Sixty-five years after independence, Nigeria’s hospitals still bear the scars of neglect, leaking roofs, broken equipment, and absent staff. While the nation celebrates its sovereignty, the health system meant to sustain its people remains dangerously fragile.
Doctors, union leaders, and health advocates warn that decades of underinvestment, collapsing primary care, and recurrent strikes have left millions exposed.
They insist that lofty government pledges will count for little unless translated into functioning clinics, trained personnel, and affordable services at ward level.
“By Now We Should Have Achieved Universal Healthcare”
“At 65, Nigeria’s health sector still struggles with poor infrastructure, underfunding, inadequate workforce, and a weak primary healthcare system,” said Dr. Izuagba Kelechi, Publicity Secretary of the Medical Women’s Association of Nigeria (MWAN), FCT Chapter, in an exclusive interview with Pinnacle Daily.
She warned that the country spends too little on health, relies heavily on out-of-pocket payments, and continues to lose professionals to brain drain.
“By now, Nigeria should have achieved universal basic healthcare, reduced maternal and child mortality, and built a self-sustaining, equitable health system capable of serving all citizens well,” she said, calling for urgent investment in PHCs, health insurance expansion, and retention packages for skilled workers.
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President Bola Ahmed Tinubu campaigned on a promise to make healthcare a right rather than a privilege. He pledged to strengthen primary healthcare, expand the National Health Insurance scheme, establish specialist centres, and stem the exodus of doctors.
Since taking office, his administration has launched the Health Sector Renewal Investment Initiative (HSRII) and announced multi-billion-dollar partnerships to upgrade facilities and retrain workers.
Yet, on the ground, many PHCs remain non-functional. Hospitals still struggle with staff shortages, unpaid arrears, and poor infrastructure. For patients, the result is predictable: delayed treatment, higher costs, and avoidable deaths.
Also speaking to Pinnacle Daily, Dr. Adamu Onu, Medical Director of Gariki Hospital, Abuja, acknowledged modest improvements but stressed that progress is uneven.
“We are not where we should be. There has been progress, but there is still much more to be done,” he said, pointing to shortages of trained personnel, inadequate financing, and the uneven distribution of facilities, especially in rural areas.
He noted that Nigerian clinicians remain among the best trained globally and praised reforms at PHC level, but warned that reforms must move from policy documents to real services.
The most recent shock to the system came in September 2025, when the National Association of Resident Doctors (NARD) declared a nationwide warning strike.
The action, which began on September 12, was suspended after two days following court directives and government engagement.
Speaking exclusively to Pinnacle Daily, Dr. Tope Zenith Osundara, NARD National President, explained:
“Some of our demands have been met. Govt has promised to look into other issues. Strike suspended, resumption to work today. We did this as a sign of goodwill and to assist Nigerians who are seeking healthcare in our various health facilities.”
But unresolved demands remain:
- Unpaid arrears.
- Downgrade of membership certificates.
- Manpower shortage.
- Release of corrected remuneration circular from the National Salaries, Incomes and Wages Commission (NSIWC).
While the suspension brought temporary relief, doctors warn that unless these issues are resolved, fresh strikes could erupt. For patients in teaching hospitals, where resident doctors provide much of the care, every strike is a matter of life and death.
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- Health budget allocation: Less than 5% of national budget (Abuja Declaration target: 15%).
- Out-of-pocket spending: 70–80% of health costs borne by households.
- Primary Health Centres: ~30,000 nationwide; fewer than 20% fully functional.
- Doctor–patient ratio: ~1:4,000–5,000 (WHO recommends 1:600).
- Maternal mortality ratio: ~512 per 100,000 live births (among the world’s highest).
- Infant mortality: ~54 per 1,000 live births.
- Health insurance coverage: Fewer than 10% of citizens covered.
- Brain drain: Thousands of doctors and nurses emigrating annually.
These figures, widely cited by clinicians, advocacy groups, and recent health surveys, highlight the deep gaps in Nigeria’s health financing, staffing, and infrastructure.
Health worker strikes are not only about pay. They reflect unpaid arrears, delayed training funds, career stagnation from accreditation downgrades, unsafe working conditions, and crippling staff shortages that push doctors to work dangerous hours.
“Strikes are not just about salaries. They are about dignity, safety, and the ability to practise medicine competently, conditions that also protect patients,” one union leader said.
The repeated recourse to strikes underscores both the urgency of grievances and the failure of timely, trust-driven negotiation between government and health workers.
Policy vs Practice: Where the Gaps Lie
Experts say Nigeria’s health system falters at four critical points:
- Financing: Budget allocations remain far below continental commitments.
- PHC functionality: Renovations mean little without staff and steady supply chains.
- Workforce retention: Recruitment, pay, and career progression are inconsistent, fuelling emigration.
- Governance: Announced funds rarely match transparent disbursement or monitored delivery.
What Needs to Be Done Now
Frontline clinicians and analysts recommend urgent steps:
- Release unpaid arrears and publish a clear timetable for obligations.
- Fast-track a PHC “minimum essentials” package — power, water, drugs, diagnostics, staff — prioritised in underserved wards.
- Publish the corrected NSIWC remuneration circular and implement hazard allowances.
- Ensure transparent disbursement of HSRII funds with independent monitoring.
- Introduce retention packages for early-career doctors and nurses, with rural service incentives.
- Expand NHIA coverage through subsidised premiums for the less privilege people and informal sector.
Timeline at a Glance
- Dec 2023 — Govt launches HSRII, announces funding mobilisation.
- 2024 — NHIA expansion pilots, NSIA-linked health projects begin.
- June 2025 — Tinubu administration highlights commitments to PHC upgrades.
- 12–15 Sept 2025 — NARD strike; suspended after two days with partial concessions.
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At 65, Nigeria faces a choice: continue a cycle of strikes and stalled delivery, or use the current political mandate to establish clear, measurable targets that make PHCs functional, doctors paid, and insurance meaningful.
“If we cannot sustain our healers, we cannot sustain the people,” Dr. Kelechi warned.
For millions of Nigerians, health is not an abstract policy. It is a mother in labour at midnight, a child with fever, an accident victim waiting in the emergency ward.
Independence anniversaries will mean little until the government can prove in clinics, wards, and villages that healthcare is not just a promise, but a guarantee of survival.
Tinubu’s Health Promises vs Progress (2023–2025)
| Promise | Status | Reality on Ground |
| Upgrade 17,000+ PHCs | Ongoing | Many still non-functional; staff shortages persist |
| Expand health insurance to 40% by 2030 | Early rollout | <10% currently covered |
| Reverse brain drain | Limited | Thousands of doctors emigrating annually |
| Boost health funding | Announced in budgets | <5% allocation; Abuja Declaration target 15% |
| Improve doctors’ welfare & pay | Partial | Arrears, remuneration circular unresolved; strikes continue |
Esther Ososanya is an investigative journalist with Pinnacle Daily, reporting across health, business, environment, metro, Fct and crime. Known for her bold, empathetic storytelling, she uncovers hidden truths, challenges broken systems, and gives voice to overlooked Nigerians. Her work drives national conversations and demands accountability one powerful story at a time.
