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Analysis

Examining Nigeria’s Health System and Preventable Deaths, by Alabidun Shuaib AbdulRahman 

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Examining Nigeria’s Health System and Preventable Deaths, by Alabidun Shuaib AbdulRahman 

 

My last week’s column, ‘The Agony of a Columnist,’ was written from a place I never expected to occupy. It was not an attempt at catharsis, nor was it designed to elicit sympathy. It was simply an account of what happened when a citizen encountered the Nigerian healthcare system at its most critical moment and found it wanting. The death of my eight-month-old daughter occurred within a public hospital that, on paper, appeared functional. What followed exposed a gap between appearance and capacity that deserves closer scrutiny rather than sentiment.

 

This week’s column is broader. It is about structure, policy, and outcomes. It is about what the data says and what lived experience confirms about the state of healthcare delivery in Nigeria, a system that reflects not only underperformance but failure at its most consequential moments.

 

Considering another recent case that captured national attention, that of Ifunanya Lucy Nwangene, a 25-year-old Abuja-based singer who was bitten by a cobra in her home. She sought emergency care immediately, moving from one health facility to another, and struggled to obtain antivenom and appropriate treatment before it was too late.

 

Accounts vary on the specifics, but the tragedy is indisputable. Her death, amid circumstances that could have been preventable, echoes the avoidable loss of my own child and reflects the same systemic weaknesses that place ordinary citizens at risk every day. Reports indicate that approximately half of Nigerian hospitals lack the capacity to manage snakebite cases effectively and that nearly all facilities experience difficulties in administering antivenom, the only treatment recognized by the World Health Organization for venomous bites. Such deficits in treatment capacity, emergency response, essential medicines, and clinical training are not anomalies; they are the predictable outcome of chronic systemic weakness.

 

Nigeria’s healthcare system is structured across primary, secondary, and tertiary levels. According to the latest facility registry data, there are roughly thirty-eight thousand six hundred forty-five operational health facilities nationwide, a figure that includes both public and private establishments, translating to approximately eleven facilities per one hundred thousand people in a population exceeding two hundred and twenty million. Primary care facilities account for nearly eighty-eight per cent of all facilities, secondary care roughly twelve per cent, and tertiary facilities less than one per cent.

 

On paper, the distribution seems extensive, but quantity does not equal quality or functionality. The majority of primary healthcare centers, which form the first line of defence, are unable to deliver essential services consistently due to shortages of trained personnel, drugs, water, power, and equipment. Only about twenty per cent of primary facilities are considered fully functional, leaving millions of Nigerians dependent on emergency care that is often delayed or unavailable.

 

Health outcomes are determined by human resources as much as infrastructure, yet Nigeria’s health workforce is severely strained. The doctor-to-population ratio remains well below the World Health Organization’s recommended threshold of one doctor per six hundred people, with practical estimates ranging from one doctor per four thousand to one per five thousand citizens, and some areas experiencing ratios as low as one per nine thousand eight hundred.

 

Nurses and midwives are similarly scarce and unevenly distributed, favoring urban centers over rural and peri-urban areas. Absenteeism and burnout are systemic risks exacerbated by poor remuneration, unsafe working conditions, and limited career progression. The migration of trained health professionals abroad not only represents a loss of public investment but reduces the system’s capacity to respond to emergencies, increasing the likelihood that predictable crises result in preventable deaths.

 

Funding is a primary driver of these gaps. Nigeria is a signatory to the 2001 Abuja Declaration, committing to allocate at least fifteen per cent of annual budgets to health, yet the highest allocation recorded in any year remains below six per cent. By comparison, global benchmarks suggest public health spending should constitute at least five per cent of GDP to achieve basic universal health coverage, while Nigeria currently allocates approximately half a per cent. Per capita health expenditure ranges between ten and fifteen US dollars annually, which is insufficient to ensure functional hospitals, reliable emergency response, or the availability of essential drugs and equipment.

 

The inadequacy of public funding shifts the burden to households. Out-of-pocket payments account for nearly seventy to seventy-five per cent of total health spending, meaning that patients and families finance care at the point of illness rather than through pooled systems. Less than ten per cent of Nigerians are covered by any functional health insurance, and coverage is largely limited to formal sector employment. As a result, families often delay care, ration treatment, or avoid facilities altogether until conditions deteriorate beyond recovery.

