Nigeria’s Safety Net is Vanishing in a World that is Turning Inward
Early on during the COVID-19 pandemic, there were some of us who believed that the glaring failure of the Nigerian healthcare system would serve as a wake-up call for Nigeria’s political class. As the borders closed in 2020 and as the world debated how best to defeat this strange virus that seemed to control our lives at the time, Nigerian elites and leaders of the political class were briefly confronted with a healthcare system they could not escape: hospitals without functional ICU units, lack of a working vaccine, and a dependence on often crowd-funded PPEs.
Five years later, Nigeria’s 2025 health budget still sits at 5.18% of total expenditure, far below the 15% pledged in the 2001 Abuja Declaration. Our healthcare system continues to crumble and scientific researchers have settled into an even more grim reality: that their own government will never be interested in funding their work or equipping their laboratories [at least, not without some form of duress]. Sadly, we are slowly running out of time because the winds of change are blowing heavily. Western nations [that have served as funding bulwarks for our decrepit healthcare system] are now retreating into isolationism, signaled by Donald Trump’s “America First” resurgence and drastic USAID cuts.
Nigeria’s refusal to prioritize self-reliance in health and research is plainly suicidal. When the aid pipeline finally runs dry, millions of Nigerians will come to discover that what they thought was an infinite safety net was only a temporary illusion of generosity. Trump’s freeze on foreign aid, including critical HIV and malaria programs, has already exposed Nigeria’s vulnerability. Despite informally proclaiming ourselves as "the giant of Africa", over 1.8 million Nigerians rely on U.S.-funded HIV treatments, with malaria and tuberculosis interventions hanging in the balance.
This dependency on foreign saviors is deeply entrenched in our political and policy system. Nigeria receives about 1.02 billion dollars annually from USAID, which funds around 90% of its HIV treatment programs. For decades, instead of using that support to build domestic capacity, successive governments have treated it as an excuse to defer responsibility. The 2025 budget allocates ₦2.48 trillion to health, a modest pool beside the ₦4.91 trillion assigned to defense and ₦4.06 trillion for infrastructure. This is a country that bears roughly 20% of global maternal deaths and the world’s highest malaria burden, yet consistently invests the barest minimum in preventing or managing these crises. The recent sickle cell drug breakthrough, developed abroad despite Nigeria’s high sickle cell disease prevalence and deep reservoir of patient experience, is also symbolic and captures a political class that relates to healthcare as charity from elsewhere rather than as a strategic policy of national sovereignty.
Less than 0.2% of GDP goes into research and development, suffocating local innovation before it can breathe. The doctor-to-patient ratio hovers around 1:5,000, and continues to worsen as health professionals emigrate in search of dignified work. Health insurance remains fragmented and exclusionary; only about 5% of Nigerians have any form of coverage, leaving roughly 70% to pay for care out of pocket. Each statistic is a policy choice masquerading as fate. Even when gestures toward reform arrive, they come half-formed. President Bola Ahmed Tinubu’s 2024 Health Sector Renewal Initiative, which promised hospital upgrades and pooled drug procurement, has stalled halfway between announcement and implementation. The redesigned Basic Healthcare Provision Fund (BHCPF) still lacks the scale and governance strength needed to anchor primary care for the poorest Nigerians. Policy documents continue to multiply while hospital wards remain overcrowded, understaffed, and under-equipped.
Reversing our current trajectory requires making some very bold decisions. Meeting the Abuja Declaration target and allocating 15% of the national budget to healthcare would inject roughly ₦7.46 trillion, rather than ₦2.48 trillion, into repairing decades of neglect and decay. Executive Orders should be used not just as media headlines, but as tools to genuinely incentivize local drug manufacturing and diagnostics production, building on the intent of the 2024 Health Sector Renewal Initiative. A serious expansion of the BHCPF, coupled with regional collaboration across African states to pool resources and negotiate fairer prices, would begin to turn fragmented efforts into a coherent, multi-sectoral health security strategy.
The Nigerian political elite have long treated healthcare as a problem for tomorrow. Well, tomorrow has arrived, bringing with it frozen aid, shifting alliances, and a global competition for limited resources. While the US aid freeze expands and European partners follow suit, our underfunded and overburdened healthcare system may eventually buckle under the weight of preventable deaths. The 5.18% health allocation in the 2025 budget [despite the prevailing changes happening internationally] is a quiet death sentence written into fiscal policy.
-Boluwatife OLU Afolabi