Nigeria's healthcare sector has long struggled with underfunding, weak regulation, and public distrust, driving a $1 billion annual medical tourism exodus. With declining official development assistance (ODA) from major donors, retaining every healthcare dollar has never been more urgent as the country strives for self-sufficiency. Despite efforts in health sector reforms to achieve the current administration's ambition to position Nigeria as Africa's leading healthcare destination through Nigeria's Health Sector Renewal Investment Initiative (NHSRII), real transformation hinges on a critical factor: restoring public trust in the local healthcare system.
A 2016 PwC survey highlighted a lack of trust in Nigeria's healthcare system, prompting many Nigerians to seek specialised treatment abroad. Nearly a decade later, this trust deficit remains.
The 2025 Healthcare Federation of Nigeria (HFN) Annual Conference, held on February 27 and 28, signalled a renewed commitment to reversing this trend. Industry leaders and policymakers convened with a common agenda to explore innovative health financing models, strategic public-private partnerships, and policy reforms that will enable Nigeria to meet its own healthcare needs.
Dr. Pamela Ajayi, former president of HFN, noted that Nigeria is already witnessing a remarkable shift, with hospitals in Lagos offering high-quality cardiology, oncology, and orthopaedic treatments that are attracting patients from neighbouring African countries. "Patients are now coming to Nigeria for specialised surgeries and treatments. We are getting there, but we must continue investing and promoting our institutions to make Nigeria the preferred destination for high-quality medical care in Africa."
Towards Self-Sufficiency: Strengthening Local Manufacturing
The shrinking global financing landscape has exposed Nigeria's healthcare vulnerabilities due to heavy reliance on foreign aid. At the HFN Conference, Dr. Abdu Mukhtar, National Coordinator of the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC), noted that despite a population of over 200 million, Nigeria produces less than 20% of its medical commodities -- falling behind smaller economies with stronger pharmaceutical industries.
Key health sector reforms to bridge this gap include a Presidential Executive Order currently being implemented, that exempts local pharmaceutical manufacturers from Value Added Taxes (VAT) and import duties, as well as incentives and policy frameworks to shape market conditions. According to Mukhtar, various landmark agreements secured by PVAC to boost local production and Nigeria's recent entry into the African Medicines Agency (AMA) further strengthen the country's capacity to locally manufacture and export medical products. Yet, industry leaders argue that true progress requires a mindset shift. "We build roads and airports with our resources yet rely on foreign donors for vaccines and essential medicines. This must change," Dr. Chikwe Ihekweazu, Acting Director of the World Health Organization's Africa Regional Office said.
Why Public-Private Partnerships are essential
The combination of Nigeria's poor government health expenditure, at a mere 0.5% of GDP-one of the lowest globally- coupled with out-of-pocket costs exceeding 70%, fosters public scepticism about the accessibility and affordability of healthcare services. Experts argued that while increasing public health financing in line with the Abuja Declaration is vital, it must be complemented by efficient resource utilisation to achieve long-term self-sufficiency, underscoring the role of public-private partnerships (PPP).
In rethinking health financing, Professor. Khama Rogo, former Lead of the Health in Africa Initiative at the World Bank Group called for a paradigm shift in PPP, stressing that Africa's health sector must stop operating as two separate entities, public and private. Instead, he advocated for a unified approach where public-private partnerships are structured to maximise impact. He also warned against fragmentation, stating that "ego-driven private enterprises and institutional inefficiencies continue to limit progress."
Trust in local healthcare is key to positioning Nigeria as a medical tourism destination
Trust is the foundation of any robust healthcare system -- and in Nigeria, it's a critical factor in establishing the nation as a medical tourism hub. Despite ongoing reforms, many Nigerians lack confidence about the quality and consistency of local healthcare services, leading to a reliance on medical treatment abroad.
Between 2005 and 2022, over 27,500 doctors left the country, with nearly 4,000 more exiting in 2024 alone. This mass migration of skilled professionals, combined with billions lost annually to medical tourism, places mounting pressure on an already fragile system.
Central to reversing this trend is the goal of achieving Universal Health Coverage (UHC) -- not only as a health financing framework but as a trust-building mechanism. As Lagos State's Health Commissioner, Prof. Akin Abayomi, aptly puts it: "When patients trust that they will receive world-class treatment without financial shocks, they are less likely to seek alternatives abroad." The state's efforts to scale health insurance coverage are rooted in this understanding.
At the national level, the National Health Insurance Authority is making moves to deepen coverage and enhance service quality. This includes increasing capitation fees for service providers, prioritisation of emergency care for vulnerable groups, towards achieving the 20-25% target. These policy shifts aim to reduce the risk burden on patients and rebuild confidence in public health systems.
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But financing alone won't suffice. Regulatory oversight remains one of the most under-leveraged tools in restoring trust. While Nigerian healthcare professionals are globally respected, the domestic system suffers from weak enforcement of standards -- largely due to poor implementation of the 2014 National Health Act. Dr. Richardson Ajayi, Chairman of the National Health Facility Regulatory Agency, emphasised this: "Rather than depending on a conscientious doctor, you need a system that the patients can rely on."
The Path Forward
Ultimately, if trust is restored and sustained; Nigeria has the potential not only to retain its healthcare spending but to position itself as a medical hub for the African region -- transforming its healthcare system from one people seek to escape to one they actively choose. As Dr Olumide Okunola, Senior Health Specialist at the World Bank rightly pointed out, "countries that have done well in medical tourism have done well at home. They have prioritised public financing and that has driven medical tourism".