 

The human consequences of these systemic failures are evident in national health indicators. Nigeria continues to have one of the highest maternal mortality ratios in the world, exceeding eight hundred deaths per one hundred thousand live births, and accounts for approximately twenty per cent of global maternal deaths despite representing less than three per cent of the world population. Infant and under-five mortality remain high, with recent surveys showing roughly sixty-seven deaths per one thousand live births and one hundred and ten per one thousand respectively. Many of these deaths result not from rare or complex conditions but from the inability of the health system to provide timely, skilled intervention for preventable or manageable illnesses. Malaria, pneumonia, childbirth complications, and neonatal distress often escalate into fatalities that could have been avoided had emergency care been available, adequately staffed, and well-supplied.

 

Infrastructure alone does not solve the problem. Hospitals are renovated, equipment procured, and wards repainted, but functionality depends on staffing, reliable power, water, supply chains, and governance. Electricity supply is particularly critical, as hospitals depend on continuous power for monitoring, oxygen delivery, laboratory diagnostics, and refrigeration of vaccines and essential medicines. Yet many facilities rely on intermittent generators with uncertain fuel supply, leaving patients exposed to system failures that no renovation or new building can correct.

 

Primary healthcare centers, despite their numbers, are frequently unable to provide preventive and early intervention services, meaning that conditions that should be addressed at the community level escalate to secondary facilities that themselves are overstretched.

 

Accountability within the health system is diffuse. Budget allocations are announced, but utilization and outcomes are weakly monitored. Staffing requirements are often unmet, and enforcement is inconsistent. Failures rarely attract consequences proportional to their impact, leaving citizens, including vulnerable infants and young adults, to bear the cost. Hospitals are frequently evaluated on the wrong metrics, such as bed count or physical infrastructure, rather than whether care is actually delivered. Time-sensitive emergencies cannot wait for policy announcements or cosmetic compliance; delays and absenteeism in these circumstances are measured in lives lost.

 

Both my personal experience and the case of the young singer illustrate these realities. My daughter was taken to Suleja General Hospital where initial symptoms did not appear severe, yet she required urgent intervention. Medical review was delayed, oxygen was administered without a definitive diagnosis or treatment plan, and a requested transfer to another facility was not effected in time. In the singer’s case, urgent antivenom administration was critical to survival, yet the system’s gaps prevented timely care, and the result was fatal. These outcomes are not anomalies; they are predictable expressions of systemic failure.

 

Nigeria does not lack reform frameworks. Initiatives exist to revitalize primary healthcare, expand health insurance, and improve maternal and child health outcomes. Some interventions have produced measurable gains in targeted areas, but they remain uneven and insufficiently scaled, often undermined by governance failures and weak operational oversight. The result is a system that prioritizes form over function, presenting the appearance of readiness while leaving emergency response and routine care vulnerable to failure. The consequences are borne not by policy-makers or administrators, but by citizens whose lives hang in the balance.

 

The purpose of revisiting last week’s column is not to relive personal grief but to insist on institutional reflection. Every preventable death, whether of a child in a public hospital or a young adult succumbing to a snakebite or otherwise, represents a failure of policy, funding, and governance. Healthcare is not an area where delays, absenteeism, or cosmetic compliance can be absorbed without consequence. Systems either respond, or they fail. In Nigeria, the record shows repeated, predictable failures. Mortality data, budget analyses, facility assessments, and lived experience all converge to the same conclusion: when the health system is tested, it often cannot deliver.

 

The crisis is visible, documented, and persistent. Nigeria’s hospitals function intermittently, supply chains are fragile, essential medicines are inconsistently available, and health workers are overstretched. Until outcomes, rather than infrastructure announcements, become the primary measure of success, preventable deaths will continue.

 

Tragically, the cost is measured not only in statistics but in lives that could have been saved. My daughter’s loss was personal, and the death of Ifunanya Nwangene was public. Both expose the same reality: a healthcare system that cannot guarantee timely, competent response in emergencies is not merely underperforming; it is failing its most fundamental obligation.

