How Nigeria lost public healthcare crown

…Five-kobo revolution proposed to rescue struggling health infrastructure

In the 1960s, when Nigeria’s public hospitals still gleamed with promise, a young man named Joe Okoro fell mysteriously ill in his hometown in Enugu State. For five long years, he moved from one native healer to another, swallowing herbs and reciting incantations, but his ailment worsened.

Then one day, his uncle decided to take him to University College Hospital (UCH), Ibadan, then regarded as one of the best hospitals in Africa. Within five days, the same illness that defied traditional medicine was cured.

“That was the kind of healthcare system Nigeria had. In those years, our hospitals were well-equipped, our doctors were motivated, and patients from across West Africa came here for treatment. We were a shining example,” said Bode Karunwi, a Nigerian dentist and entrepreneur, told BusinessDay.

The 1960s and 1970s marked Nigeria’s golden age in healthcare. Oil revenues were strong, medical schools flourished, and local hospitals rivalled some in Europe.

“At UCH Ibadan and other public hospitals in Nigeria, surgeons performed complex heart and kidney operations. The Saudi royal family once flew to Nigeria for specialised treatment. Nigerian medical degrees were recognised across the Commonwealth. Nigerian doctors could work in London or Toronto without retraining. Our hospitals had power and water, and the government funded research. Public hospitals weren’t death traps, they were centers of excellence,” Karunwi further said.

He added that in that era, health was viewed as a pillar of national progress, as medical education was heavily subsidised.

“Teaching hospitals in Lagos, Zaria, and Enugu were staffed by both Nigerian and expatriate specialists. But as the oil boom faded and politics overtook planning, the foundation began to crack, Kurunwi stated.

By the mid-1980s, Nigeria’s once-vibrant health system began its long decline. Chronic underfunding, corruption, and brain drain hollowed out its core. “The rot began when the government stopped seeing healthcare as a priority. Year after year, budgets shrank. Equipment broke down. The best doctors left,” the dentist explained.

While the Abuja Declaration of 2001 committed Nigeria to spending 15 percent of its national budget on health, the country has never crossed five percent. According to the World Bank data, Nigeria’s total health expenditure remains around 3.5 percent of gross domestic product (GDP), with government spending barely 0.5 percent.

The consequences are devastating. Today, Nigeria records one of the highest maternal mortality rates in the world: 1,047 deaths per 100,000 live births. The doctor-to-population ratio stands at 23 per 100,000, far below the World Health Organization (WHO)’s minimum of 100 per 100,000. People are dying from preventable conditions. The healing Joe Okoro got in five days in the 1960s may never happen today.

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Hospitals in ruin, doctors in flight

In the present day Nigeria, the story has reversed completely. Nigerians now travel abroad to India, the UK, and Dubai spending over $1 billion annually on medical tourism.

Meanwhile, hospitals that once attracted foreign patients now beg for diesel to keep the lights on. In 2024, UCH Ibadan temporarily shut down some wards because it could not pay electricity bills. Relatives of patients then brought small generators to power fans and oxygen machines.

At the heart of the crisis is the human toll on health workers who still choose to serve.

Mohammad Usman Suleiman, president of the Nigerian Association of Resident Doctors (NARD), told BusinessDay that many physicians now work under extreme exhaustion, some dying on duty. “Doctors work 48-hour shifts without rest. The arrears owed to us, CONMESS reviews, promotion allowances, and accoutrement benefits run into years,” he said.

NARD’s data show that hundreds of doctors emigrate monthly. “Our hospitals are emptying out. We train them here with taxpayers’ money, only for them to serve in Saudi Arabia, Canada, or the UK,” Suleiman lamented.

A 2023 survey by the Nigerian Medical Association (NMA) found that over 75 percent of Nigerian doctors were actively seeking opportunities abroad.

A system that fails its own people

For ordinary citizens, the result is devastating. Over 70 percent of Nigerians pay for healthcare out of pocket, often pushing them into poverty.

At a teaching hospital in Enugu, the relatives of a diabetic patient recently had to buy oxygen cylinders, test strips, and even gloves before she could be treated. Every blood sugar check cost N500. “If this is happening in a teaching hospital, what happens in smaller hospitals?” her brother asked bitterly.

In many communities, Primary Health Centres (PHCs), the first line of care, are ghost facilities. According to Public Health Sustainable Advocacy Initiative (PHSAI) data, 40 percent of PHCs lack electricity, and many have no staff quarters or drugs.

“What you see are mothers giving birth in candlelight, nurses fetching water from wells, and patients buying their own syringes. It is tragic, but it is also fixable,” Ayo Adebusoye, PHSAI chairman, told BusinessDay.

How public healthcare lost the crown

Oyewale Tomori, a professor, renowned virologist and former president of the Nigerian Academy of Science, traced it to weak political will and dependency on donors. “When donor funds dry up, everything collapses. You can’t build a national system on handouts. Health is national security. Once disease spreads, borders can’t save you,” Tomori told BusinessDay.

He warned that dwindling global funding threatens programmes for HIV, tuberculosis, and immunisation. Without domestic investment, outbreaks like polio could return.

Similarly, Wellington Oyibo, a professor and tropical disease expert at the University of Lagos, noted that Nigeria’s reliance on imported malaria products is stifling local innovation. “We must invest in local manufacturing and data-driven disease elimination,” he urged.

According to The Lancet Nigeria Commission, the country needs an additional $6 billion yearly to achieve moderate health coverage, roughly $30 per citizen.

Yet, each year, over $1 billion dollars leaves Nigeria through medical tourism alone.

“It is an absurd situation. We spend billions abroad instead of fixing our own hospitals. We are exporting our sickness and importing bills,” Adebusoye, earlier quoted, observed.

The crisis, he added, is not only medical but economic: “Poor health reduces productivity, increases poverty, and shortens lives. Nigeria’s life expectancy is barely 54.9 years, one of the lowest in the world. That is the price of neglect.”

Read also: ‘Primary Healthcare Centres should not be run by youth corps medical doctors’

Rebuilding what was lost

Despite the grim picture, Kurunwi insisted that revival is possible, with the right mix of funding, accountability, and innovation.

First, he said, Nigeria must implement the Abuja Declaration, which mandates at least 15 percent of federal, state, and local budgets to health, especially primary care.

Second, reforms such as the Basic Health Care Provision Fund (BHCPF) must be transparently managed, even as Kurunwi stated that, “We need to see results at the local level – working health centres, drugs on shelves, and trained staff.”

Third, he proposed a telecom-inspired health financing model, where a N0.05 (five-kobo) levy per second of voice call could be channelled to the National Health Insurance Authority (NHIA) to fund universal coverage. “With about 150 million active phone lines, that could generate over N2 trillion a year. That is enough to cover millions of Nigerians under the NHIA,” he said.

Kurunwi also called for single-digit interest loans for hospital investors to rebuild infrastructure, similar to what the telecom industry enjoyed two decades ago.

If these measures are implemented, Kurunwi believes Nigeria could regain its lost glory within a decade.

“We can reverse the brain drain. If doctors see a functioning system and fair pay, they will return. We can make Nigeria the healthcare hub of West Africa again, just like in Joe Okoro’s time,” Adebusoye added.

For the PSHAI chairman, the story of Okoro’s miraculous healing in 1968 is more than nostalgia. It is a symbol of what was possible, and what can happen again. “In those days, our hospitals healed people and gave them hope. Today, people go there to die. But we can change that story, if we choose to,” Adebusoye added.