Nigeria’s healthcare crisis needs more than government spending, it needs ingenuity
In the 1960s, Nigeria’s healthcare system stood as a regional benchmark. Lagos University Teaching Hospital (LUTH) was the destination for complex surgeries, and Ibadan’s University College Hospital drew medical tourists from across West Africa.
A senior health professional, Dr Bode Karunwi, whom I interviewed recently, recalled those years with nostalgia.
“We trained the best doctors on the continent,” he said. “Our hospitals were well-equipped and respected. We didn’t talk about medical tourism; Nigeria was the destination.”
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Half a century later, the story could not be more different. Hospitals now struggle to function amid power cuts, outdated equipment, and shortages of essential drugs. Doctors are fleeing abroad in record numbers, and the few remaining are overwhelmed.
“The first step is integration with the Telcos. All telecom operators, from MTN to Airtel, Glo, and 9mobile, would collect the 5 kobo levy in real time through existing billing systems, automatically crediting it into a central Health Insurance Fund.”
According to Nigeria’s National Association of Resident Doctors, the country has less than 12,000 resident doctors for a population exceeding 220 million. That’s roughly one doctor for every 18,333 people, compared to the World Health Organisation’s (WHO) recommended ratio of 1:600. Members of the NARD account for close to 50 per cent of doctors in Nigeria; when the others are factored in, that takes the total number of doctors in the country to 24,000, which works out to an abysmal ratio of 1:9,166.
The consequences of scarce and partly inexperienced doctors are visible in every state.
Maternal mortality remains among the highest in the world. According to the most recent UN estimates for the country, compiled from 2023 figures, one in 100 women dies in labour or in the following days.
That puts it at the top of the league table of countries with the highest maternal deaths.
In 2023, Nigeria accounted for well over a quarter – 29% – of all maternal deaths worldwide.
That is an estimated total of 75,000 women dying in childbirth in a year, which works out at one death every seven minutes.
In addition to this, life expectancy hovers at 55 years, one of the lowest globally. Yet the root of the crisis is not just the decay of infrastructure or the flight of talent but the failure of financing.
The limits of government spending
Nigeria’s 2025 federal health budget of N2.48 trillion represents roughly 5% of total spending, still far below the 15% Abuja Declaration target African heads of state set in 2001. To put this in perspective, the United Kingdom, with a population one-third of Nigeria’s size, spends over £180 billion, over N340 trillion, annually on the National Health Service (NHS). Even Ghana, which has a fraction of Nigeria’s GDP, has maintained a more consistent funding mechanism through its National Health Insurance Scheme.
Public health financing in Nigeria has long been hostage to oil revenues and budget cycles. When global oil prices fall, health funding contracts, a pattern that has persisted for decades. What results is a system perpetually under-resourced, forcing most Nigerians to pay out-of-pocket for healthcare. The World Bank estimates that over 70% of total health expenditure in Nigeria comes directly from households, pushing many into poverty after major illnesses.
Relying solely on government funds, therefore, is a strategy destined to fail.
A micro-levy for macro-change
The healthcare expert I spoke with offered a radical yet pragmatic solution: a 5 kobo surcharge on every second of voice calls, to be channelled directly into Nigeria’s national health insurance pool.
At first glance, it seems modest. But the arithmetic is striking. As of May 2025, Nigeria’s teledensity stands at 79.65 percent, with about 220 million active mobile lines. MTN, the country’s largest operator, reported N3.73 trillion in revenue in the first nine months of 2024, implying over N5 trillion annually.
A 5 kobo (N0.05) per second levy, applied industry-wide, could conservatively raise N2 trillion each year. That’s nearly matching the federal health budget. MTN alone could contribute about N900 billion, based on usage patterns.
This approach mirrors a growing global trend of micro-levies for public goods – small charges aggregated across millions of daily transactions that generate substantial public revenue without noticeable pain to consumers.
