By Daniel Nduka Okonkwo
Nigeria’s healthcare crisis is measured in the lives lost by mothers during childbirth, children dying from treatable infections, accident victims who wait in vain for emergency assistance, and families pushed into poverty because they cannot afford medical treatment. Across the country, ordinary citizens endure preventable suffering in hospitals without adequate equipment, communities without accessible healthcare, and facilities struggling with shortages of qualified personnel. Behind these tragedies lies a fundamental question of governance: what is the value of government if it cannot adequately protect the lives of the people it governs? Nigerians pay taxes, contribute to the economy, and fulfil their civic obligations, yet too many are left to confront illness and death without the protection of a functioning healthcare system. As citizens prepare to vote, healthcare must become a serious test of leadership. Examine the records, question the promises, and hold public officials accountable. Vote with your eyes open. Do not waste your vote.
For millions of Nigerians, falling ill is no longer simply a medical emergency; it can become a financial crisis, a struggle against institutional neglect, and, in the most tragic circumstances, a fight for survival against a healthcare system that may not be equipped to respond. A pregnant woman arrives at a hospital needing an emergency Caesarean section, but the facility lacks the necessary capacity. A child develops a treatable infection, but access to qualified medical personnel and essential medicines comes too late. An accident victim needs immediate trauma care, but an ambulance is unavailable or the nearest properly equipped hospital is too far away. Behind these circumstances lies a national question that demands more than political explanations: how many Nigerian lives are being lost because essential healthcare is inaccessible, unaffordable, poorly equipped, or delivered too late? Nigeria’s healthcare crisis is not merely a matter of inadequate hospital buildings or insufficient government announcements. It is a question of public responsibility, institutional performance, and the fundamental right of citizens to survive conditions that modern medicine can often prevent or treat.
Nigeria ranked 187th out of 191 countries in the World Health Organization’s World Health Report 2000, which assessed health-system performance. In November 2021, The Guardian Nigeria reported that the Association of Community Pharmacists of Nigeria claimed the country had since climbed to 163rd. That figure came from the association, not from the WHO, which has not published a comparable global ranking since 2000. Neither number is a current measure, but the question behind them still stands: after successive health policies, larger budget allocations, and repeated promises of reform, why do Nigeria’s mortality rates, failing facilities, and financial barriers still show such deep weakness? Progress is not measured by policies announced or hospitals commissioned. It is measured by whether a woman survives childbirth, whether a child is treated in time, and whether an ordinary citizen can get care without being ruined.
Few indicators expose the human cost of healthcare failure more painfully than maternal mortality. The World Health Organization, UNICEF, UNFPA, the World Bank Group, and the United Nations Department of Economic and Social Affairs estimated that Nigeria recorded approximately 75,000 maternal deaths in 2023. The World Bank’s corresponding international dataset identifies Nigeria as one of the countries carrying the largest national shares of global maternal mortality. The WHO’s reported maternal mortality ratio for Nigeria was approximately 993 deaths per 100,000 live births in 2023, dramatically above the Sustainable Development Goal target of 70 by 2030. Yet their implications are devastating. Pregnancy-related complications such as haemorrhage, eclampsia, sepsis, and obstructed labour can often be managed when skilled personnel, blood supplies, emergency surgery, and referral services are available. When these interventions are delayed or unavailable, a condition that should not be fatal can become a death sentence. The national conversation must therefore move beyond the number of women who die and examine the institutional circumstances that prevent maternal deaths from persisting.
The tragedy is equally severe among Nigerian children. UNICEF’s latest country data estimates that 855,676 children under five died in Nigeria in 2024, with an under-five mortality rate of 115.6 deaths per 1,000 live births. The Federal Ministry of Health and Social Welfare’s Nigeria Demographic and Health Survey 2024, published in September 2025, independently reported an under-five mortality rate of 110 deaths per 1,000 live births for the five years preceding the survey. The difference reflects the datasets’ respective estimation periods and methodologies, rather than a contradiction that should be concealed. The 2024 survey also recorded neonatal mortality of 41 deaths per 1,000 live births. Malaria, pneumonia, diarrhoeal diseases, complications of premature birth, neonatal infections, and malnutrition remain major threats to child survival. Many of these conditions are preventable or treatable through immunisation, adequate nutrition, prompt diagnosis, appropriate medication, and functional primary healthcare. When families cannot access these basic services, childhood illness becomes a national mortality crisis. Behind every statistical estimate is a family whose future has been permanently altered by the death of a child.
