2025 makes it 17 years since we published our first editorial reflecting on issues relating to health and our health sector in Nigeria! We thank all of you for reading. Without you, there would be no need for Nigeria Health Watch.
If asked about the top health news story in Nigeria's health sector in 2024, it would be hard to pinpoint just one issue. The year has been shaped by multiple health challenges, opportunities and milestones. At the start of 2024, there was a lot of anticipation that "health was back on the front burner." This followed the 2023 appointment of new leadership- Professor Muhammad Ali Pate as Coordinating Minister, a position that elevates him among his peers and gives him a convening authority. His administration subsequently introduced the Nigeria Health Sector Renewal Investment Initiative (NHSRII), to overhaul the health sector by focusing on four critical pillars: Effective Governance, Quality Health Systems, Unlocking Value Chains, and Health Security. This initiative, executed through a Sector-Wide Approach (SWAp), aimed to "set the ball rolling" in 2024.
With every new team, there is a process of forming, norming, storming, and performing. However, it was clear to all health sector stakeholders that ths was not business as ususal in Nigeria. Subsequent appointments to key health sector parastatals followed, and a new team was in place. After some initial hesitation, both internal and external stakeholders started aligning with the aspirations of the Minister and his team, and work started in earnest.
The year culminated in two significant events for the health sector. The first-ever Health Sector Joint Annual Review (JAR) brought together key stakeholders in the sector. The Federal Ministry of Health and Social Welfate presented Nigeria's State of Health Report, emphasising transparency and progress in the ongoing healthcare transformation. This was followed by the National Council on Health meeting in Maiduguri, Borno State, a city recently ravaged by devastating floods that strained an already fragile health system. These events, set the foundation and established a baseline on which performance of the sector will be measured and also set health sector priorities for 2025.
As we look ahead to 2025, we propose five critical issues that need urgent attention in the coming year.
(1) Declining Development Assistance:Time for Nigeria to Step-up
Official development assistance (ODA) continues to decrease globally due to economic pressures and an evolving political reality with many donor countries focusing on their domestic priorities. Nigeria will need to invest more of its own funds into health to support human capital development. This is not charity! It will be critical to building the country's long-term economic prosperity. The 0.7% ODA target, agreed upon in 1970 and reaffirmed by EU nations in 2005 and 2021, was designed to help fund global development, but many countries have struggled to meet it due to domestic financial issues and now citizens in many of these countries are beginning to turn away, asking their poiltical leadershiop to focus on local issues. For instance, between 2014 and 2021, the share of health aid from the USA and UK dropped by 1.1% and 5.4%, respectively. In addition, Germany, the second-largest ODA provider, cut $5.3 billion from its core development assistance. Much of the aid has been re-directed toward refugee support in Europe and aid to Ukraine, where the war continues inside Europe.
Looking ahead, President Bola Ahmed Tinubu's proposed 2025 budget allocates just 5.18% (2.48 trillion naira) to health, falling short of the 15% target set by the Abuja Declaration. This shows why Nigeria needs to make its health spending more effective. The Sector-Wide Approach (SWAp), which aligns donors with national policies and a common framework, will need to maximize the impact of available resources. With global aid shrinking, Nigeria's ability to increase its domestic investment in health will be essential for improving outcomes and driving economic growth in the year ahead.
(2) Staying Ahead of Health Security Threats
In 2025, ongoing threats to health security, including disease outbreaks, will continue to challenge Nigeria. The country has continued to face outbreaks such as Lassa fever and dipetheria, and the surge of mpox in the Democratic Republic of the Congo (DRC) and other African nations led the World Health Organization (WHO) and the Africa Centre for Disease Control (CDC) to declare the outbreak a public Health emergency of international concern (PHEIC) and continental security (PHECS), respectively. This emphasises the need for preparedness, early detection systems, research, and international collaboration.
Research and development, in addition to capacity building, are essential in addressing these health threats. A significantt milestone in 2024 was Nigeria's participation in the first Phase 2 clinical trial of a Lassa fever vaccine candidate, through a CEPI-funded study. This progress must be built upon in 2025, as Lassa fever has persisted for over 50 years. Strengthening international collaboration with strong national public health agencies at the centre will be crucial, as shown by the rapid response to the Marburg outbreak in Rwanda led by the Rwanda Biomedical Centre, offering important lessons for Nigeria and the region.
