The year 2024 brought renewed hopes and expectations for the health sector, with the current administration pledging robust healthcare delivery through various initiatives and international partnerships. However, significant challenges persist. Stakeholders attribute the slow progress in the sector to funding gaps, recurring disease outbreaks, brain drain, and other systemic issues.
It is no longer news that the migration of skilled healthcare professionals, coupled with insufficient resources, has compounded the challenges in providing adequate care across the country. This is even as disease outbreaks, both endemic and emerging, further strained the country’s already fragile healthcare system. While progress has been made in some areas, these challenges underline the urgent need for a comprehensive, multi-faceted approach to address the root causes and ensure that the commitment to improving healthcare delivery translates into tangible results for all Nigerians in 2025.
2024 Health Budget
The health sector in Nigeria was allocated N1.502 trillion, representing just 5.46 percent of the country’s national budget. Despite Nigeria’s commitment to the 2001 Abuja Declaration, which set a target of allocating 15 percent of the national budget to health, this goal remains unmet.
Experts argue that the country is still far from achieving this target, pointing to several critical challenges. Beyond the inadequate allocation, delays in budget releases and poor prioritisation continue to hinder the effective utilisation of available funds, further stalling progress in strengthening the healthcare system.
The immediate past chairman of the Nigerian Medical Association (NMA) Plateau State Branch, Dr. Bapiga’an Audu, described the situation as unfortunate: “It’s unfortunate that despite being a signatory to this agreement, Nigeria has consistently fallen short of the target since 2001. Budget releases are often delayed, poorly prioritized, or underutilized, further compounding the sector’s challenges.”
Dr. Audu’s statement underscores the ongoing difficulties within the health sector, emphasising that despite the commitment to the Abuja Declaration, the lack of proper funding, timely disbursements, and effective management continues to hinder meaningful progress.
Dr. Audu urged collaborative efforts to address these issues, emphasising the government’s responsibility as the lead driver:
“The government must lead this process. Healthcare is capital-intensive, and addressing funding gaps is critical to progress,” he said.
Similarly, past president of the Nigerian Association of Resident Doctors (NARD), Dr. Emeka Orji, lamented the worsening situation. He said “No Nigerian government has ever met the Abuja Declaration target. The current budget allocation to health is less than six percent, which systematically deprives the sector of resources for infrastructure, manpower, and staff welfare.”
Flooding And Cholera Outbreak:
Cholera continues to pose a significant public health challenge in Nigeria, with recurrent outbreaks worsening in 2024. The situation was exacerbated by flooding in the northern states, leading to a surge in cases. These recurring outbreaks highlight the urgent need for improved sanitation, better disaster preparedness, and strengthened healthcare responses to control the spread of waterborne diseases.
As of October 13, 2024, Nigeria recorded 14,237 cases of cholera across 35 states and the Federal Capital Territory (FCT), with 378 deaths, resulting in a case fatality ratio of 2.7 percent.
Director-general of the Nigeria Centre for Disease Control (NCDC), Dr. Jide Idris , stated that “Floods in northern states like Borno, Adamawa, Jigawa, Yobe, and Kano have exacerbated cholera outbreaks, making these areas the epicenters.”
Cholera, a waterborne disease caused by Vibrio cholerea, thrives in environments with poor sanitation. Many communities lack access to clean water, relying on unsafe sources such as rivers and wells, which perpetuates the cycle of infection.
Moreover, the absence of proper sanitation facilities further compounds the problem, as inadequate waste disposal contaminates water sources and perpetuates the cycle of infection.
Stakeholders have opined that efforts to combat cholera in the country must prioritize improving access to clean water and sanitation infrastructure.
Investing in reliable water supply systems, promoting hygiene education, and implementing effective sanitation practices are crucial steps towards reducing the incidence of cholera outbreaks.
A public health expert, Dr. Francis Anayo told LEADERSHIP Sunday, that addressing the root causes like inadequate clean water access is pivotal in breaking the cycle of cholera outbreaks. “Sustainable solutions, including investments in water supply and sanitation infrastructure, are urgently needed,” he said.
Brain Drain:
The mass migration of healthcare professionals, commonly known as the “Japa Syndrome,” has left Nigeria’s healthcare system severely under-resourced. This exodus of skilled doctors, nurses, and other medical personnel has further strained the already fragile healthcare infrastructure, leading to a shortage of qualified staff, diminished care quality, and increased pressure on the remaining workforce. The migration continues to be a major challenge, undermining efforts to improve healthcare delivery in the country.