One of the most disturbing questions confronting Nigeria’s healthcare system is how many lives are being lost because emergency medical care arrives too late, is unavailable, or is simply beyond the reach of those who need it. Research cited in a peer-reviewed study published in BMJ Open estimated that effective emergency-care delivery in Nigeria could potentially save approximately one million lives annually. That is not a record of confirmed deaths caused by hospital failures, nor proof that 1.2 million Nigerians die every year from inadequate healthcare. It is, however, an indictment of the scale of the opportunity Nigeria is failing to seize. Behind the estimate are the consequences of delayed ambulance response, poorly coordinated referrals, inadequate emergency facilities, shortages of trained personnel, and the inability of patients to obtain urgent treatment when every minute matters. The 2018 Lancet Global Health Commission on High-Quality Health Systems estimated that 8.6 million deaths annually across 137 low- and middle-income countries were amenable to personal healthcare, including deaths linked to poor-quality treatment and failure to access care. That global estimate must not be passed off as Nigeria’s own death toll. Nigeria’s specific figures require country-level evidence. But the central question cannot be avoided: how many Nigerians who might otherwise survive are dying because the institutions responsible for emergency response, diagnosis, referral, and treatment are not delivering care when it matters most? This is not merely a debate about statistics. It is a test of the country’s capacity to protect human life.
For ordinary Nigerians, access to healthcare is increasingly determined by purchasing power. The WHO African Health Observatory’s Nigeria Health Systems and Services Profile, updated in October 2026, identifies out-of-pocket expenditure as one of the country’s most serious healthcare financing weaknesses. The Commonwealth Fund’s international healthcare profile reports that out-of-pocket payments accounted for approximately 70.94 percent of total healthcare expenditure in Nigeria in 2023. The WHO African Health Observatory separately reports that such payments exceed 75 percent in its cited health-financing profile, reflecting differences in the underlying reporting periods and datasets. Either measure demonstrates an extraordinary dependence on direct household payments. For a low-income family, a medical emergency can mean borrowing money, selling property, abandoning treatment, or choosing between hospital bills and basic household needs. A patient with hypertension may stop buying medication because the cost has become unsustainable. A person with diabetes may delay diagnostic tests until complications become severe. A pregnant woman may postpone hospital attendance because she cannot afford transportation, consultation, or delivery costs. These are not simply individual financial difficulties. They are consequences of a financing structure that transfers a substantial portion of healthcare risk from the state and insurance system to families least able to bear it.
The National Health Insurance Authority Act of 2022 created an important legal framework for expanding financial protection and advancing universal health coverage. However, legislation does not automatically translate into nationwide access. The WHO African Health Observatory’s health-financing profile identifies only approximately five percent of Nigerians as covered by health insurance, prepayment, or comparable risk-pooling arrangements in its cited baseline. The Commonwealth Fund’s more recent profile provides separate public and private coverage estimates, illustrating that coverage figures depend on the definition and reference year used. The central challenge remains the same: millions of Nigerians, particularly informal-sector workers, rural households, unemployed citizens, and economically vulnerable families, remain exposed to direct medical expenses. The expansion of state health insurance schemes and the Basic Health Care Provision Fund offers an opportunity to change this reality, but enrolment, benefit coverage, service availability, and actual reimbursement must be examined separately. An insurance card is of little value if an enrolled patient cannot find a participating facility, obtain prescribed medication, or receive the treatment promised under the scheme. Universal health coverage must be measured by the care people actually receive and the financial protection they experience, not merely by the number of programmes established.
