Critical Healthcare Condition: Time to Act

Femi Akintunde-Johnson

The Nigerian healthcare system is on the verge of collapse. Stakeholders, including healthcare professionals and citizens, have continuously asked a critical question over the past five years: should the Nigerian government declare a state of emergency on healthcare delivery? This question reflects the dire situation of health services in Nigeria, where systemic failures have not only crippled medical facilities but have also driven a mass exodus of healthcare professionals abroad, leaving millions of citizens without adequate care.

The Nigerian healthcare sector’s multiple challenges – underfunded and dilapidated hospitals, an overwhelmed and underpaid workforce, and soaring rates of medical tourism—point toward an urgent need for reforms. As many have suggested, it is not merely a matter of improving services but potentially calling for a state of emergency to spark a radical transformation. 

The World Health Organization (WHO) provides clear guidelines on declaring emergencies, particularly in the health sector. WHO advises that certain key parameters must be met before declaring a health emergency. These include the existence of hazards that pose a severe threat to public health, critical issues that may lead to mass migration due to poor healthcare, and situations that demand immediate international attention.

In the Nigerian context, many of these parameters are present. The country is currently facing a brain drain in the healthcare sector, with professionals migrating to other nations in search of better working conditions and higher salaries. Furthermore, the dilapidation of primary health care services and underfunded government hospitals contribute to severe threats to public health. The inability to provide sufficient medical care has led to preventable deaths and chronic under-treatment of diseases. As the WHO points out, if the healthcare system is so compromised that it affects the population’s survival and quality of life, it warrants the government’s immediate attention and could justify declaring a state of emergency.

The current administration under President Bola Ahmed Tinubu has signed several executive orders aimed at addressing key sectors, including healthcare. However, early observations suggest that these orders, while well-intentioned, are not yet yielding the significant reforms the system desperately needs. One of the key challenges the administration faces is reversing the effect of years of neglect in healthcare infrastructure and workforce management. There is also an ongoing challenge related to improving the welfare of healthcare workers, many of whom continue to strike for better pay, working conditions, and access to modern medical equipment. In the absence of immediate reform, there is the risk that more medical professionals will migrate, further deepening the brain drain that is already crippling the sector. The government’s executive orders, if well-implemented, could help bridge some of these gaps, but the scope of the problem requires much more aggressive and wide-reaching policies than have been seen thus far.

Medical tourism, the phenomenon where citizens travel abroad for medical treatments, has become a prominent issue in Nigeria. As of 2023, Nigerians spend about $1 billion annually on medical treatment abroad. This trend reflects the deep mistrust in the local healthcare system, with both the affluent and government officials seeking healthcare in countries with more functional medical services. Countries like India and the United Kingdom have become popular destinations for Nigerians seeking everything from routine surgeries to complex medical procedures. This is a telling indictment of the Nigerian healthcare system: even the wealthiest citizens, who can afford the best care in Nigeria, do not trust the system to provide it. This is a clear sign that reform is overdue.

One of the most significant threats to Nigeria’s healthcare system is the ongoing brain drain. Thousands of doctors, nurses, and other healthcare professionals have left the country in search of better opportunities abroad. According to estimates, over 5,000 Nigerian doctors are currently practicing in the UK, while many more are scattered across the United States, Canada, and Saudi Arabia. This exodus is primarily driven by poor working conditions, low pay, and the lack of adequate resources in hospitals. A healthcare worker in Nigeria often faces insurmountable challenges, from outdated equipment to insufficient drugs, making it difficult to provide even basic care. As a result, many opt to leave for countries where they can practice in better conditions and receive fair compensation for their work.

The shortage of healthcare professionals has led to an overburdened system, where the remaining workforce is stretched thin and unable to provide adequate care to the growing population. The WHO recommends a doctor-to-patient ratio of 1:600, but Nigeria currently operates with a ratio of 1:2,500. This alarming disparity highlights the urgency of addressing this issue through targeted reforms.

Primary healthcare is often referred to as the backbone of a country’s healthcare system, and in Nigeria, it is in shambles. Many primary health centers lack even the most basic equipment and drugs. Government hospitals, which are supposed to be the providers of last resort for many citizens, are similarly under-equipped and poorly maintained. Teaching hospitals, which are supposed to be centers of excellence and provide the highest level of care, have become dangerous places where patients face life-threatening conditions. It is not uncommon to hear stories of patients dying from preventable conditions due to the lack of functioning equipment, medicine, or skilled personnel. Private hospitals, which are often seen as an alternative, are prohibitively expensive for most Nigerians. As a result, the majority of the population is left with no choice but to rely on an ineffective public healthcare system.

The problems facing the Nigerian healthcare system are deep-rooted, but they are not insurmountable. Several steps could be taken to bring about sustainable reform. The government must increase its budgetary allocation to healthcare. The Abuja Declaration, signed by African Union countries, recommends that 15% of a nation’s budget be allocated to healthcare. Nigeria has consistently fallen short of this target, allocating less than 5% in recent years. To address the brain drain, the government must improve the working conditions and pay of healthcare professionals. This includes ensuring that hospitals are equipped with the necessary tools and resources to allow healthcare workers to perform their duties effectively.

 Primary healthcare must be strengthened to provide preventive care and reduce the burden on tertiary institutions. This will require investment in infrastructure and training, as well as ensuring that rural areas have access to quality care. Collaboration with the private sector could help alleviate some of the challenges facing the public healthcare system. Public-private partnerships could provide funding for hospital equipment, medical supplies, and training for healthcare workers. Expanding access to affordable healthcare insurance could reduce the burden of healthcare costs on citizens and ensure that more people have access to quality care.

The Nigerian healthcare system is at a crossroads, and without urgent reform, the situation will continue to deteriorate. Declaring a state of emergency on healthcare could be a necessary step toward rebuilding a system that is failing millions of Nigerians every day. The time for action is now.