Usually positioned as a transformative period, every transition inherently carries the promise of a brighter future. The fiercely contested presidential elections in February 2023, though marked by acrimonious campaigns and a flood of litigations, also served as a catalyst for a potential policy reset. This, in turn, opens avenues for critical reforms across key sectors, notably the healthcare sector.
Naturally, national aspiration for the nation centres around a new administration that prioritises health. The leadership appointments within the health sector by the President Bola Tinubu administration signal a promising commitment to the prioritisation of health. The designations of Professor Muhammad Ali Pate as the Coordinating Minister of Health and Social Welfare, Dr Tunji Alausa as the Minister of State for Health, and Dr Salma Ibrahim Anas as the Special Adviser, Health to the President set an enthusiastic tone for a health sector poised to fulfil the new administration’s campaign promise for health, aligning with its Renewed Hope Agenda.
These key appointments at the forefront of the country’s health sector were complemented by the selection of Dr Muyi Aina to lead the National Primary Health Care Development Agency (NPHCDA) and Dr Kelechi Ohiri to head the National Health Insurance Authority (NHIA). The unquestionable competence of these appointees underscores the presence of well-suited individuals in their respective roles, creating a harmonised leadership team that presents a genuine opportunity for the nation.
Nigerians harbour significant hopes and expectations for the healthcare sector. The intensification of economic challenges underscores the pressing need for a well-functioning health system that guarantees access to affordable, readily available, and high-quality healthcare. Despite sporadic successes, our health indices have seen minimal improvement in recent years, maintaining a perception of stagnation and acting as a drain on the economy. The existing economic constraints and fiscal limitations only amplify the complexity of this challenge.
Within these challenges, there lies a unique opportunity for the Nigerian health sector to transition from being a mere beneficiary of an improved economic landscape to becoming a proactive driver of economic growth. The new leadership team has articulated a strategy aimed at bringing about enhancements in the health sector, focusing on pivotal areas. These areas warrant renewed attention, aligning with the Coordinating Minister of Health and Social Welfare’s four-point agenda. Here are five focal opportunities for the current administration to ensure the evolution of a health sector that aligns with the aspirations of Nigerians.
A tangible demonstration of the current administration’s commitment to healthcare, transcending rhetoric, is its actual investment in the sector. Despite initial disappointment stemming from the absence of additional health funding in the N2.18 trillion supplementary budget approved by Nigeria’s cabinet in October 2023, the newly proposed budget for 2024 allocates N1.23 trillion to health. However, this figure accounts for less than five per cent of the proposed N27.5 trillion aggregate government expenditure. Historically, Nigeria has consistently allocated insufficient funds to the health sector. Considering the nation’s escalating population and persistent health challenges, investing in healthcare is not merely a cost but a strategic and indispensable investment in the well-being and productivity of the population. Such an investment also contributes significantly to the country’s economic prosperity.
Investing in health is fundamentally a political choice, demanding unwavering political will at the highest echelons to ensure equitable healthcare access for all citizens. This commitment can serve as a potent source of political capital for the administration. To establish the groundwork for achieving Universal Health Coverage (UHC), a comprehensive strengthening of health systems is imperative, with robust primary healthcare positioned as the pivotal axis around which other enhancements in healthcare delivery revolve.
The Nigeria Health Sector Renewal Compact and Investment Initiative, endorsed by Mr. President during UHC day in December 2023, provides an early testament to the existence of political will at the highest levels. This landmark event not only signifies a dedication to enhancing funding mechanisms for primary healthcare but also outlines an integrated monitoring and accountability framework. If executed, this sector-wide approach promises improved coordination and enhanced alignment between the government and development partners. The commitment expressed by the Coordinating Minister of Health and Social Welfare is evident in the promise to redesign the Basic Health Care Provision Fund (BHCPF), aiming to elevate the number of functional Primary Health Care Centers (PHCs) from 8,000 to 17,000. Furthermore, the commitment to allocate $3 billion of pooled and non-pooled financing toward primary healthcare between 2024 and 2026 demonstrates a proactive approach. Achieving these ambitious goals would undoubtedly herald brighter days ahead for the nation’s healthcare landscape.
The international migration of health workers has reached breaking point for healthcare delivery in Nigeria. In 2023, it was notable to hear politicians proffer solutions and proposing poorly thought through legislation to stop the migration of health workers. The World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel sought to establish principles based on the ethical recruitment of health workers. However, the Code of Practice is voluntary, so there is no legal enforcement on adherence. The reality is that Nigeria is training an insufficient number of health workers for a population of nearly 200 million people. The WHO recommends a density of 4.45 doctors, nurses and midwives per 1000 people in order to provide health services and achieve universal health coverage.
To address the international migration of health workers, many of the core problems must be addressed, including both the “push factors” that cause people to leave Nigeria and the “pull factors” that draw health workers to their destination countries. The Lancet Nigeria Commission recommended the training of more health workers to increase the current supply. However, the government should also leverage the Nigerian diaspora, ensuring that there is an enabling and conducive environment for health professionals looking to invest or engage with the Nigerian health sector. This would enable the country to benefit from a “brain gain.”
In 2023, several pharmaceutical companies made the alarming announcement of ceasing operations in Nigeria. A primary challenge faced by manufacturers was the absence of local production for pharmaceutical raw materials, particularly Active Pharmaceutical Ingredients (APIs). This predicament was further exacerbated by the unstable exchange rate and persistent issues with power supply in the country. The cumulative effect has been a substantial increase in the cost of medicines, forcing patients into difficult decisions, such as reducing their medication dosage or, in more severe cases, forgoing essential treatments.
Nigeria, akin to many other African nations, heavily relies on the importation of medicines, diagnostics, and vaccines. The vulnerabilities of this dependency were starkly exposed during the COVID-19 pandemic. Subsequent initiatives, including the African Vaccine Manufacturing Accelerator (AVMA) and Partnership for Vaccine Manufacturing (PAVM), have emerged with the aim of enhancing access to medicines across Africa. These initiatives also involve the establishment of manufacturing sites specifically dedicated to vaccines, addressing a critical need in the region.
The Coordinating Minister of Health and Social Welfare has underscored medical industrialisation and unlocking the health value chain as key priorities. The appointment of Dr. Abdu Mukhtar as the National Coordinator of the Presidential Unlocking Healthcare-Value Chain Initiative signifies a concerted effort to expand domestic manufacturing of pharmaceuticals and diagnostics in Nigeria.
In 2024, a heightened focus on strengthening health security is imperative, with crucial lessons from the COVID-19 pandemic serving as a guide. The noteworthy improvement in Nigeria’s Joint External Evaluation (JEE) score, rising from 39% in 2017 to 54% in 2023, reflects enhanced capabilities in preventing, detecting, and responding to infectious disease outbreaks. To consolidate the gains made during the COVID-19 response, sustained investments in surveillance and laboratory infrastructure, along with robust support for Emergency Operations Centres (EOCs) in each state, are crucial. With these measures, the country can better equip itself to prevent, detect, and respond effectively to infectious disease threats.
President Tinubu’s declaration that “health is back on the front burner” during UHC day in December 2023 signals a pivotal shift in priorities. Recognising that the health sector has long been under-prioritised, the full and successful implementation of the National Health Act, 2014 (NHA 2014) is paramount. President Tinubu’s commitment to demonstrating health’s prominent position on the “front burner” should involve leveraging the capacity of the private sector while ensuring the comprehensive implementation of the NHA (2014). Revitalising the health sector in Nigeria is undoubtedly a formidable challenge, yet there is the belief that by directing attention to the five issues outlined above, the future holds promise and brightness.