 

The reality requires less rhetoric and more reform, less emphasis on appearances and more attention to function. Budget allocations must be credible and linked to measurable outcomes, staffing requirements must be enforced, essential medicines and equipment must be reliably supplied, and emergency systems must be consistently operational. Until these conditions are met, Nigeria will continue to produce tragic but predictable stories of lives lost to systemic weakness, and citizens will continue to confront a healthcare system that appears reassuring until it is tested at its most critical moments.

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Analysis

Is Nasir El-Rufai on the Peril? By Alabidun Shuaib AbdulRahman

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Is Nasir El-Rufai on the Peril? By Alabidun Shuaib AbdulRahman

 

There is something almost Shakespearean about the current phase of Nasir Ahmad El-Rufai’s political journey. Once firmly lodged within Nigeria’s innermost corridors of power, the former governor of Kaduna State now finds himself navigating choppy waters—estranged from elements of the establishment he helped midwife, locked in public disagreements with former allies, and increasingly defined by sharp media interventions rather than executive authority. The question therefore suggests itself with urgency: is Nasir El-Rufai on the peril, politically speaking, or merely repositioning for another audacious ascent?

 

To answer that, one must first understand the architecture of his rise. El-Rufai has always thrived at the intersection of intellect and insurgency. From his days as Director-General of the Bureau of Public Enterprises to his tenure as Minister of the Federal Capital Territory between 2003 and 2007, he cultivated the persona of a reformer unafraid of entrenched interests. In Abuja, he enforced the capital’s master plan with relentless precision, demolishing structures deemed illegal and digitising land administration through the Abuja Geographic Information System. Admirers saw courage; critics saw cold technocracy. But none doubted his influence.

 

His political resurrection after years in relative exile was equally strategic. As a central figure in the coalition that birthed the All Progressives Congress in 2013, El-Rufai demonstrated both tactical patience and elite networking. The APC’s 2015 victory was not merely a partisan turnover; it was a reconfiguration of Nigeria’s power map. In securing the governorship of Kaduna State that same year, El-Rufai transitioned from federal reform czar to subnational executive with a mandate to replicate structural transformation.

 

Kaduna was never going to be an easy laboratory. With its near parity of Muslim and Christian populations and a history of sectarian volatility, governance required not only administrative efficiency but also delicate social navigation. El-Rufai chose the path he knew best—structural reform. He implemented a Treasury Single Account to streamline finances, overhauled the civil service, and embarked on sweeping education reforms that culminated in the disengagement of more than 20,000 primary school teachers who failed competency tests. The state borrowed heavily for infrastructure, betting that long-term growth would justify short-term fiscal strain.

 

To his supporters, these were acts of bold leadership in a polity allergic to tough decisions. To his critics, they revealed a governor more comfortable with spreadsheets than sentiments. Southern Kaduna’s recurrent violence further complicated his record. His insistence on framing the crisis largely as criminality rather than ethno-religious persecution was analytically defensible in some respects, yet politically combustible. Perception hardened into distrust among segments of the population who felt unseen and unheard.

 

Even so, he secured re-election in 2019, proof that reform and controversy can coexist in Nigeria’s electoral calculus. But it was the transition from governor to elder statesman that has proven most perilous.

 

El-Rufai entered the 2023 political season as a visible ally of President Bola Tinubu during the APC primaries. His intellectual heft and northern pedigree positioned him as a bridge-builder within the party’s power arithmetic. When Tinubu won the presidency, many assumed El-Rufai would feature prominently in the new administration. His nomination as a minister appeared to confirm that trajectory until the Senate declined to confirm him, reportedly citing security concerns.

 

In Nigerian politics, symbolism often outweighs substance. The rejection was more than procedural; it signalled a rupture. For a politician accustomed to shaping events rather than reacting to them, the development marked a subtle but unmistakable shift from insider to outsider. Since then, his public commentary has grown more pointed. He has questioned the direction of the ruling party, hinted at betrayals, and portrayed himself as a custodian of principles sidelined by expediency.

 

Is this evidence of peril or repositioning?

 

There are at least three dimensions to consider. The first is institutional. El-Rufai no longer controls a state apparatus. Without the leverage of executive office, influence must be exerted through persuasion, coalition-building and narrative framing. This transition is difficult for leaders whose authority was reinforced by command structures. His recent media engagements which implies candid, combative and occasionally accusatory suggest a man recalibrating his tools.

