By Adewale M Okoya
The warning by Nigerian resident doctors that they may embark on a nationwide strike from August 10 if the Federal Government fails to meet its obligations should concern every citizen. Sadly, this is not the first time doctors have threatened industrial action. Over the years, strikes in the health sector have become a recurring feature of our national life, with devastating consequences for ordinary Nigerians. While political office holders and the wealthy can travel abroad or seek treatment in expensive private hospitals, the average Nigerian has nowhere else to turn.
This is not merely a policy failure; it is a matter of life and death. I still remember with deep sadness how my sister lost her battle with breast cancer during one of the prolonged strike actions in the health sector. Like many other families, ours paid a heavy price for a crisis that could have been avoided. Behind every strike are countless untold stories of patients who died while waiting for treatment, expectant mothers who could not access emergency care, accident victims who arrived too late and people whose conditions deteriorated because hospitals were either closed or operating far below capacity. If Nigeria were to conduct a comprehensive audit of lives lost because of avoidable disruptions in healthcare services, the findings would be both heartbreaking and alarming.
The truth is that the solution is no longer a mystery reserved for experts. Many countries have already demonstrated that a properly designed health insurance system can provide sustainable funding for healthcare while reducing the financial burden on government. Nigeria does not need to reinvent the wheel. We simply need the political will to adapt proven models to our own circumstances.
The United Kingdom provides one of the world’s best-known examples. Through the National Health Service (NHS), every eligible resident receives healthcare that is largely free at the point of use. The NHS is funded primarily through taxation and has ensured universal access to healthcare for more than seven decades. Although the system faces pressures such as growing demand and workforce shortages, it continues to guarantee that access to treatment depends on medical need rather than personal wealth. This principle has protected millions of people from financial hardship while promoting better public health.
Germany offers another successful model. Every worker is required to belong to a statutory health insurance fund unless they qualify for private insurance. Contributions are shared between employers and employees, creating a stable and predictable source of funding. The result is a healthcare system that consistently ranks among the best in Europe, with modern hospitals, well-equipped facilities and timely access to medical care.
Japan has also demonstrated that universal health insurance can succeed. Every resident is required to enrol in a health insurance scheme, while government subsidies ensure that low-income citizens are not left behind. Patients contribute only a portion of treatment costs, making healthcare affordable without compromising quality. Life expectancy in Japan remains among the highest in the world, showing the long-term benefits of investing in accessible healthcare.
Closer to home, Rwanda has shown that even an African country with limited resources can achieve remarkable progress. Through its community-based health insurance scheme, known as Mutuelles de Santé, millions of citizens now have access to affordable healthcare. The programme has significantly increased healthcare utilisation and improved health outcomes, demonstrating that universal coverage is achievable when governments show commitment and accountability.
These examples teach a common lesson. Sustainable healthcare depends on predictable financing, strong institutions, transparency and accountability. They also prove that universal health coverage is not a luxury reserved for wealthy nations. It is a practical policy choice.
Nigeria already has the National Health Insurance Authority, formerly known as the National Health Insurance Scheme. Many state governments have also established their own health insurance programmes. Unfortunately, implementation has been slow, coverage remains low and corruption has weakened public confidence. Allegations of mismanagement, including past controversies surrounding the scheme, have distracted attention from its original purpose. Yet these failures should encourage reform rather than abandonment.
A properly managed health insurance system would generate a reliable pool of funds to improve healthcare delivery. It would support the construction of new hospitals, modernise existing facilities, purchase essential drugs and medical equipment, strengthen emergency services and ensure that doctors, nurses and other healthcare workers receive fair and timely remuneration. Better funding would also reduce the frequent disputes that often lead to industrial action and help retain skilled professionals who currently leave Nigeria in search of better working conditions abroad.
The philosopher Aristotle observed that “The greatest wealth is health.” His words remain as true today as they were more than two thousand years ago. No nation can build a prosperous economy if its people are unhealthy or if hospitals become battlegrounds between government and healthcare workers.
Similarly, Confucius wisely said, “The strength of a nation derives from the integrity of the home.” The family is weakened when loved ones die because they cannot access timely healthcare. Every avoidable death leaves behind grieving parents, spouses and children whose lives are permanently changed.
The need for reform extends beyond healthcare. Education, housing and other critical sectors also require sustainable financing and greater private sector participation. This is why many experts continue to advocate for a leaner and more efficient government that focuses on regulation, transparency and accountability while encouraging responsible private investment. However, healthcare deserves urgent attention because lives are lost every day that meaningful reforms are delayed.
The Federal Government should accelerate the implementation of universal health insurance by ensuring that every eligible resident is enrolled, including workers in the informal sector, who make up a large proportion of Nigeria’s workforce. Technology should be deployed to improve enrolment, reduce fraud and ensure that contributions are transparently managed. Independent oversight, regular audits and strict penalties for corruption must become integral parts of the system.
Political parties should also recognise that healthcare is not merely a campaign promise but a moral obligation. Universal health insurance should form a central pillar of every party’s manifesto ahead of future elections. Nigerians deserve a healthcare system that works regardless of who occupies public office.
Martin Luther King Jr. once reminded us that “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” Nigeria cannot continue to accept a system where survival depends on wealth, connections or luck. Every strike that leaves patients without care is a reminder that the current system is failing those it was designed to serve.
The time has come to move beyond promises and emergency interventions. Nigeria must build a healthcare system that is properly funded, professionally managed and accessible to every citizen. We owe that much to those who have already paid the ultimate price, and to generations yet unborn.
