Analysis
Examining Nigeria’s Health System and Preventable Deaths, by Alabidun Shuaib AbdulRahman
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.
Analysis
Tinubu, EFCC and the Danger of Political Interference, by Alabidun Shuaib AbdulRahman
Tinubu, EFCC and the Danger of Political Interference, by Alabidun Shuaib AbdulRahman
There are moments when the intention behind an official decision may be defensible, yet the decision itself opens a door that ought to concern every citizen. President Bola Ahmed Tinubu’s intervention in the Economic and Financial Crimes Commission’s freezing of an Osun State Government account is one of those moments.
On August 6, 2026, with the Osun governorship election only nine days away, Tinubu directed the EFCC to return to court, vacate the order freezing an account belonging to the Osun State Government and discontinue the action it had instituted. The President said he was “deeply embarrassed” not by the EFCC’s exercise of its mandate, which he acknowledged was backed by a court order, but by its timing.
His explanation was understandable. Tinubu said actions taken by federal institutions were ordinarily attributed to him as President, whether or not he had prior knowledge of them. Since the election was approaching, he argued, nothing should be done that could create the impression that the EFCC or another Federal Government agency was being used to influence the election.
The argument is “morally” correct. But it also creates a difficult constitutional and institutional question: where does legitimate presidential concern about an election end and operational interference in an anti-corruption agency begin?
The EFCC did not arbitrarily descend on Osun. The commission said it had observed “huge transfers of funds into different corporate entities” from the state account and had acted to halt what it considered suspicious movement of public money. It argued that the approaching election could not become an excuse for an anti-corruption agency to ignore suspected movement of public funds.
Governor Ademola Adeleke, however, said the account was used for workers’ salaries and had been placed on a “Post No Debit” status. He demanded an explanation from EFCC Chairman Ola Olukoyede and described the action as another assault on Osun’s democracy.
The political atmosphere surrounding the matter had also been poisoned long before the account was frozen. In June, the Diaspora Committee of the All Progressives Congress Governorship Campaign Council in Osun asked the EFCC to freeze accounts allegedly connected with a reported N13.7bn annual ghost-workers payroll scandal. The committee claimed the money could be diverted to finance vote-buying ahead of the August 15 election. That background makes the EFCC’s action politically sensitive. But sensitivity is precisely why institutional independence matters.
The EFCC is a creation of statute. Under the EFCC (Establishment) Act, its chairman and members are appointed by the President, subject to Senate confirmation, while the law also provides for the chairman’s tenure and removal. The Presidency therefore has substantial influence over the commission’s leadership. That, however, does not make the President the operational head of every EFCC investigation.
There is an important distinction between constitutional authority over an institution and operational control of its investigations. A President may appoint the EFCC chairman, exercise statutory powers concerning the office, formulate broad government policy and demand accountability from federal agencies. But an anti-corruption agency must retain sufficient operational independence to determine whom to investigate, what evidence to pursue and what enforcement action to take.
Curiously, Tinubu himself made this case in the same statement. He said that since assuming office in May 2023, he had consistently maintained that anti-corruption and law-enforcement agencies should perform their statutory responsibilities independently and professionally, “without fear or favour, or political interference.” He added that he had deliberately refrained from directing or interfering in EFCC operations. That is why the Osun intervention becomes more concerning.
If a President can intervene in an operational decision because its timing might create an appearance of political interference, then the President has necessarily exercised influence over an operational decision. That does not automatically make the intervention unlawful. But it creates a precedent that future administrations may exploit.
Tinubu may genuinely believe the EFCC action could have been interpreted as an attempt to influence the Osun election. Another President could make the same argument about an investigation involving a governor, a minister, a major campaign financier or a politically influential contractor. If the principle becomes that the Presidency can intervene whenever enforcement action creates political controversy, the exception could eventually swallow the rule.
Nigeria’s history with the EFCC offers enough warnings. The commission was established in 2002 and began operations under President Olusegun Obasanjo, with Nuhu Ribadu becoming its pioneer chairman in 2003. Ribadu’s aggressive pursuit of governors, ministers, bankers and other powerful Nigerians gave the EFCC international prominence. But his controversial removal in 2007 also generated questions about the vulnerability of the commission to presidential and political interests.
Farida Waziri’s tenure produced another controversy. Appointed by President Umaru Musa Yar’Adua in 2008, she was removed by President Goodluck Jonathan on November 23, 2011. Years later, Waziri alleged that Jonathan’s administration had interfered with investigations and that her refusal to back down from a probe contributed to her removal. Though Jonathan rejected the allegation and challenged her to identify whom he had allegedly ordered her not to investigate.
The significance of those disputes is not simply who was right. It is that Nigerians repeatedly witnessed a situation in which the political leadership had enormous influence over the institution expected to investigate politically powerful people.