Nigeria’s healthcare infrastructure presents another disturbing contradiction between official facility numbers and actual service capacity. The WHO African Health Observatory’s Nigeria Health Systems and Services Profile, updated in October 2026, reports that approximately 80 percent of the country’s public health infrastructure is dysfunctional. It also identifies inadequate funding, weak equipment-maintenance arrangements, and insufficiently trained personnel as factors contributing to the problem. This is a particularly serious finding because the existence of a primary healthcare centre does not establish that it can provide essential medical services. A functional facility requires qualified staff, reliable electricity, clean water, essential medicines, diagnostic equipment, infection-control systems, and dependable referral arrangements. A maternity unit without emergency obstetric capacity cannot adequately protect women facing complications. A facility without reliable cold-chain storage cannot safely maintain temperature-sensitive vaccines. An emergency unit without oxygen, monitoring equipment, or trained personnel cannot provide the level of care required by critically ill patients. The consequences are especially severe in rural communities, where distance and transportation costs can turn an already inadequate facility into the only available option. Nigeria must therefore investigate not simply how many facilities have been constructed or renovated, but how many are genuinely functional, adequately staffed, and capable of saving lives.
The migration of Nigerian healthcare professionals has become one of the country’s most serious workforce challenges. The Federal Ministry of Health and Social Welfare’s State of Health of the Nation Report 2024 recorded that approximately 3,974 Nigerian doctors migrated internationally in 2024 alone, with destinations including the United Kingdom, Canada, and Saudi Arabia. The report also identifies migration among nurses, midwives, pharmacists, and other health professionals. The WHO African Health Observatory’s workforce assessment identifies poor remuneration, difficult working conditions, industrial disputes, uneven workforce distribution, and weak strategic coordination as significant challenges. This is not simply a story about professionals seeking better opportunities abroad. It is also an examination of the institutional conditions that make retaining qualified personnel difficult. When experienced doctors and specialists leave, the remaining workforce must contend with rising patient numbers, demanding workloads, and shortages in critical specialties. Rural hospitals and primary healthcare centres are particularly vulnerable because qualified professionals are often concentrated in major urban centres. It would be inaccurate to describe all remaining practitioners as unqualified or incapable; many continue to provide dedicated service under difficult circumstances. The real responsibility lies with the institutions charged with creating conditions that retain medical talent and ensure that professional expertise is distributed according to population need.
Nigeria’s healthcare financing must also be examined against the commitment African leaders made in 2001 under the Abuja Declaration to allocate at least 15 percent of their annual national budgets to health. More than two decades later, Nigeria remains substantially below that benchmark. According to the Presidency’s 2026 budget speech, the federal government proposed ₦2.48 trillion for health within a total expenditure framework of approximately ₦58.18 trillion. This represents roughly 4.3 percent of the proposed expenditure, although the exact percentage varies with the budget denominator used. January 2026 analysis also placed the proposed allocation at approximately 4.2 percent. The figures expose the continuing gap between Nigeria’s international commitment and its actual budgetary priorities. This must go further than comparing percentages. It must examine the difference between appropriated funds, actual releases, cash disbursements, procurement commitments, and completed projects. How much money reaches primary healthcare facilities? How much is spent on medicines, emergency services, workforce development, and equipment maintenance? How many projects are completed, independently inspected, and operational? A healthcare budget should ultimately be judged by measurable improvements in the quality, accessibility, and affordability of services. Without that scrutiny, annual appropriations risk becoming political accounting exercises disconnected from the lives they are supposed to protect.
Nigeria’s healthcare performance must also be viewed within its regional context. Ghana, Senegal, and Côte d’Ivoire have pursued different strategies for expanding healthcare coverage, improving community-level services, and strengthening maternal and child health interventions. Ghana’s National Health Insurance Scheme and Community-based Health Planning and Services programme, commonly known as CHPS, offer examples of efforts to extend services beyond major hospitals. Senegal’s community-based health structures and maternal-care interventions provide another useful comparative reference. These countries may be facing their own challenges. However, their experiences raise important questions about how Nigeria allocates resources, organises primary healthcare, and protects vulnerable populations from medical expenses. The appropriate comparison is not to suggest that Nigeria can simply copy another country’s system. Its population size, federal structure, geography,y and disease burden require tailored solutions. The question is why a country with substantial human and economic resources has not yet built a sufficiently dependable primary healthcare network capable of delivering basic services to every community. Regional comparisons should become instruments of institutional learning rather than exercises in national embarrassment.
