Health is a right, and a basis for growth
With its comprehensive reform package and focus on training youth, Nigeria is looking to strengthen its healthcare system while paying attention to how regional collaboration can play
a part in boosting knowledge and trade
What role can health systems and health system reform play in establishing trust?
Trust is earned, not given. When we have the trust of the people, whether on the infectious diseases that cross boundaries or non-communicable diseases, you want them to trust our messaging. Saying we have the evidence and rigorous scientific methods ignores the fact that people have agency. Building health systems by achieving universal health coverage between crises is vital to gaining and maintaining trust. Primary health centres, with their frontline workers, are closer to communities, and can deliver vaccines, antimalarials, antibiotics and more – so in a crisis they’re already a trusted part of the community. However, since only barely half the world’s population has access to basic health services, we have unfinished business in terms of universal health coverage, and a trust deficit that means we have to work harder when we have a crisis.
President Bola Tinubu is very intentional in thinking that prosperity will only occur if you focus on people’s health and well-being. Health is a right and also a basis for human capital. So the political choice is at the highest level in Nigeria.
Our reform agenda has four pillars. First is governance. Nigeria has a complex, fiscally decentralised federal system. My role as coordinating minister is to make sure we’re all going in the same direction and that our development partners also shift, so we serve the needs of our citizens. It requires being more transparent and accountable and also having our regulators function better.
Second is population health outcomes. Where is basic health delivered? We’ve got 34,000 facilities, including 24,000 primary healthcare centres. We set a target to make 17,000 functional as retail outlets. They need frontline health workers, commodities and financing. We are retraining 120,000 frontline health workers to be the ‘shopkeepers’. On the demand side, we are expanding our Vulnerable Group Fund to provide affordability for the poorest and vulnerable while expanding social health insurance.
We are also revitalising infrastructure, upgrading hospitals and training health workers at the state level, and investing in cancer equipment. Nigerians can see this extension of government services through the health system, which helps credibility in a crisis.
Third is the healthcare value chain. Our large country depends on imports for many things we need – pharmaceuticals, biologicals, medical devices. How can health also be part of the economic sector? We’re unlocking the value chain through an executive order to provide regulatory reforms and fiscal incentives, and shape the market by encouraging local production and reducing reliance on expensive imports. Although our procurement laws prioritise locally produced goods, limitations in domestic production still force dependence on imports, driving up costs.
Fourth is health security. The One Health steering committee, which I chair, includes the ministers for agriculture, water, environment and health and the Nigerian Centre for Disease Control. It coordinates efforts on prevention, preparedness, the International Health
Regulations and contingent financing. We’ve learned from simulation exercises and outbreaks of diphtheria, meningitis, and now cholera and mpox. We keep an eye on what could be present at the federal and sub-national levels – which is key, given the impacts of climate change.
The global system could be challenging if our partners don’t talk to each other. They are trying to help us without listening to how we want to help ourselves. So we’re taking a sector-wide approach that articulates our own consensus on what we want and then identifies how they can work with us. Then they can defragment their resources, whether it’s technical assistance, or pooled or parallel financing. With coherence we can hold each other accountable. Half of Nigeria’s public spending on health is from official development assistance, much spent on planning, administration and technical issues. There are efficiency gains if you also strengthen national systems and institutions that are sustainable, whether on the knowledge side of research, science and governance or on service delivery or the value chain or health security. So we reduce dependency.
How is the country’s large youth population part of your planning?
We have doubled the quotas for medical, nursing and pharmacy schools to increase our frontline health workforce, particularly in the north where the health burden is high, and women want to be seen by women. We need our girls to go to school and go into medical fields. That hits multiple objectives: health, gender and economic empowerment.
Second, how do we train more of our youth and also have agreements with recipient countries to invest in pre-service training? Currently, 67% of our health workers go to the United Kingdom, 10% to Canada, 2% to the United States, and some to the Middle East and Europe. We can have constructive agreements so if they go for a short term and return, we provide incentives to have a track for career fulfilment and other benefits.
Third, in addition to our 350,000 health workers, we also need non-core health workers – the manufacturers, regulators, scientists, logistics and supply chain and service providers. We work with the Mastercard Foundation to create 150,000 jobs for our youth to become economists, engineers, computer scientists, whatever.
If we embed health in multiple facets of society, trust grows. We face rising costs, but with the measures we have been able to take, people don’t see us as partisan. President Tinubu has elevated health so it is a basis for healing and unification, because everyone can work together on malaria or HIV or immunisation.
How does Nigeria’s strategy fit into the African context?
We see ourselves as integrally linked within a wider vision of the continent, in a cooperative manner. Africa should contribute to the global solution. Without a national regulator to regulate properly, you undercut your ability to industrialise. Without the workforce and talent you create, you also have challenges. On pooled procurement mechanisms, there is much work to do on laws and regulations to allow purchases – but you have to start somewhere. We can connect through free trade arrangements and produce for Europe, the US and other places. Imagine the jobs, the innovation and all that will come! If you have clinical trial centres, in our three teaching hospitals, we add to the diversity in the world and create a cohort of people versatile in scientific methods who can contribute new knowledge. Industries all over the world can benefit.