 

The second dimension is relational. Politics is sustained by networks, and networks are sustained by trust. Reports of mistrusts between El-Rufai and key federal figures, as well as friction with his successor in Kaduna, complicate his positioning. In Kaduna, reviews of past contracts and policies have cast shadows backward, feeding narratives of vendetta on both sides. At the federal level, silence has often met his critiques, a strategy that can either isolate a critic or amplify him, depending on public mood.

 

The third dimension is strategic. Nigeria’s political elite operates in long cycles. Conversations about 2027 are already underway in quiet rooms. El-Rufai’s national profile, intellectual agility and northern base make him a potential factor in any future coalition calculus. His current dissent may therefore be less about grievance and more about differentiation—an effort to craft an identity distinct from a government facing economic and security headwinds.

 

Yet peril remains a real possibility. Nigeria’s political memory can be unforgiving. Leaders who overplay their hand risk alienation from both establishment and grassroots. If El-Rufai’s critiques are perceived as personal vendetta rather than principled dissent, his moral capital may erode. Moreover, the electorate has grown increasingly wary of elite quarrels that appear disconnected from everyday hardship. A politician who once sold reform as necessity must now demonstrate empathy as convincingly as efficiency.

 

Still, history suggests that El-Rufai has often converted adversity into opportunity. After leaving the Obasanjo administration under clouds of controversy, he returned stronger within a new coalition. After early resistance in Kaduna, he consolidated his authority and reshaped the state’s administrative culture. His career has been punctuated by phases of apparent crisis followed by strategic resurgence.

 

The deeper question may not be whether he is on the peril, but whether Nigeria’s political environment can accommodate his style of engagement. El-Rufai thrives on intellectual contestation and structural overhaul. He is less adept at the slow, conciliatory art of consensus politics. In a federation where legitimacy often rests on accommodation as much as achievement, this imbalance can be costly.

 

There is also the matter of narrative control. El-Rufai has long been his own chief spokesman, deploying social media and interviews with precision. In the absence of political office as he is currently, narrative becomes power. His recent outbursts once again keep him in the national conversation. Silence would have signified retreat.

 

So, is Nasir El-Rufai on the peril? The answer is layered. Institutionally, yes—he stands as an outsider in the power structure he once influenced. Relationally, yes—alliances appear strained and rivalries sharpened. Strategically, however, peril can be prelude. In politics, moments of vulnerability often precede recalibration and El-Rufai has always been a master of that.

 

Ultimately, El-Rufai’s future will hinge on whether he can transform dissent into constructive coalition-building. If he remains defined by grievance, the peril may deepen into isolation. If he channels critique into a broader vision that resonates beyond elite circles, the current turbulence could become a staging ground.

 

For now, he occupies an ambiguous space: not dethroned, not enthroned; neither silenced nor fully embraced. In that ambiguity lies both danger and possibility. Nasir El-Rufai has built a career on defying expectations. Whether this chapter marks decline or reinvention will depend less on his adversaries than on his capacity to balance conviction with conciliation.

 

The peril, if it exists, is not merely political. It is existential—the risk that a man defined by reform and combat may struggle in an era demanding reconciliation and breadth. But in Nigeria’s ever-shifting theatre of power, yesterday’s peril can become tomorrow’s platform.

 

Alabidun is a media practitioner and can be reached via alabidungoldenson@gmail.com

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Analysis

Nigeria – US Defence Cooperation: A Reflection from the Diaspora, by Boniface Ihiasota 

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Nigeria – US Defence Cooperation: A Reflection from the Diaspora, by Boniface Ihiasota 

 

The defence relationship between Nigeria and the United States represents one of the most complex and consequential aspects of Nigeria’s foreign policy in the 21st century. Rooted in decades of military engagement, training, strategic dialogue, intelligence sharing, and equipment acquisition, this partnership reflects shared interests in regional stability, combating violent extremism, and strengthening military institutions. For many in the Nigerian diaspora, this cooperation carries both hopes for enhanced security at home and concerns about sovereignty, national strategy, and the implications of external influence.

