The Politics of Healthcare in Nigeria: Creating a Roadmap to a Brighter Future

Adeduntan IFUMSA


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The World Health Organization (WHO) defines health, as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.

In the developed nations of the world, exemplified by the USA, Britain, and Canada, the above WHO advisory, has been accepted as the standard of care, as a healthy workforce is a productive workforce.

The health sector is critical and drives other sectors of a country, as only healthy people can plan for security, development and economic advancement.

Contrary to the above, the underdeveloped nations of the world exemplified by our nation- Nigeria, have not fully incorporated or accepted the above WHO counseling, as the standard of care for their people.

For instance, the WHO requires nations to apportion not less than 13% of the annual budget to health care delivery, because of the heavy capital financial outlay required for health maintenance.

Throughout the globe, health care financing is very capital intensive. The very low allocation to health, is responsible for among other reasons, the rot and decay in the system, the inability to train ,retain and keep highly skilled professionals due to poor reimbursement-the “Brain Drain” to the civilized nations.

As an “insider”, a great political factor affecting allocation to health in Nigeria, is that health care is regarded as a social welfare and not revenuegenerating or yielding; in other words revenue consuming. For instance in Government Circles, the Ministries of Health, Women affairs, Sports, Education, Science and technology, are regarded as social welfare ministries, with not much revenue coming back to the Government treasury.

Whereas, the Ministries of Finance (responsible for budgeting and taxation), Lands and Housing, Physical Planning, Works, Petroleum resources, Agriculture, Solid Minerals are revenue generating.

Hence, Governments across the board – Federal, State and Local; are almost always willing to allocate most of their scarce resources to these revenue generating ministries. Only a paradigm shift by a knowledgeable head of Government can change this ;as evidenced by the current 2018 budget where Health came 12th, as Power, Works and Housing got the highest capital project proposal with N555.88 billion, almost two times that of health-N340.45 billion

Sadly over the years, the allocation to health in Nigeria has been abysmally low.Nigeria hosted the Heads of State of member countries of the African Union (AU) in 2001 and made the “Abuja Declaration”, under which the leaders pledged to commit at least 15 percent of their annual budgets to improving their health sector.

Since the declaration, Nigeria has not attained the pledged funding benchmark ;as the federal government has never voted more than six percent of its annual budget to the health sector.

The highest percentage since the declaration was in 2012 when 5.95% of the budget was allotted to health.

In July 2013, Nigeria again hosted over 50 African Heads of State in a special summit that was tagged ‘The Abuja +12 meeting”, which reviewed the progress made on the promise of the Abuja Declaration on health funding.

Nigeria has consistently ignored the commitment it made alongside other African countries 16 years ago on funding of health care services for its citizens; whereas smaller African countries are doing so e. g in 2016,RWANDA allocated 18% of the budget,BOTSWANA,17.8%,MALAWI,17.1%,ZAMBIA,16.4%,BURKINA FASO15.8%.In 2015,USA allocated 20.7%,GERMANY 19.4%.

In the 2018 Budget proposal which President Muhammadu Buhari presented on Tuesday November 7th to the National Assembly, he allocated N340.45 billion, representing 3.9 percent of the N8.6 trillion expenditure plan to the health sector.

This allocation is less than the 4.23 percent in 2016(6.08 trillion budget, health allocation 221.7 billion)and the 4.16 percent (2017-304billion,out of a budget of 7.4 trillion made to the health sector showing a downward trend.

The appropriation expenditure for health for fiscal year 2018 had since been increased to 9.1 trillion by the National assembly and assented to by the President due to public pressure.

Similarly, the National Health Act, which was signed into law in December 2014, by then President Good luck Jonathan, stipulates that one percent of the consolidated revenue fund of the federal government should be set aside to finance health initiatives in the country. That too has never been complied with.

Breakdown of the 2018 Health Budget proposal

If the appropriation bill had been passed as presented on Tuesday November 7th 2017, by President Buhari, the N340.45 billion allocated to health, meant that government planned to spend N1,888 on each citizen for the whole year.

In the 2018 health budget proposal, N269.34 billion was earmarked for recurrent expenditure- which refers mainly to expenditure on operations, wages and salaries, purchases of goods and services, and current grants and subsidies; while N71.11 billion is for capital expenditure.

Though there was a little increase in the capital expenditure when compared to the N51.1bn earmarked for it in 2017, in percentage term it was a decline as the 2017 budget was N7.4 trillion while that of 2018 budget is N8.6trillion

It is estimated that Nigerians spend N359.2 billion on medical tourism annually.


a) According to the World Health Organization, Nigeria is rated 187th out of 191 countries, in terms of health care delivery as evidenced below:

A Maternal mortality ratio of 576 /100,000 live birth (NDHS, 2013), Oyo State (148)

Infant Mortality rate of 70/1000 live birth 3rd highest in the world by WHO (Oyo State 59)

Neonatal mortality rate of 39/1000 live birth (Oyo State42)

Under 5 mortality rate 120/1000 live birth (Oyo State73).

b) Recent outbreak of Monkey pox, Measles, Lassa fever, and the fight to end polio resurgence.

c) Poor primary health facilities.

d) Lack of functioning cancer radiotherapy machines or treatment centres.

e) Poor health emergency responses.

f) Thousands of medical doctors continue to flee from Nigeria in search of better life in the United States of America and United Kingdom.

g) The health sector has also experienced series of industrial actions by its workers over unpaid salaries and other administrative anomalies. The Joint Health Sector Unions and Assembly of Healthcare Professionals, JOHESU, recently embarked on industrial action to protest among other issues, salaries adjustments, promotion arrears, and improved work environment for its members.

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Creating a Roadmap to A Brighter future

A) Health education of the populace in terms of disease causation and prompt treatment.

B) A robust Primary Health care systems across the country.

c) Massive commitment by Government to

Childhood immunizations against measles, whooping cough, diptheria, polio, pneumonia etc.

d) Massive training of Skilled Birth attendants.

e) Infant/School Nutrition for children less than 5years.

f) Health Insurance Scheme.

g) Endowment funds to be solicited from High Net Worth individuals.

h)Public Private Partnership to reduce the burden on Government for capital purchases; like Heavy machines and equipments, such as CAT SCAN,MRI,EEG,DUPLEX ULRASOUND,ECHOCARDIOGRAM ETC.

H) Outsourcing of some Services e.g. laundry, Cleaning, Environmental Sanitation, Laboratory services

I) Partnership with Donor Agencies both foreign and Local.

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