Nigeria’s health system requires radical overhaul, experts warn

Nigeria urgently needs to overhaul its health system if it is to reduce an exceptionally high burden of disease that is hampering the country’s development, according to a report by a group of global health experts.

Nigeria, Africa’s most populous country, has some of the world’s worst health statistics, according to Ibrahim Abubakar, dean of University College London’s faculty of population health sciences and chair of the Lancet Commission that published the report.

The commission makes the case that health lies at the core of national legitimacy and that, without it, the foundations of democratic government are shaken in a country that boasts Africa’s largest economy and is home to about one in five people on the continent.

Nigeria inherited a defective health system from the British colonial period, according to the report. But since independence in 1960, successive governments have failed to “re-establish a social contract, including an underlying ethos and expectation of the government’s duty to provide health-creating conditions”.

Nigeria, which is projected to become the world’s third-most populous country by 2050 with 400mn people, has an average life expectancy of 54, the fifth lowest in the world. Ghanaians, who have a similar standard of living, live 10 years longer.

It accounts for 20 per cent of the world’s maternal deaths — those in or shortly after childbirth — despite the fact that its population of 206mn makes up just 2.6 per cent of the global population.

Such is the “near-absence” of records that only one in 10 deaths is registered, creating a paucity of data that makes it impossible to take rational decisions about healthcare priorities, states the report, one of the most comprehensive studies of Nigeria’s healthcare system in recent years. It calls for the digitalisation of mostly paper-based records as a priority.

“There’s no shortage of areas where Nigeria is the worst in the world,” said Abubakar, a professor of infectious disease epidemiology at UCL.

The report, released in Abuja on Wednesday, was funded by the Bill & Melinda Gates Foundation but all the commissioners were Nigerians based at home and abroad.

Despite highlighting shortcomings in the health system, the commission argues that an overhaul of the system is feasible and affordable.

It recommends that the Nigerian government pays for health insurance coverage for 83mn of the country’s poorest people. Most Nigerians pay for healthcare out of their own pockets, it says, meaning that treatable diseases can have a catastrophic impact on a family’s finances.

Universal healthcare coverage is not impossible, the report suggests. “Countries with systems comparable with Nigeria’s, such as Ethiopia and Indonesia, have planned or implemented ambitious programmes to deliver health insurance coverage.”

The report stated that its recommendations could be partly funded by shifting costly petroleum subsidies, which it estimated at N1.5tn ($3.6bn) a year, into healthcare. It called on the government to “establish legally ringfenced pre-determined health budgets outside of the [four-year] electoral cycle . . . to ensure sustainable funding and strategic planning”.

Nigeria spends 4 per cent of gross domestic product on health, below the minimum 5 per cent recommended by the World Health Organization. The report recommends a substantial increase.

Another of the report’s recommendations is to shift the focus of healthcare from what it calls “a dysfunctional focus on curative care” to prevention by improving access to adequate sanitation and clean water, and tackling air pollution.

“This report provides a number of excellent recommendations, some of which are already being implemented but many of which we will carefully consider,” said Yemi Osinbajo, Nigeria’s vice-president, who chairs a recently convened committee looking at health reforms.