Blueprint for implementation
The design of such a scheme must prioritise transparency, efficiency, and competition. Dr Karunmi gave a sense of how this could work.
The first step is integration with the Telcos. All telecom operators, from MTN to Airtel, Glo, and 9mobile, would collect the 5 kobo levy in real time through existing billing systems, automatically crediting it into a central Health Insurance Fund.
The next step is the creation of digital health accounts. Each mobile subscriber would have a unique digital health account linked to their phone number. These accounts would be accessible via a national health insurance app, showing accumulated contributions and enabling enrollment with licensed Health Maintenance Organisations (HMOs).
The third step is to foster competitiveness among HMOs. To encourage service quality, individuals could switch HMOs if dissatisfied, fostering a market-driven model where efficiency and customer satisfaction determine performance.
The final step is setting up regulatory oversight.
A Health Insurance Regulatory Commission, modelled after the Nigerian Communications Commission (NCC), would monitor operations, pricing, and service delivery.
This model would not only enhance funding but also instil a culture of accountability and performance-based competition, long absent in Nigeria’s public health system.
Learning from others: Global precedents for health financing show private funding is way out.
Several countries have cracked the healthcare puzzle through innovative financing models that combine public oversight with citizen participation.
Through its Mutuelles de Santé system, Rwandan households contribute small premiums, scaled to income levels, with government subsidies for the poorest. Coverage now exceeds 90% of the population, one of the highest in Africa.
Leveraging digital innovation, M-TIBA in Kenya allows citizens to save, send, and spend funds specifically for healthcare via mobile money. As of 2023, it had reached over 4 million users, many of whom had never been insured before.
In Indonesia, the Jaminan Kesehatan Nasional (JKN) scheme, launched in 2014, now covers 90% of the country’s 270 million citizens. It is funded through small mandatory payroll contributions from employers and workers, supplemented by government payments for the poor.
Thailand’s Universal Coverage Scheme uses a combination of tax revenue and co-payments, achieving near-universal health access within a decade.
The common thread across these cases is broad participation and incremental payment. Citizens contribute modestly, but consistently, toward collective healthcare security.
Nigeria, with its massive mobile penetration, is uniquely positioned to adopt a digital-first, pay-as-you-go health financing system that mirrors the success of its telecom revolution.
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The cultural challenge
Nigeria’s health crisis is not merely institutional; it’s attitudinal. Many Nigerians aspire to first-world healthcare but resist paying for it. The same contradiction defines the education sector: a societal demand for Ivy League quality but a preference for low-cost, underfunded institutions.
This mindset, says the healthcare expert, must change. “People must understand that good healthcare is not a gift — it’s a shared investment,” Dr Karunwi said. “If everyone contributes a few kobo per call, we can build a system where no Nigerian is denied care because they’re poor.”
Changing this psychology, from dependency on government to co-ownership of outcomes, may be Nigeria’s most important reform.
The economic case for health
Investing in healthcare is not charity; it’s smart economics. A 2022 McKinsey study found that every $1 invested in health yields up to $4 in economic return through higher productivity and reduced absenteeism. Nigeria’s losses from poor health outcomes, which include preventable deaths and medical tourism, are estimated to exceed N1.6 trillion annually.
Redirecting even part of that through domestic financing would have a multiplier effect, stimulating employment, technology innovation, and human capital development.
It’s execution time.
President Bola Tinubu’s decision to make health insurance compulsory is a commendable start. But legislation without funding and implementation will not move the needle. The 5 Kobo health fund represents a viable bridge between aspiration and action. It’s an idea that merges technology, regulation, and shared civic responsibility.
Imagine a Nigeria where every phone call contributes, in its small way, to saving lives. A market trader in Aba, a farmer in Katsina, and a teacher in Ekiti, each unknowingly helping to fund a national safety net. It’s a vision both humble and revolutionary.
If executed well, this could be Nigeria’s version of the mobile money miracle that transformed East Africa, a moment when innovation, inclusion, and necessity converged.
