A recent report by SBM Intelligence that no state in this federation achieves even 30 per cent preparedness for health emergencies calls for urgent action to redress. Nigerian authorities at every level should declare a state of emergency on health security for the people. SBM Intelligence, a self-described ‘Africa-focused market/security intel gathering and strategic consulting firm’, noted that the highest score according to its study was 26.85 per cent by Abia State, followed by other states with even worse scores.
The reasons for this depressing result, well-articulated in the report, include structural deficiencies, poor fiscal prioritisation, and the exodus of healthcare professionals to more conducive work environments in other climes. Indeed, it is reported that more than 67 per cent of Nigeria-trained doctors work outside the country, with the consequence that the nationwide doctor-to-patient ratio is now 1:15,361, and in states such as Bauchi, it is even more alarming, at 1:54,249.
‘Health Emergency Preparedness’ (HEP) is explained by the World Health Organisation (WHO) as the capability ‘to respond immediately and effectively to potential health threats and emergencies caused by any hazard.’ These ‘hazards’ are cited to include infectious diseases, food contamination, and threats associated with climate change. To be effective, HEP requires what has been described as ‘a continuous cycle of planning (and) reacting to manage such threats to public health as pandemics and natural disasters.’
To this end, it is reasonable to consider, among other issues, the number of health professionals available and their distribution, the number of Primary Health Centres (PHCs) and local drug manufacturing companies in the country, and even the availability of genuine drugs versus fake products.
Deriving from the SBM Intelligence report and others in the public domain, it needs to be said directly: Nigerian governments are failing disastrously in their primary constitutional obligations of ‘security and welfare’ to their citizens. Specifically, section 17 (3) (d) enjoins the State [through the instrumentality of government] to direct its policy towards ensuring that ‘there are adequate medical and health facilities for all persons.’ This is the law that, we should think, every respectable, law-abiding government ought to implement.
Countries that place the utmost consideration on their human capital put a premium on an effective and efficient healthcare sector. And this is not all about money but primarily about the quality of thinking among and action by their leadership. Cuba is a good example. This not-so-materially-rich country had the highest doctors-to-citizens ratio of 95.4:10,000 as of 2021. Indeed, Cuba ranks ahead of New Zealand, Italy, France, the United Kingdom, Denmark, and Saudi Arabia in the 2024 Healthcare Index compiled by worldpopulationreview.com. According to this index, Nigeria’s 2023 figure is 3.8 doctors per 10,000 people.
People are especially at risk of infectious diseases when they are multidimensionally poor. This form of poverty includes inadequate nutrition and a lack of appropriate and timely medical treatment if and when required. Age, gender, and living conditions in urbanised environments are also factors that put people at risk of health emergencies. In view of this, WHO says ‘the rapid detection, verification, assessment, and communication of potential health threats is essential to save lives and reduce the negative impact of health emergencies.’
Federal, state, local governments, and communities have roles to play in ensuring Public Health Emergency Preparedness and Response (PHEPR). This is important because, too often, citizens expect the government to do everything for them. People in the community must also take responsibility for devising unique solutions to their own environmentally specific public health challenges. Even the clear articulation of these challenges and needs is better worked out by communities than by distant government officials in the state and federal capital.
That the federal government does not prioritise the health of citizens is easily proven by the annual budgetary allocation to the sector. The WHO is reported to recommend allocating at least 15 per cent of the annual national budget to health, or even six to seven per cent of GDP. Nigeria’s 2025 federal budget of N49.74 trillion allocates 4.99 per cent or N2.48 trillion to the health sector. Again, this is a far cry from the 2001 Abuja Declaration’s recommendation of at least 15 per cent of total government expenditure for health.
The WHO Global Health Security Index (2021), which measures a country’s capacity to prepare and/or respond to epidemics, ranked Nigeria, with 38 per cent, 86th of 195 countries surveyed. If Nigerian decision makers agreed with the dictum that ‘health is wealth’ and allocated six per cent of the country’s nominal GDP of N372.8 trillion to the sector, that would be at least N22.36 trillion to, among other improvements, incentivise and retain fleeing medical personnel, attract additional ones, put in place an excellent infrastructure and a conducive work environment. But this, or at least something close to it, can be done if the government musters the political will to pursue the highest good of the greatest number in the polity.
President Bola Ahmed Tinubu’s Action Plan for a Better Nigeria campaign document promised, if elected by voters, among other ear-pleasing statements, to ‘strengthen our national primary health care network…to ensure that no person lives more than 3km or 30 minutes’ walk from a primary health facility’. Furthermore, he stated that ‘working with State and Local Governments, we will encourage preventative measures … [that] will be grassroots-based, gender sensitive, and affordable’.
In specific reference to ‘Public Health Emergency’, Tinubu agreed on the ‘imperative …to improve our public health response preparedness’. His Minister of Health and Social Welfare, Dr Muhammad Pate, reportedly said in March 2024 that there were a total of 300,000 health professionals, including only 55,000 doctors, to serve the (2024) 229.5 million citizens. He noted that in the preceding five years, 16,000 doctors left these shores.
WHO recommends at least 10 doctors to 10,000 people; the 2022 global average was 17.2 to 10,000. Nigeria’s doctor-to-population ratio in 2023 was calculated to be 3.8 to 10,000.
Besides personnel, the Primary Healthcare Centre (PHC) is considered foundational to society’s healthcare system because it is the first point of care, especially in rural communities. It is of critical importance that PHC functions optimally and affordably to prevent health issues from getting serious and requiring more complicated, more expensive treatment.
Health security is most urgently necessary in the country. Only people who are alive and well can meaningfully contribute to national development or utilise roads and other physical infrastructure. The SBM Intelligence report is a wake-up call to the Tinubu administration to declare an emergency in the public health sector as soon as possible, in fulfilment of his expressed commitment in his manifesto.
