Analysis of the Federal Government’s allocation of only N1.336 trillion to healthcare in the 2024 budget, is well below the estimated N1.6 trillion (over $1bn) Nigerians spend annually on medical treatments abroad.
So also did the combined healthcare expenditure of just N1.39 trillion by all 36 states in 2023 fall below the annual medical tourism splurge.
The Nigerian healthcare system continues to face significant challenges, with both federal and state governments struggling to meet essential health funding needs, while cost of citizens quest for basic and specialized treatment abroad exerts pressure on scarce foreign exchange.
This is just as the exodus of doctors, nurses, and other health practitioners, often termed the “Japa” syndrome, has contributed to a doctor-to-patient ratio of just four doctors for every 10,000 patients. This figure falls starkly short of the World Health Organization’s recommendation of one doctor per 600 patients. BudgIT’s “State of States Report 2024,” which carries the theme “Moving Healthcare Delivery from Suboptimal to Optimal,” reveals that the doctor-patient ratio in states such as Taraba is as low as one doctor per 17,959 residents. Bauchi, in particular, struggles, with only 10.9 percent of its hospitals staffed with at least one general medical practitioner.
This report, recently launched in Abuja, calls attention to Nigeria’s dire need for healthcare reforms, especially in human resources.
In terms of spending, BudgIT’s analysis highlights how far below potential state healthcare budgets fall. Cumulatively, states allocated N2.3 trillion to health in 2023 but spent only N1.39 trillion—reflecting a mere 58.16 percent budget performance.
For medical equipment purchases, only N35.72 billion was utilized, with nine states showing no records of any expenditures on equipment in their 2023 budgets.
These states—Edo, Ekiti, Katsina, Ogun, Ondo, Osun, Oyo, Yobe, and Zamfara—further emphasise the gap in healthcare investments across Nigeria.
Additionally, N104.27 billion was spent on constructing and rehabilitating hospitals and clinics, while just N15.31 billion went toward purchasing drugs and medical supplies, with Delta, Ebonyi, and Niger having no records of these expenditures.
According to the National Health Facility Registry, beyond financial limitations, are infrastructure as there are for instance 38,182 hospitals in the country, 74.08 percent of which are government-owned, including 27,022 primary health centers. According to BudgIT, although public primary health care facilities are generally accessible—serving a ratio of 8,960 people per facility, below the WHO benchmark of one facility per 10,000 people—the pressure on these facilities is intense, with uneven distribution exacerbating the situation in underserved areas.
Experts warn that this shortage of infrastructure and essential medical supplies leaves millions vulnerable to preventable diseases and limits the healthcare system’s ability to manage chronic conditions.
As foreign hospitals have become a viable alternative for many Nigerians, the Nigerian Sovereign Investment Authority (NSIA) estimates that Nigerians spend over $1 billion annually on medical tourism, primarily for oncology, orthopedics, nephrology, and cardiology services.
A public health expert, Dr. Lanre Adejumo, describes the situation as a “national emergency,” urging urgent reform to healthcare funding and infrastructure to curb the rising trend of medical tourism.
“We need urgent reforms to address our healthcare infrastructure and funding,” Dr. Adejumo emphasizes, as escalating medical tourism costs create a pressing need for sustainable local alternatives.
Also, Professor Bala Audu, president of the Nigerian Medical Association (NMA) at a recent forum in Abuja points out that Nigeria’s contributions to the global medical tourism market, expected to reach $180 billion by 2030, exacerbate the country’s already severe capital flight issues.
To him, with an annual outflow of over $2 billion on foreign healthcare, Nigeria is effectively “exporting” its patients. Professor Audu warns.
“This is predicted to get worse unless we intervene as a nation.” His recommendations for reversing medical tourism include government initiatives to improve health worker remuneration, security, and access to essential medical equipment to retain the remaining professionals and attract those who have left.
The NMA emphasises that part of the solution lies in implementing policies already in place. The National Policy on Health Workforce Retention, for example, focuses on improving the welfare of healthcare professionals, enhancing workplace conditions, and providing adequate diagnostic equipment to address the systemic issues fueling the brain drain.
Professor Audu further stresses that without robust policy enforcement, remaining health professionals will continue to suffer from burnout, excessive workload, and limited resources, further aggravating the healthcare crisis.
Similarly, a report by African intelligence firm SB Morgen reveals the lack of preparedness across Nigerian states to address, prevent, or mitigate health emergencies.
Using metrics like health budget per capita, human development index, doctor-to-population ratios, and child mortality rates, the report ranks Nigeria’s states based on a Health Preparedness Index (HPI), with all 36 states scoring below the 40-point minimum threshold out of 100. Lagos, the highest-ranking state, only achieved a score of 25.09, while Yobe, at the bottom, scored 11.83. In Kano, where an estimated 20 million people are served by just 600 doctors, the doctor-to-patient ratio stands at one doctor for every 33,000 patients.
Stakeholders are worried that the challenges faced by Nigerian healthcare professionals include inadequate medical equipment, worsening insecurity, poor working conditions, and unsatisfactory salaries.
Between 2019 and 2023, over 1,000 medical consultants left the country for better prospects abroad, and nearly 900 resident doctors followed suit just between January and September 2023, according to the Medical and Dental Consultants Association of Nigeria, citing poor funding and outdated facilities.
Public health professor Tanimola Akande, a former National Chairman of the Association of Public Health Physicians of Nigeria, points out that the Nigerian elite’s preference for medical tourism reflects an ongoing failure to prioritise investment in domestic healthcare.
“The money spent on medical tourism, if channeled to improving local health facilities, would go a long way to reduce medical tourism in Nigeria,” he argues.
Diseases such as malaria, cholera, tuberculosis, and measles continue to plague the states, especially during the rainy season, with Borno, Kogi, and Plateau reporting high cases annually.
Borno, for example, recorded over half a million malaria cases in 2023, with 15,036 classified as severe. Northern states remain vulnerable to outbreaks of cerebrospinal meningitis and measles, while Lassa fever remains endemic in states like Kogi and Anambra.
These diseases further strain the healthcare system and reflect the states’ inadequate capacity to handle infectious and chronic diseases.
As Nigeria faces shrinking fiscal space and rising debt burdens, Iniobong Usen, Head of Research and Policy Advisory at BudgIT, emphasizes the need for states to diversify their revenue streams. He recommends leveraging natural resources, technology, public-private partnerships, and human capital to fund critical health infrastructure and social protections.
To sustain healthcare funding, states must avoid excessive reliance on foreign loans, given exchange rate volatility and increasing fiscal constraints he advised.
By prioritizing debt transparency, states can ensure that borrowed funds are invested in high-impact projects, potentially revitalizing Nigeria’s healthcare sector in the long run.
Analysts believe that without significant policy shifts, infrastructure improvements, and investment in healthcare personnel, Nigeria’s health system remains vulnerable. Comprehensive, sustained reforms are needed to retain healthcare workers, reduce capital flight to medical tourism, and build a resilient healthcare system that meets the needs of the country’s citizens.
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