The Muhammadu Buhari administration provided another example. Buhari appointed Ibrahim Magu as acting EFCC chairman in 2015, despite the controversy that followed the Senate’s rejection of his nomination for substantive confirmation. On July 10, 2020, Buhari approved Magu’s suspension to allow a presidential panel to investigate allegations against him.
Again, the larger issue was institutional. The leadership of the EFCC remained heavily dependent on the Presidency, even though the commission’s work could directly affect members and allies of the governing political establishment. That is the weakness Nigeria has failed to resolve.
The President appoints the EFCC chairman. The commission investigates people who may have enormous political connections. The chairman therefore operates within an institutional structure in which the most powerful political office in the country has significant influence over the leadership of the agency.
This is why the Osun matter cannot be reduced to whether Tinubu had the right to be concerned about the election. Of course, he did. Elections must be protected from intimidation, manipulation and the misuse of state institutions. The harder question is whether that legitimate concern should be exercised through a presidential direction concerning a live EFCC enforcement matter.
There is also an important constitutional distinction regarding Adeleke. Section 308 of the 1999 Constitution grants a sitting governor immunity from civil or criminal proceedings in specified circumstances. But immunity is not exoneration. It does not mean a governor cannot be investigated, that evidence cannot be gathered or that public funds associated with a state government are beyond investigation.
If the EFCC had credible evidence of suspicious transfers, Adeleke’s candidacy should not automatically extinguish the commission’s investigative responsibility. Conversely, the approaching election should not give the EFCC licence to turn an investigation into a political weapon. The law must be stronger than both impulses.
That is why the better solution should have been procedural rather than presidential. If the EFCC had obtained a freezing order from a court and concerns subsequently arose about its timing or effect on essential state services, those concerns could have been presented before the court. If salaries needed to be paid, the government could have sought appropriate judicial relief.
Adeleke, too, must allow due process to take its course. If the EFCC acted unlawfully, the courts provide the remedy. If the allegations are false, evidence and due process should establish that fact.
For Olukoyede, the lesson is equally clear. The EFCC’s greatest asset is not proximity to the President but distance from political instruction. The commission must be prepared to investigate opposition politicians and members of the ruling party, governors and former governors, ministers and political financiers according to the same evidentiary standard.
Tinubu’s intervention, even if motivated by a legitimate desire to protect the integrity of the Osun election, should concern Nigerians. Institutions survive governments. Presidents come and go. Political parties win and lose elections.
If Tinubu truly wants Nigerians to believe that the EFCC is independent, the next step is obvious. He should help build an institutional framework in which no future President will need to intervene to prove that the EFCC is not being used politically. That is the real test of leadership. And that is the difference between fighting corruption under a President and building a country where the fight against corruption does not depend on the President.
Alabidun is a media practitioner and can be reached via alabidungoldenson@gmail.com
Analysis
Jingir’s Words and the Challenge of Religious Tolerance, by Boniface Ihiasota
Jingir’s Words and the Challenge of Religious Tolerance, by Boniface Ihiasota
Nigeria’s greatest strength has always been its diversity. Muslims, Christians, traditional worshippers and citizens of other beliefs have lived, worked, traded and built families across the country’s complicated social landscape. That is why recent utterances attributed to Sheikh Sani Yahaya Jingir deserve more than partisan applause or condemnation. They demand reflection.
At an event attended by, among others, Kano State Governor Abba Yusuf and Jigawa State Governor Umar Namadi, Sheikh Jingir renewed his support for a Muslim-Muslim presidential ticket ahead of the 2027 elections. He argued that Muslims should mobilise behind such a ticket and urged his audience to obtain their Permanent Voter Cards. He also referred to those opposed to his position as “infidels” and said Muslims should “show the infidels their limit.”
There is, of course, nothing inherently undemocratic about a Muslim advocating for Muslim candidates. Democracy gives every citizen the right to support candidates according to personal convictions, including religious convictions. The problem begins when political competition is framed as a contest between religious communities, particularly in a country where religious identity has historically been capable of provoking suspicion, fear and violence.
From the perspective of many Nigerians in the diaspora, this language is especially troubling. Those of us watching Nigeria from abroad understand that the country’s image is not determined only by government policies or economic statistics. It is also shaped by how Nigerians treat one another. When influential religious voices appear to portray fellow citizens as outsiders or enemies because of their faith, the damage extends beyond politics.
Nigeria is constitutionally a secular state, and Section 42 of the 1999 Constitution prohibits discrimination against citizens on grounds including religion. The implication is important: political participation is a citizenship right, not a privilege reserved for members of the religious majority.
This is where religious leadership carries an enormous responsibility. A Sheikh, pastor or traditional religious leader does not speak only to those seated before him. His words travel through social media, enter homes, influence young people and can be repeated long after the original gathering has ended.