Despite these efforts, health security has not received the prioritisation it needs, especially considering it is a key priority in the Coordinating Minister for Health's four-point agenda. Of all the four pillars, it seems to receive the least attention. In 2025, elevating health security and investing in stronger regional coordination will be critical.
(3) Keeping Nigeria's Health Workers at Home
In 2025, the migration of Nigeria's health professionals will remain a challenge due to poor working conditions, low pay, and limited career opportunities. This brain drain negatively impacts local healthcare delivery, creating shortages of skilled workers that strain the health system and hinder economic growth. To address this, solutions such as improving working conditions, offering better incentives, and providing career development opportunities will be critical. The National Policy on Health Workforce Migration, introduced in August 2024, aims to tackle this challenge by creating incentives to retain local staff and attract healthcare workers from the diaspora to return to Nigeria.
Aligned with this policy, the launch of the African Medical Centres of Excellence, beginning with the first 500-bed centre in June 2025 in Abuja, will provide an exciting opportunity. A partnership between Afreximbank and King's College Hospital, London, the centre will focus on training healthcare professionals and transferring knowledge. Once launched, it will be important to monitor training progress and the impact on health workforce migration.
However, beyond training, ensuring healthcare workers have conducive working conditions and fair remuneration will be key to retaining talent and strengthening Nigeria's health system.
4. Prioritising and Strengthening Primary Health Care
In 2025, establishing primary healthcare as the cornerstone of Nigeria's health system is imperative. For years, discussions have centered on enhancing primary healthcare, yet tangible progress remains limited. The Joint Annual Review, for instance, launched the Maternal Mortality Reduction Initiative (MAMII) to address maternal mortality rates. However, without robust primary healthcare infrastructure, such initiatives face significant challenges.
Central to improving primary healthcare is the effective operation of the Basic Health Care Provision Fund (BHCPF). Established under the National Health Act, the BHCPF aims to bolster access to essential health services. Since its inception, over ₦143 billion has been disbursed to states and the Federal Capital Territory, yet many primary healthcare centers remain underfunded and understaffed.
Additionally, state health insurance schemes are vital for expanding coverage. In 2024, the National Health Insurance Authority (NHIA) announced that it had surpassed its target by enrolling 2 million Nigerians, a 14% increase from the previous year, so 19.4 million individuals are now insured.
To achieve universal health coverage, Nigeria must prioritise primary healthcare, ensuring adequate funding, infrastructure, and enrollment in health insurance schemes. We need to reduce the fragmentation in the system and ensure that each initiative leverages on the other This approach is essential for improving health outcomes and building a healthier future for all Nigerians.
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(5) A Greater Focus for the Private Sector in Healthcare
In 2025, the private sector will continue to play a huge role in Nigeria's healthcare system, helping bridge gaps in access and quality. Right now, the private sector accounts for more than 50% of healthcare delivery, which makes it an essential part of making sure services are available across the country. Despite this reality, there does not seem to be any strategic approach in defining their role and enablng the private sector's development.
To ensure healthcare is more affordable and accessible for everyone, it is key to support the private sector in offering high-quality care. Leveraging technology should also be able to make healthcare processes more efficient and effective, making it easier for people to get the care they need. But to really make this work, the government and private sector will need to work together and collaborate closely.
Looking ahead, President Bola Tinubu's 2024 Executive Order is set to push forward a plan to make healthcare more affordable and turn Nigeria into a global hub for health products and technology manufacturing, driven by the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC). By focusing on local production, Nigeria can reduce its reliance on imported medical products. But for this to succeed, both the government and private sector need to keep working together to strengthen the healthcare system to improve health outcomes for everyone.
Some successful initiatives realised in 2024 that can be built upon include MoUs signed through PVAC with the US Pharmacopeial Convention (USP) and Vestergaard Sàrl, who will form a joint venture with a local manufacturing partner.
In 2025, Nigeria faces critical health challenges that demand immediate and sustained action. Addressing these issues will require a concerted effort from the government, healthcare professionals, and the community to ensure a healthier future for all Nigerians.
Wishing all our readers a fantastic New Year!