 

At its core, Nigeria-US defence cooperation has evolved from traditional military diplomacy to a more multi-faceted, operational collaboration. Since the early 2000s, the United States has provided sustained security sector assistance to Nigeria. According to U.S. government data, more than $232 million in security support was delivered between 2000 and 2021, with notifications of $593 million in Foreign Military Sales and approximately $305 million in direct commercial defence sales to support counter-terrorism, border security, and professionalization of the Nigerian Armed Forces. In 2022 the U.S. announced nearly $997 million in a major foreign military sale that included attack helicopters and associated training as part of long-term capability enhancement.

 

In practical terms, the partnership nurtures capacity building, professional military education, and logistics cooperation. Both nations have exchanged senior military leaders and engaged in joint strategic dialogues to align responses to shared threats. Nigerian defence officials and U.S. counterparts have regularly convened to strengthen frameworks for cooperation, reaffirming commitments to respect Nigeria’s sovereignty while leveraging U.S. technical expertise.

 

As insecurity in Nigeria has worsened, especially with the prolonged insurgency of Boko Haram and the Islamic State West Africa Province (ISWAP) as well as rising banditry and extremist violence, the practical aspects of the partnership have taken on heightened urgency. Recent developments illustrate this vividly. In early 2026, Nigeria formally invited additional U.S. military support for training, intelligence sharing, and technical assistance. Nigeria’s Defence Headquarters on Monday confirmed the arrival of about 100 U.S. military personnel and equipment at Bauchi, with planned joint training exercises aimed at enhancing Nigerian troops’ capacity to detect and neutralize extremist groups. Local authorities clarified that the U.S. personnel serve in advisory and training roles, under Nigerian command, in line with bilateral agreements and respect for Nigerian sovereignty.

 

In neighboring Abuja and among diaspora communities, these movements sparked broad discussions about what external military involvement means for Nigeria’s autonomy and long-term security strategy. Advocacy groups like Citizens for Strategic Defence Cooperation have publicly endorsed the expanded partnership while stressing that it does not erode Nigeria’s sovereignty. They describe the engagement as “measured and strategic,” focused on capacity building, intelligence systems, and joint problem-solving rather than occupation or direct combat.

 

Beyond boots on the ground, the United States has engaged Nigeria in targeted counter-terrorism operations. In late 2025, the U.S. carried out airstrikes against Islamic State-linked camps in northwest Nigeria with Nigerian approval, employing precision guided munitions through U.S. Africa Command (AFRICOM) platforms. These strikes were designed to disrupt militant networks operating from Sahel corridors and were followed by coordinated intelligence sharing.

 

Still, the defence cooperation is not without controversy. In the diaspora, commentary reflects a spectrum of views: from optimism about the gains in confronting violent extremism to unease about foreign intervention and the framing of Nigeria’s internal conflicts in international discourse. Former U.S. statements by political leaders, including those linking Nigeria’s actions to religious persecution or threatening aid cuts, have sometimes strained diplomatic goodwill, prompting the Nigerian government to clarify its position and reject broad characterizations of the security situation.

 

Nonetheless, there are tangible operational outcomes that diaspora stakeholders often highlight as evidence of positive cooperation. Enhanced intelligence sharing has contributed to improved situational awareness for Nigerian forces during operations like Operation Hadin Kai in the North East and Operation Fasan Yamma in the northwest. The timely delivery of military hardware — including drones, helicopters, spare parts, and support systems — pledged by the U.S. demonstrates a sustained material investment in Nigeria’s defence architecture.

 

For many Nigerians abroad, this partnership epitomizes the balancing act between external support and internal agency. On one hand, there is recognition that no nation is an island in confronting transnational threats. On the other, there is a persistent call for transparency, accountability, and strategies that prioritize civilian protection and national ownership of security frameworks.

 

In conclusion, Nigeria–U.S. defence cooperation is a nuanced, evolving relationship rooted in shared interests and longstanding military engagement. While it brings considerable resources, training, and strategic depth to Nigeria’s fight against violent extremism, it also requires careful navigation of national interests, sovereignty considerations, and public perceptions — both at home and within the vibrant Nigerian diaspora. Ensuring that this cooperation yields tangible security improvements without undermining national autonomy remains a shared challenge for both nations.