Femi Fani-Kayode, Nigeria’s ambassador-designate to South Africa, made precisely this point in his reaction to Jingir’s comments, describing the rhetoric as provocative and warning that Nigeria is neither a Muslim nor a Christian country but a secular, multi-religious state. Human-rights lawyer Deji Adeyanju similarly warned on August 10, 2026, that religious rhetoric capable of deepening divisions between Christians and Muslims threatens national cohesion.
The lesson should not be that religious people must abandon their convictions. Quite the opposite. Strong faith should make Nigerians more committed to justice, dignity, compassion and peaceful coexistence. Nigeria does not need religious leaders who pretend that differences do not exist. It needs leaders mature enough to acknowledge those differences without turning them into political weapons.
The 2027 elections will come and go. Presidents will change, parties will win and lose, and politicians will eventually leave office. But Nigeria will remain. Muslims will continue living beside Christians; Christians will continue doing business with Muslims; and millions of families will continue to transcend religious boundaries. That enduring relationship is more important than any political ticket.
From the diaspora, therefore, the message is simple: Nigerians may disagree passionately about candidates, parties and policies, but we must never allow political competition to convince us that our fellow citizens are less Nigerian because they worship differently. Religious freedom means the freedom to believe. Religious tolerance means allowing another citizen to believe differently without treating that difference as a threat. Nigeria needs both.
Analysis
Lessons from the Catholic Bishops’ Visit to Tinubu, by Boniface Ihiasota
Lessons from the Catholic Bishops’ Visit to Tinubu, by Boniface Ihiasota
The recent visit of the Catholic Bishops’ Conference of Nigeria to President Bola Ahmed Tinubu at the Presidential Villa was more than a ceremonial engagement. It became one of the clearest illustrations yet of the widening gap between official optimism and the daily realities confronting millions of Nigerians. The discussions that followed—and the public reactions they generated—have once again underscored the indispensable role of religious institutions in shaping national conversations on governance, accountability and social justice.
Led by the President of the Catholic Bishops’ Conference of Nigeria, Archbishop Matthew Man-Oso Ndagoso, the bishops used the opportunity to raise concerns over insecurity, economic hardship, unemployment and the general welfare of Nigerians. They also urged President Tinubu to formally invite Pope Leo XIV to Nigeria, arguing that such a visit would strengthen peace, unity and national reconciliation.
President Tinubu, on his part, defended his administration’s reforms, insisting that the difficult decisions taken since assuming office were necessary to rescue the economy from years of structural distortions. He maintained that security architecture was being repositioned and that prosperity would eventually follow the current sacrifices.
Ordinarily, such exchanges between government and faith leaders are healthy in every democracy. However, the conversation assumed greater significance after Cardinal John Onaiyekan publicly disclosed that the President disagreed with many of the bishops’ assessments. According to the Cardinal, the bishops told Tinubu that “the economy is not helping our poor people,” while the President maintained that the economy was improving. The revelation immediately triggered widespread debate across political and religious circles because it exposed two sharply contrasting narratives about the state of the nation.
Yet, facts remain stubborn. Nigeria continues to face severe economic challenges. Inflation has remained elevated over the past two years, food prices have climbed dramatically, and millions of households continue to struggle with declining purchasing power. The World Bank has repeatedly warned that while reforms such as fuel subsidy removal and exchange-rate liberalisation may improve long-term fiscal sustainability, they also impose painful short-term costs on vulnerable citizens unless accompanied by robust social protection measures.
This explains why the bishops’ intervention resonated beyond the Catholic faithful. Religious leaders occupy a unique position in Nigerian society. They interact daily with ordinary citizens who seek assistance through churches, mosques and community organisations. Consequently, their assessment of public suffering often reflects grassroots realities that official statistics may not immediately capture.
The reactions also revealed an important democratic principle. Criticism of government should not automatically be interpreted as political opposition. Throughout Nigeria’s democratic history, both Christian and Muslim leaders have consistently spoken against corruption, insecurity, injustice and poverty irrespective of which party occupies Aso Rock. Their constitutional freedom to speak truth to power remains essential to democratic accountability.
At the same time, government officials equally have the responsibility to explain policies and defend their decisions. Democracy thrives not when everyone agrees but when disagreements are managed through dialogue rather than hostility. The exchange between Tinubu and the bishops should therefore be viewed as evidence that democratic engagement remains alive, provided both sides continue to listen respectfully.
The larger lesson is that perception matters almost as much as policy. Economic indicators may improve on paper, but if ordinary Nigerians cannot afford food, healthcare, education or transportation, public confidence will remain elusive. Governments ultimately earn legitimacy not through optimistic speeches but through measurable improvements in people’s quality of life.
As Nigeria journeys toward the 2027 elections, the meeting between the Catholic bishops and President Tinubu should remind both leaders and citizens that governance is not merely about defending statistics or winning arguments. It is about restoring hope. That hope will be strengthened only when policy outcomes begin to match the lived experiences of the millions whose voices the bishops sought to amplify.
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