Beyond the campaign trail: Making Nigeria’s health promises work with the private sector

Nigeria’s politicians are preparing to make new promises on health, but the country has a more immediate problem: it has yet to deliver on many of the promises it has already made. Nearly 25 years after signing the Abuja Declaration, health remains far below the 15 percent spending benchmark. Thousands of primary healthcare centres are still not fully functional, while health budgets are often only partly implemented. The problem is no longer a shortage of policies. It is the political will and implementation capacity to make them work.

That distinction matters as the 2027 political contest takes shape. Nigeria does not need another campaign in which health is reduced to promises of new primary health centres, expanded insurance coverage or more hospitals. Candidates should instead be asked how they will finance, implement and sustain the commitments already on the books.

That also means asking a second question: who will help the government deliver them? Nigeria does not operate a public-only health system. Private hospitals, pharmacies, diagnostic centres, laboratories, manufacturers and health technology companies already provide a substantial share of healthcare across the country. The private sector has facilities, capital, technical expertise and operating capacity that the government will need if reforms are to move from policy documents to functioning services. It should therefore be treated not simply as an industry to regulate or a stakeholder to consult, but as an accountable implementation partner.

The case for stronger health financing is also becoming clearer, particularly at the state level. The Abuja Declaration provides a clear benchmark, but the states today have considerably more fiscal space than they did when that commitment was made. BudgIT’s analysis shows that combined state revenue increased from about N4.84 trillion in 2022 to N15.53 trillion in 2025. Yet increased revenue has not translated into proportionate health spending. The state budgeted N1.32 trillion for health but spent only N816.64 billion, an implementation rate of 61.9 percent. No state spent as much as N10,000 per person on health.

This should be a campaign issue. Every gubernatorial candidate should be able to state what their state budgeted for health over the last three years and what was actually spent. Candidates should also explain what proportion of their state’s expanded fiscal space they intend to commit to health. The question is not simply whether a government can announce a larger health budget. It is whether it can release the money and spend it on the right projects.

Health insurance presents the same problem in another form. The National Health Insurance Authority Act, signed in 2022, made health insurance mandatory in principle. Yet coverage remains far from universal, with informal workers still largely outside the formal financing system. The NHIA has continued to publish quarterly coverage data, while the Federal Government in 2025 issued a directive requiring ministries, departments and agencies to implement mandatory health insurance and accept either NHIA or qualifying private plans. The direction is significant, but it also illustrates the work still required to turn a legal obligation into broad coverage.

The next government will inherit that harder task: building the systems that make compliance possible, expanding coverage beyond formal employment and ensuring that accredited public and private providers can participate on viable terms. Health insurance cannot become meaningful simply because coverage is mandatory on paper. It must become a financing mechanism that patients can actually use when they need care.

Primary care offers another clear example. Nigeria does not simply need more buildings. It needs functioning facilities. The National Primary Health Care Development Agency’s own framework makes clear that a functional PHC requires more than four walls. It needs staff, power, water and sanitation, medicines, diagnostics, equipment and the capacity to provide essential services. Yet thousands of facilities remain unable to meet these basic requirements.

A campaign promise to build another health centre is easy to announce. A costed plan to make existing health centres functional is harder but far more valuable. Candidates should therefore identify non-functional facilities in their states and constituencies, cost their rehabilitation and commit to a timetable for bringing them back into service.

This is also where the distinction between government ownership and government responsibility matters. Government does not have to perform every function itself to remain responsible for the outcome. Facility management, diagnostics, pharmacy services, equipment maintenance and other functions can be delivered through capable private partners against clear standards and measurable results.

Cancer care presents another gap between policy and capacity. Responsibility for the national cancer response sits with the National Institute for Cancer Research and Treatment, which is implementing the Nigeria Cancer Health Fund alongside broader national cancer-control efforts. The fund is designed to reduce the financial barrier to treatment, while the government is also expanding cancer infrastructure and working towards wider financial protection for patients.

But the scale of the challenge remains enormous. Nigeria has only about 13–14 functioning linear accelerators against an estimated need of 200. Expanding oncology capacity will require sustained public investment, but it will also require private capital, expertise and operating capacity. Indeed, NICRAT’s leadership has itself highlighted the importance of public-private partnerships in radiotherapy, with nearly half of operational radiotherapy centres reportedly operating through PPP arrangements.

That is the model that should be extended. States should consider co-funding cancer treatment and working with capable private providers to expand access, rather than leaving patients dependent on a small number of facilities.

Nigeria has also already taken important steps on other health reforms. The challenge is to make them work. Emergency care, for example, cannot depend entirely on federal reimbursement pathways. States can build and strengthen emergency medical and ambulance services, while the National Assembly addresses the legal and financing gaps that remain. Quality regulation presents a similar challenge. Nigeria already has standards governing health facilities; the priority should be consistent enforcement across public and private providers, rather than assuming that another institution alone will solve the problem.

The same principle applies to the health-sector compacts already signed. The Health Sector Renewal Compact has been expanded to include local governments, the private sector, civil society, and traditional and religious leaders, while the Power-for-Health Compact brings public and private health facilities into a shared effort to improve reliable and affordable electricity. The government reported in 2025 that 37 of 41 key performance indicators under the presidential health reform commitments had been achieved, showing that the Compact is capable of driving measurable implementation.

The next question is whether the private sector will have a meaningful role in the mechanisms that determine what happens next. A private-sector signature should mean more than attendance at a signing ceremony. It should translate into seats in relevant working groups, participation in review mechanisms and a clear role in implementation.

