By Adaobi Rhema Oguejiofor
Nations measure health in billions of naira or even dollars. But for ordinary people, the true measure of a nation’s health is far simpler: how long its people live. Nigeria has been spending more on healthcare, announcing reforms, expanding programmes and committing substantial public resources to the sector. Yet one of the clearest indicators of national health continues to tell a troubling story.
In 2023, life expectancy in Nigeria stood at about 54 years, according to World Bank data. Rwanda recorded about 68 years, Ghana 65 years and Kenya 64 years, while the sub-Saharan African average was approximately 62 years. This gap is difficult to ignore. It indicates that a child born in Nigeria is statistically expected to live for more than a decade fewer years than a child born in Rwanda. When compared with Ghana, the difference is roughly 11 years.
Behind these numbers are millions of individual stories involving mothers who die during childbirth, children lost to preventable diseases, patients who arrive at hospitals too late, families unable to afford treatment and communities where healthcare remains physically or financially out of reach. Yet Nigeria’s story is not one of complete stagnation.
The World Health Organization (WHO) says life expectancy increased from 46.5 years in 2000 to 55.44 years in 2022. Routine immunisation has also improved, while malaria and HIV prevalence have recorded declines. This indicates that the country has made significant progress.
The question, however, is why that progress has not been enough. And perhaps more importantly, why has increasing public attention and spending on healthcare not translated into a much longer and healthier life for the average Nigerian?
The Billions Behind the Promise
Nigeria’s health budget has risen considerably in nominal terms over the past six years. In 2021, the Federal Government allocated about N549.8 billion to health, representing 4.05 per cent of the federal budget. The figure rose to approximately N724.9 billion in 2022, or 4.23 per cent.
By 2023, the allocation had crossed the trillion-naira mark, reaching about N1.07 trillion, equivalent to 4.91 per cent of the budget. In 2024, it increased further to about N1.34 trillion, although its share of the overall budget fell slightly to 4.64 per cent.
The broader federal health-sector envelope was estimated at N2.83 trillion in 2025, while N2.48 trillion was provided for health in the 2026 budget. These health-sector figures can vary according to what is included in the calculation, particularly statutory transfers and other health-related allocations.
Nigeria’s recent federal health-budget trajectory
On paper, the increase appears substantial. But the size of a budget does not automatically translate into better health outcomes. Nigeria has consistently fallen short of the 15 per cent health-spending commitment under the Abuja Declaration. More importantly, inflation, population growth, rising medical costs and the country’s enormous disease burden can reduce the real impact of nominal increases.
A budget can provide money for a hospital without ensuring that the hospital has enough doctors. It can fund equipment without guaranteeing maintenance. It can allocate money for medicines without ensuring uninterrupted supply.
The real question, therefore, is not simply how much Nigeria budgets for health, but how much of that money becomes accessible, affordable and effective healthcare.
One of Nigeria’s biggest health-financing problems is the burden placed on households. WHO reports that out-of-pocket payments account for more than 75 per cent of total health expenditure in Nigeria, exposing low-income families to catastrophic health spending and possible impoverishment
For a family already struggling with food, rent, transportation and school expenses, a medical emergency can become a financial disaster. A patient may postpone a doctor’s visit because there is no money for consultation. A mother may delay taking a sick child to hospital because transport is unaffordable. Another patient may buy only part of a prescribed medication because the full course is too expensive.
By the time such patients eventually reach a hospital, an illness that could have been treated early may have become more complicated and expensive. This is why health insurance and financial protection are central to improving life expectancy.
Nigeria’s health system also faces a persistent primary healthcare challenge; a strong health system should prevent disease, detect illnesses early, provide basic treatment and refer complicated cases before they become emergencies. But access and quality remain uneven across the country. WHO identifies limited access to quality and integrated health services, preventable illness and mortality, and weak governance and accountability as Nigeria’s major health challenges.
For a woman in a remote community, the difference between a functioning primary healthcare centre and a poorly equipped one can be the difference between receiving timely antenatal care and developing a life-threatening complication.
For a child with malaria, early diagnosis can mean the difference between recovery and an emergency. Primary healthcare is therefore not a lesser form of medicine. It is the foundation upon which longer lives are built.
A Health Problem Beyond Hospitals
Nigeria is also fighting a double burden of disease. Malaria, tuberculosis and other infectious diseases remain significant threats, while hypertension, diabetes, cancer, cardiovascular disease and other non-communicable diseases are increasing.
This places enormous pressure on a health system that must simultaneously manage acute infections and chronic conditions requiring years of treatment and monitoring. Prevention therefore becomes critical.
It is cheaper to prevent complications from hypertension than to treat a stroke. It is cheaper to detect cancer early than to treat advanced disease. It is cheaper to control risk factors for diabetes and cardiovascular disease than to manage their complications.
Longer lives require a shift from simply treating sickness to preventing it. And health is not created in hospitals alone.
It is shaped by food, clean water, sanitation, housing, education, income, road safety, the environment and security
Water and sanitation policies are health policies. Food-security policies are health policies. Education and social-protection policies are health policies. The health ministry cannot solve Nigeria’s life-expectancy problem by itself.
No Health Budget Can Work Without People
Nigeria needs doctors, nurses, midwives, pharmacists, laboratory scientists, community health workers and other professionals to turn policies and allocations into actual care. Yet the migration of Nigerian healthcare professionals seeking better opportunities abroad continues to put pressure on the workforce that remains.
A doctor handling too many patients has less time per patient. A nurse working excessive shifts faces exhaustion. A rural health centre without adequate personnel cannot provide the services its infrastructure was designed to deliver.
The question is therefore not only how many health workers Nigeria trains, but how many remain, where they work and under what conditions. A country can build hospitals faster than it can build and retain the workforce needed to run them.
When a health budget is announced, the public hears the headline figure. But patients experience something else: whether a facility has electricity, whether essential medicines are available, whether laboratory equipment works, whether a doctor is present and whether treatment is affordable.
These details determine whether a budget becomes healthcare. Nigeria’s experience shows that increasing expenditure alone cannot guarantee better outcomes. Efficiency, accountability, financial protection and frontline delivery matter just as much.
The country’s rising health allocations should therefore be judged against tangible outcomes like fewer maternal and child deaths, stronger primary healthcare, lower out-of-pocket spending, better access to medicines, a stronger health workforce and ultimately longer, healthier lives.
A Longer Life Cannot Be Budgeted into Existence
Nigeria’s health challenge is larger than its annual appropriation. It is about whether public spending becomes functioning healthcare. It is about whether people can seek care early, whether primary healthcare receives adequate attention, whether preventable deaths are treated as national emergencies and whether Nigeria can retain enough health professionals to serve its growing population.
Nigeria has already shown that improvement is possible. Life expectancy has risen by almost nine years since 2000, according to WHO. But at roughly 54 years, the country’s life expectancy remains below the sub-Saharan African average and far below the global average. The figures are not meant to inspire despair but rather to create a sense of urgency.
Because the ultimate purpose of healthcare spending is not to produce impressive numbers in budget documents. It is to ensure that a child survives infancy, a mother survives childbirth, a worker survives a treatable illness, an elderly person receives dignified care, and families do not have to choose between medicine and food.
Nigeria’s health sector does not merely need more money. It needs more value from every naira spent. And perhaps that is the real meaning of going beyond the budget. It is moving from asking, “How much did Nigeria spend on health?” to asking the question that matters most, “How many more years did Nigerians get to live because of it?”
