated poorly in healthcare provision. In a report
released by The Legatum Institute, a London-based global healthcare assessment organization,
Nigeria was ranked 11th out of 12 African countries with poor healthcare system. The
countries include Central African Republic, South Sudan, Chad, Lesotho, Somalia, Sierra Leone,
Swaziland (Eswatini), Liberia, Guinea, Angola, Nigeria and Equatorial Guinea.
Despite this poor performance ranking, no concerted effort is being made by government to
improve quality service delivery, as budget allocation to the health sector has been on the
downward swing. Since Nigerian leaders who determine the condition of the sector, do not
utilize the facilities due to poor services, it means the Nigerian healthcare system is designed to
service the health needs of the poor and common Nigerians, and not Nigerian leaders.
Put differently, the healthcare system in Nigeria is determined and conditioned by the thought
process and preferences of those who do not use the services. For example, the President of
the Federal Republic of Nigeria and his cabinet members, including the Minister of Health,
together with the Senate President and members of the Legislature, who approve the nation’s
tertiary healthcare budget, do not patronize services of Nigerian hospitals.
State governors and their cabinet members, as well as members of the state houses of
assembly responsible for approval of budget for secondary healthcare in the country, also, do
not patronize health facilities at this level. Same applies to the various local government
chairmen and council members whose jurisdiction cover primary healthcare. They all seek
better healthcare outside their domains.
The poor premium placed on the health sector by Nigerian leaders have obviously prevented
them from knowing that there is a correlation between robust funding of healthcare system
and a healthy workforce, and by extension, robust economy. A vibrant economy is contingent
upon a healthy population and a healthy workforce, as health is a critical contributory factor to
economic development. This is the reason advanced economies invest so much in healthcare
services, a contrast to Nigeria’s healthcare sector that is troubled by incapacity, unable to
address mounting health challenges in the country.
The healthcare delivery system in Nigeria is executed through public and private facilities.
Unfortunately, the private healthcare providers are also enmeshed in unprofessional conduct
driven by pecuniary motive. Most of them take advantage of the country’s weak systemic
policies to deliver poor health services. Regulatory authorities like the National Agency for Food
and Drug Administration and Control (NAFDAC), National Health Insurance Authority (NHIA),
and The Medical and Dental Council of Nigeria (MDCN) are not doing enough to enforce
professionalism and standards in the country’s healthcare system.
I recently lost a friend to prostrate operation in one of the private hospitals in Lagos. Prior to
the operation, he walked into the hospital by himself, looking normal. But what he took to be a
proactive step to avoid future complications, ended his life. He was admitted under a health
insurance cover managed by an HMO on executive plan with full options. But rapid
deterioration of his health in the hospital triggered skepticism on whether quality of treatment
was commensurate with subscribed insurance plan.
There are numerous public complaints about HMOs conniving with private hospitals to render
inadequate and poor services for financial gains. Most of these hospitals deliberately delay
diagnosis and treatment until approval is obtained from HMOs, notwithstanding conditions of
patients and category of insurance plans. The NHIA which carries out accreditation of HMOs
before approval must look beyond this process to ensure they are continually monitored during
operations.
My late friend’s case reminded me of a professional colleague, Mr. Yusuph Olaniyonu, who
narrated how God spared his life and given another chance to live again at 58. His story
brought to fore, the ineptitude, inefficiencies, unprofessionalism and lack of commitment and
management of patients in Nigerian hospitals. His experience also proved that without
connection at the top, patients can die out of share negligence and abandonment without
consequence.
After undergoing six major operations and three minor procedures for prostrate, his survival
was still on a cliff edge, necessitating the intervention of the Minister of Health through the
help of ThisDay Publisher, Nduka Obaigbena and former Senate President, Bukola Saraki. This
intervention notwithstanding, hopes dimmed, leading Saraki to fly him to Egypt where he
underwent successful corrective surgical operations.
Olaniyony’s case casts aspersion on the entire medical system in Nigeria, and exposed the
agony voiceless Nigerians go through in Nigerian health facilities. Trust deficit induced by poor
services in Nigerian hospitals, has given rise to patronage of unlicensed and quack herbal health
practitioners whose activities are damaging vital organs of innocent Nigerians, with
concomitant reduction in life expectancy.
It is depressing to know that out of about 34,000 general hospitals, 21,000 primary health
centers and 60 teaching hospital and federal medical centers located across the country, only
about 41,000 hospitals are functional.
Government must therefore reorder its priorities to make health facilities efficient, affordable
and reliable to enable both leaders and poor Nigerians alike to receive treatment in-country, as
against resort to medical tourism which cost Nigeria approximately $1.6 billion annually.
Dr. Mike Owhoko, Lagos-based public policy analyst, author, and journalist, can be reached at
www.mikeowhoko.com, and followed on X {formerly Twitter} @michaelowhoko.
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