The private sector is part of the delivery capacity.

Cancer care illustrates a broader point: the case for private-sector participation is ultimately about capacity.

Nigeria’s private health sector already operates a significant share of its hospitals, diagnostic facilities, pharmacies and other points of care. It also includes manufacturers, distributors and technology companies across the healthcare value chain. Where public capacity is insufficient, private investment can often move faster. The Healthcare Federation of Nigeria, representing the organised private health sector, has consistently advocated for this capacity to be integrated into national and state health planning and implementation.

The same logic applies to the billions Nigerians spend seeking healthcare abroad. The answer is not simply to discourage medical travel. It is to develop the specialist services Nigerians currently seek elsewhere, including oncology, cardiac care, neurosurgery and fertility treatment. Every service successfully developed at home means investment, jobs, tax revenue and professional opportunities that remain in Nigeria. The government’s role is to create the conditions in which those investments can be made with confidence.

Local manufacturing requires the same approach. Nigeria cannot achieve health sovereignty simply by announcing domestic production targets. Manufacturers need predictable regulation, reliable power, affordable capital and a credible market for locally produced medicines, equipment and other health products. The same applies to medical equipment and devices, where dependence on imports continues to expose the health system to exchange-rate pressures and supply disruptions.

This is why the healthcare value chain matters. A health system is not only hospitals and doctors. It is also the manufacturers producing medicines and equipment, the distributors moving them, the diagnostic companies providing tests, the pharmacies dispensing medicines and the technology companies connecting patients and providers. A government that wants a more resilient health system must therefore design policy around the entire value chain, not only around public facilities.

Capital is part of this equation. The private sector is not asking the government for a bailout. It is asking for an environment in which investment in healthcare is viable. Concessional credit, blended finance, risk-sharing facilities and appropriately structured credit lines can lower the cost of capital for viable healthcare businesses without turning public money into permanent subsidies. Properly designed, such instruments can help hospitals, laboratories, manufacturers and other providers expand capacity while delivering measurable public value.

There are already examples of what partnership can deliver. Public-private models in Delta State have demonstrated the potential to revitalise primary healthcare facilities, while hospital partnerships in Lagos show how government and private investors can combine resources to expand infrastructure. These should not remain isolated pilots. The next government should identify what worked, why it worked and how quickly those models can be scaled.

That is the broader opportunity. Government does not have to build every facility, employ every worker or finance every piece of equipment itself. It does, however, have to create the rules, financing arrangements and accountability mechanisms that allow every capable provider to contribute to the national health objective.

What voters should ask

This is why campaign season matters. Manifestos are easy to write and difficult to measure. As the campaigns unfold, the electorate does not need to master health financing to hold a candidate to account; it needs to ask, and keep asking, questions like these:

● What share of the state budget went to health in your last three budgets, and what share of that was actually spent?

● Will you commit, in writing, to raising the state’s health budget toward the Abuja Declaration’s 15% benchmark, now that federal allocations to states have multiplied several times over?

● How many primary health centres in this state or constituency are currently non-functional, and what is your cost, dated plan to reopen them before any promise of new ones?

● Will the state co-fund a functioning cancer treatment centre, and on what timeline?

● What will you do, concretely, to enforce the Certificate of Standards the law already requires of every health facility, public or private?

● Will the state build its own emergency medical and ambulance service rather than waiting on federal reimbursement pathways?

● Will you appropriate and release on schedule the Basic Health Care Provision Fund and other health lines already signed off?

● Will you give the private health sector a seat, not just an invitation, on the state’s health financing and planning committees?

None of these questions requires voters to be health economists. They require candidates to move beyond adjectives such as “transformational” and “world-class” and commit to numbers, timelines and outcomes. Most importantly, candidates should be asked which health commitments they will deliver in their first two years and how Nigerians will be able to measure progress.

Nigeria does not need another health manifesto that disappears after election day. It needs a delivery plan. The next government will inherit laws that have been passed, frameworks that have been signed, funds that have been appropriated and programmes that have already been tested. Its task should be to make these instruments work, close the gaps between allocation and execution, and scale interventions that have demonstrated results.

The private sector should be part of that process from the beginning, not because the government owes the industry a seat, but because Nigerians need every capable hand at the table. The Healthcare Federation of Nigeria’s proposition is therefore straightforward: government should set the direction and standards, provide the public financing and accountability, and bring capable private operators into the delivery of services where they can add capacity, investment and expertise.

The test of the coming political season should not be who can promise the most new health facilities. It should be who can take the commitments Nigeria has already made, bring the public and private sectors together to deliver them, and stay with the work long after the campaign banners have come down.

This article is a partnership between the Healthcare Federation of Nigeria (HFN) and BusinessDay to highlight policies and programmes to promote the rebuilding of Nigeria’s health sector. As a private sector-led coalition, HFN advocates for policies and partnerships to strengthen healthcare delivery. This partnership aims to spark meaningful discussions and drive transformative change in Nigeria’s health sector.

This article was authored by:

Senator Dr Lanre Tejuoso (Former Chairman, Senate Committee on Health, 8th National Assembly, and Member, HFN Board of Trustees)

Njide Ndili (President, Healthcare Federation of Nigeria, and Country Director, PharmAccess)

Dr Jennifer Anyanti (MD, SFH Advisory & Professional Services, and 2nd Vice President, HFN).