Introduction
The World Health Organization defines health access as universal health coverage, meaning that every individual should have access to necessary health services with sufficient quality, ensuring effectiveness, and without encountering financial difficulties, regardless of when and where they require such services. In Nigeria, access to healthcare is restricted across various measurements, influenced by factors within and outside the health system.
Despite Nigeria’s strategic position in Africa, the country’s healthcare system faces numerous challenges that have hindered its development, some of which include poor remuneration of healthcare workers, low investment, mismanagement of funds, lack of transparency in policymaking and procurement process inaccuracies. A 2013 report by the World Health Organization on the state of health financing in the African region showed that member states of the region, of which Nigeria is a member, are on average still far behind in meeting key health financing goals such as the 2001 Abuja Declaration target of allocating 15% of the government budget to health3. A possible explanation for the sector’s struggles to provide quality service and limited accessibility lies in its year-on-year federal budget allocation. The sector’s annual budget allocation has consistently fallen short of the 15% target for health sector funding outlined in the 2001 Abuja Declaration. Nigeria’s highestever public budget share for health since 2015 is 5.8%. This fell to less than 4% in 2019. The illustration below shows the difference between the expected and actual percentages allocated to the health sector in the national budget.
In 2024, only three countries – South Africa, Cape Verde and Botswana have met the 2001 Abuja Declaration target5. In 60% of the other countries, the health sector share of total government expenditure is below 10%, according to the World Health Organization.
The major cause of this inadequate allocation of funds in Nigeria is the government’s failure to prioritize health and healthcare7. This lack of prioritization has led to significant issues such as poor remuneration and working conditions for healthcare professionals, resulting in a shortage of skilled workers and an incredible increase in the workload of those who remain. Comparing the nurse-to-population ratios in Nigeria and the UK presents a vivid picture of the gap that exists in the state of healthcare in both nations. In the United Kingdom, where 731,058 registered nurses attend to approximately 68 million people, the ratio stands at 1:93.
Meanwhile, Nigeria, with its population of approximately 225 million and only 180,709 registered nurses as of 2021, exhibits a much higher nurse-to population ratio of 1:1,245. This striking difference highlights the gravity of the workforce shortage in Nigeria’s healthcare system, underscoring the need for urgent and strategic interventions. In a series of interviews conducted by Ciuci to understand healthcare from the perspective of Nigerian nurses, the key insight was that these nurses love their jobs and would love to remain in the profession until retirement, they however do not feel appreciated enough. They acknowledge that the standard of training they receive in Nigeria equips them to stand toe-to-toe with their international counterparts and one of their biggest joys, as alluded to by all respondents, is witnessing patient recovery. Low wages, tough economic climate, unfavorable working conditions, and lack of tools are some of the major reasons cited for the mass exodus of their fellow healthcare workers from Nigeria. Given the chance, a majority would opt to leave the country, with younger respondents displaying eagerness to explore international opportunities.
One of the respondents alluded to this when she rated her likelihood to leave Nigeria at “1,000 out of 10.” Notwithstanding these challenges, the interviews unveiled a profound love for the profession and an unwavering dedication to patient care. Some respondents mentioned that the workforce shortage has resulted in pressure and underpayment, as one respondent articulated, “the monetary compensation does not align with the work we do.” The respondents all believe that Nigeria has the potential to become a healthcare haven through increased investment in infrastructure, fostering efficiency, reducing unethical practices, and cultivating a more supportive work environment. An older and more experienced respondent stressed the justification for more resources, equipment, and infrastructure, noting that “improvisation is not genuinely encouraged in the profession, so we need to have the right tools to do the work”.
Ciuci, adopting strategic and innovative operations management approaches, continues to address healthcare challenges in Nigeria through its care expression – AGCare. Operating various healthcare assets, the institution consistently combines quality and affordability, prioritizing staff skill and well-being as a means to address the brain-drain crisis at its own assets. Managing a portfolio of healthcare establishments, the institution expands its operations management capabilities across various regions, aiming to improve patient outcomes through market-relevant strategies.
Opportunities for improvement within the healthcare system are evident, and a pivotal area is increased funding and resource allocation. By channeling more funds into the system, many critical needs will be addressed such as acquiring advanced medical equipment, expanding facilities, and ensuring an ample supply of essential resources. The integration of technology is essential for enhancing efficiency in processes such as record-keeping, diagnostics, and communication. In addition to funding, publicprivate partnerships can also leverage both sectors’ strengths to bridge gaps and optimize resource utilization.
There are several innovative developments that can be adopted from around the world. Uganda, for example, offers an effective and efficient model. The introduction of a USSD code for contacting healthcare workers, requesting for doctor consultations, laboratory tests, pharmacy products, schedule clinic appointments, subscribe to healthcare plans, chronic care management and access to exclusive offers presents an alternative to physically visiting the hospital. This innovation proves particularly advantageous for individuals residing at a distance from healthcare facilities, providing them with a convenient and efficient means of accessing healthcare services. It also reduces the pressure on the medical practitioners who they will need to see. This model first deploys health workers to the patient, and where necessary, they are referred to hospitals for treatment.
Conclusion
Recommendations derived from the interviews provide valuable 0perspectives. Investing in training and professional development programs ensures that healthcare professionals stay abreast of advancements and are equipped with the necessary skills. Establishing robust support systems for healthcare professionals, including mental health resources, can help alleviate the emotional toll associated with their roles. In addition, advocating for policy changes, informed by frontline experiences, becomes imperative to address systemic issues within the healthcare system, fostering positive transformation and sustainability.