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Analysis

Nigeria’s Tax Reforms and the Diaspora, by Boniface Ihiasota

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Nigeria’s Tax Reforms and the Diaspora, by Boniface Ihiasota

 

For Nigerians living abroad, tax policy at home has often felt distant, until the recent overhaul of Nigeria’s tax framework brought it sharply into focus. The passage of the Nigeria Tax Act, which took effect from January 1, 2026, triggered anxiety across diaspora communities, fuelled largely by fears that earnings abroad or personal remittances would now attract Nigerian tax. A closer reading of the reforms, however, shows that Nigeria is not charting a radical or punitive course against its diaspora. Instead, it is aligning more closely with internationally accepted principles of taxation based on residency and income source.

 

At the heart of the reform is a clearer definition of tax residency. Under the new framework, individuals who spend 183 days or more within Nigeria over a 12-month period, or who maintain a permanent home or substantial economic ties in the country, are considered tax residents. Only such residents are liable to tax on their worldwide income. Nigerians who live and work abroad and do not meet these conditions remain non-residents and are taxable in Nigeria only on income sourced within the country. This distinction is critical because it dispels the widespread notion that citizenship alone now triggers tax liability.

 

The Federal Government, through the Presidential Fiscal Policy and Tax Reforms Committee, has repeatedly clarified that income earned abroad by non-resident Nigerians is not subject to Nigerian tax, even when such income is remitted home. Remittances sent to family members for upkeep, education, healthcare or personal support are not classified as taxable income. This position is particularly significant given that Nigeria received an estimated $20.5 billion in diaspora remittances in 2023, according to World Bank data, making it one of Africa’s largest recipients. Taxing such flows would not only have been impractical but economically counterproductive.

 

When viewed in a global context, Nigeria’s approach is far from unusual. Most countries operate either a residence-based or source-based tax system. In the United Kingdom, for instance, non-residents are taxed only on UK-sourced income, such as rental income from property located in Britain. Canada applies similar rules, taxing non-residents only on income earned within Canada, while residents are taxed on worldwide income. China also follows a residency threshold of 183 days, beyond which global income becomes taxable. Nigeria’s reforms fit squarely within this international pattern.

 

Only a handful of countries take a different approach. The United States is the most prominent example, taxing citizens on their worldwide income regardless of where they live. U.S. citizens abroad are required to file annual tax returns and comply with foreign account reporting rules, though credits and exclusions exist to mitigate double taxation. Eritrea operates a similar system, levying a two per cent diaspora tax on its citizens overseas. Nigeria has explicitly rejected this model, opting instead for a system that balances revenue generation with global mobility and fairness.

 

Where tax obligations do arise for Nigerians in the diaspora is in relation to Nigerian-sourced income. Rental income from property in Abuja or Lagos, dividends from Nigerian companies, or profits from businesses operating within Nigeria remain taxable, regardless of where the individual resides. In many cases, such taxes are collected through withholding mechanisms and treated as final, reducing administrative burdens on non-residents. This is consistent with global practice and reflects the principle that income should be taxed where economic value is created.

 

The reforms also strengthen Nigeria’s use of Double Taxation Agreements, which the country has signed with several nations including the United Kingdom, Canada, China and South Africa. These treaties are designed to prevent the same income from being taxed twice and to provide clarity on taxing rights between countries. For Nigerians abroad who may still qualify as tax residents due to time spent at home or strong economic ties, these agreements offer essential safeguards.

 

Beyond individual taxation, the reforms signal a broader shift in Nigeria’s fiscal strategy. By simplifying tax laws, adjusting personal income tax thresholds and expanding digital compliance systems, the government aims to widen the tax net without placing undue pressure on vulnerable groups or discouraging diaspora engagement. For Nigerians abroad, this clarity matters. Many invest in property, startups and family enterprises back home, and uncertainty around taxation has long been a deterrent.

 

Ultimately, the significance of Nigeria’s tax reforms for the diaspora lies not in new burdens, but in clearer rules. They reaffirm that Nigerians abroad are not taxed simply for being Nigerian, nor for supporting families at home. Instead, tax obligations are tied to presence, economic activity and income source, in line with global norms. For a country whose diaspora plays a vital role in economic stability and development, this alignment is not just sensible policy, but a necessary reassurance.

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