According to the minister of health and social welfare, Dr Ali Pate, Nigeria now has only 55,000 licensed doctors serving over 200 million people. Over 16,000 doctors emigrated in the last five years, and another 42,000 nurses left in just three years, seeking better opportunities abroad.
This has led to an uneven distribution of healthcare workers, with urban centres like Lagos and Abuja having higher concentrations of professionals compared to rural areas.
Dr. Orji remarked that “The ‘Japa Syndrome’ will persist unless the government addresses manpower shortages, poor salaries, and infrastructural deficits. Without these interventions, the situation may escalate.”
Mental Health Crisis
Nigeria’s economic challenges, including inflation, unemployment, and insecurity, have contributed significantly to a growing mental health crisis. The rising cost of living, widespread joblessness, and persistent insecurity no doubt , placed immense psychological strain on individuals, leading to an increase in mental health issues such as anxiety, depression, and PTSD. Sadly, despite the growing need for mental health support, the sector remains underfunded and neglected, leaving many without access to proper care and treatment.
The president of the Association of Psychiatrists in Nigeria (APN), Prof. Taiwo Obindo, described the situation as dire, saying “Multidimensional poverty is pushing many into mental distress. Unfortunately, rising treatment costs and poor access to care worsen the problem.”
Despite the growing need, mental healthcare services remain underfunded and inaccessible to many Nigerians.
Universal Health Coverage (UHC)
The federal government has pledged to achieve Universal Health Coverage (UHC) by reducing out-of-pocket healthcare expenditures. However, Nigeria remains far from this goal.
LEADERSHIP Sunday checks revealed that rural and marginalised communities are still disproportionately affected, with many lacking basic healthcare services. Statistics indicate that over 70 percent of healthcare costs in the country are paid directly by individuals, leading to financial strain and, in many cases, a complete lack of care.
However, it is worth noting that despite these challenges, progress has been made through key initiatives supporting Universal Health Coverage (UHC). Notable efforts include the Basic Healthcare Provision Fund (BHCPF), the National Health Insurance Authority (NHIA), and the Primary Healthcare Revitalisation programmes. These initiatives aim to improve access to essential healthcare services, promote health insurance coverage, and strengthen primary healthcare infrastructure, marking important steps toward achieving more equitable and sustainable healthcare delivery across Nigeria.
Launched under the National Health Act of 2014, the BHCPF serves as a cornerstone of Nigeria’s UHC strategy. It funds improvements in primary healthcare, including infrastructure upgrades, personnel recruitment, and free services for vulnerable populations. By December 2024, the government reported disbursing ₦45.9 billion to primary healthcare facilities, benefiting over 8,000 centres equipped with financial and human resources.
While initiatives like the Basic Healthcare Provision Fund (BHCPF) and the National Health Insurance Authority (NHIA) have made progress, less than 10 percent of Nigerians are covered by health insurance.
“Till now in Nigeria, we are still talking about less than 10 percent health coverage for our citizens. It’s unacceptable.
“The economic realities of the day now, the current economic challenges, a lot of people that are not even health insured, you know, are having to prioritise some other things over their healthcare. Which have other consequences, in the long term, for their own health and for the health of others. So, it is really important that funding improves, but more importantly, increase the coverage of people under health insurance in the country,” he said.
A Public health expert, Dr. Theophilus Agamu, called for increased healthcare funding to meet and exceed the Abuja Declaration target of 15 percent of the national budget.
He also highlighted the importance of public-private partnerships to expand healthcare infrastructure, improve access, and invest in the training, retention, and equitable distribution of healthcare workers.
Similarly, the project director at the Development Research and Projects Centre (DRPC), Dr. Stanley Ukpai, urged the government to leverage technology for healthcare improvement.
“The government should prioritise digital solutions, such as telemedicine, to address human resource challenges in healthcare. For instance, a doctor in an urban area could consult remotely with patients in underserved areas via telemedicine, provided there is reliable internet connectivity,” he stated.
Dr. Ukpai further emphasised that “Digital hospitals are the future. Many private operators already use telemedicine to improve service delivery. The government could adopt a sector-wide approach to integrate these technologies and enhance healthcare outcomes.”
According to these experts, achieving UHC will require sustained commitment, strategic funding, and innovative approaches to address the gaps in the country’s healthcare system.