The Federal Government’s Health Sector Renewal Investment Initiative, launched in 2023, represents an important attempt to strengthen healthcare delivery, improve access, and mobilise investment across the health system. The Basic Health Care Provision Fund, established under the National Health Act 2014, is another major financing instrument intended to support essential primary healthcare services and financial protection. The Maternal Mortality Reduction Innovation Initiative, known as MAMII, also targets high-burden areas where preventable maternal deaths remain a serious concern. In November 2025, the Federal Ministry of Health reported a 17 percent reduction in maternal deaths and a 12 percent decline in newborn deaths across 172 high-burden local government areas, alongside increased utilisation of primary healthcare services supported by the BHCPF. These are government-reported results that deserve examination and independent verification, not automatic dismissal. The official BHCPF disbursement portal publishes quarterly funding information, including state-level disbursement records for 2025 and the first quarter of 2026. The critical accountability question is whether the funds translate into functional facilities, available medicines, qualified personnel, and improved survival outcomes. The government should publish comparable baseline and follow-up data, disclose facility-level performance, and enable independent verification of reported improvements.
Digital medical records, electronic patient identification, real-time maternal and child health monitoring, medicine inventories, and electronic referral systems could significantly improve Nigeria’s healthcare administration. A properly implemented digital platform can help identify facilities experiencing unusual mortality increases, monitor vaccine availability, flag high-risk pregnancies, and reduce the loss of patients between referrals. It can also strengthen the integrity of health statistics by improving the recording of births, deaths, diagnoses, and treatments. However, digitalisation must not become another expensive government publicity exercise. An electronic medical card cannot replace a qualified doctor; a digital dashboard cannot supply oxygen to a hospital without oxygen; and a cloud-based referral system cannot transport an emergency patient when there is no functional ambulance. The first requirement is reliable infrastructure, trained personnel, secure information systems, and clear institutional responsibility. Nigeria must also address the weakness of its civil registration and vital statistics systems, because incomplete recording of births and deaths limits the ability of policymakers to measure mortality accurately. Digital transformation should therefore be judged by independently verifiable improvements in patient care, data completeness, emergency response, and public accountability.
The healthcare crisis also raises questions about professional standards, patient rights, and the enforcement of existing laws. The Medical and Dental Council of Nigeria has statutory responsibilities for regulating medical and dental practice and addressing professional misconduct within its jurisdiction. The National Health Act 2014 provides a broader legal framework for the rights and obligations of healthcare providers, institutions, and patients. Where medical negligence is alleged, the facts must be established through medical records, expert evidence, professional standards, and the applicable legal process. A death following medical treatment does not automatically prove negligence, just as the existence of a hospital does not establish that it provided an acceptable standard of care. The same evidentiary discipline must apply to allegations involving diverted medical funds, abandoned equipment, procurement irregularities, and falsified facility records. The Federal Ministry of Health, state ministries, hospital management boards, the National Primary Health Care Development Agency, and relevant regulatory institutions should be asked to account for specific expenditure, performance, and oversight responsibilities. Independent auditors, professional associations, civil society organisations, and investigative journalists must be able to examine public records and obtain meaningful responses. Where evidence identifies wrongdoing, the responsible institutions must investigate and, where appropriate, impose sanctions or pursue prosecution. Accountability cannot be selective, and institutional failure must not be allowed to disappear behind administrative explanations.
Daniel Nduka Okonkwo is an investigative journalist, human rights advocate, and policy analyst based in Nigeria. He is the founder and publisher of Profiles International Human Rights Advocate (PIHRA), a platform documenting the courage of human rights defenders and examining issues of governance, accountability, security, and fundamental rights.
His reporting on Nigerian governance, security-sector accountability, public finance, and human rights has appeared in Sahara Reporters, Vanguard, Daily Trust, African Defence Forum, Opinion Nigeria, and Daily Intel.
Read more of his work on the PIHRA website:
https://www.profilesinternationalhumanrightsadvocate.com.ng/
For tips, feedback, or collaboration, contact him at dan.okonkwo.73@gmail.com.
