The Nigerian government has unveiled its latest policy to boost healthcare in the country. But it has still not met its funding commitments from past promises, writes Nzube Ifediba.
In August 2024, Nigeria’s Ministry of Health released its National Policy on Health Workforce Migration. The policy aims to strengthen the nation’s flailing health workforce. It particularly it lays out plans to use incentives to retain existing staff and attract others in the diaspora to return to Nigeria.
The incentives include:
- Programs for motivating and recognising health workers
- Tax holidays
- Health insurance
- Mortgage facilities
- Provision of healthcare supplies and facilities
The policy is a first step in the right direction. Nigeria’s health workforce is experiencing an unprecedented wave of migration to the Global North. According to the Registrar of the Nursing and Midwifery Council of Nigeria, 42,000 nurses have left Nigeria in the last three years. The Ministry of Health also reports that 16,000 doctors have emigrated, leaving behind 55,000 licensed doctors for a population of 220 million.
This migration has left Nigeria with a health workforce ratio below the median: 49 per 10,000. Nigeria is on the World Health Organisation workforce safeguard list along with 55 other countries. This health workforce shortage has hindered the achievement of the health-related sustainable development goals in Nigeria.
The Ministry’s recognition of the problem and willingness to use incentives to tackle it is encouraging.
Apart from staff retention, the policy outlines measures to:
- Monitor the inflow and outflow of human resources for health
- Expand the capacity of existing training institutions
- Improve existing health infrastructure
- Provide career support and training pathways to existing health workers
- Provide support to health workers in rural and underserved areas
- Form bilateral trade agreements with destination countries
- Utilise data for health systems research and innovation
The goals of the policy are laudable. But how will it be funded? In December 2023, President Bola Tinubu launched the Health Sector Renewal Investment Initiative, which aims to invest £717 million into the health system from 2024 to 2026. A press release from the State House described the program as a collaboration between the Federal government, State governments, and development partners. Saying is one thing, doing is another.
Nigeria is yet to allocate the 15 per cent of its annual budget to healthcare that it promised in the Abuja declaration of 2001. In 2024, the allocation was only 4.6 per cent. The highest it has been was 5.75 per cent in 2023. This comes in the midst of Nigeria’s current economic climate, which casts a shadow of doubt on the feasibility of generating any promised funds.
Economic analysis and planning
Insufficient funding is a common reason for policy failures in many Low- and Middle-Income Countries. Financial constraints contribute to fragmented and ad-hoc policy development, which hurts policy implementation in these regions. To make up for a lack of funding, most countries in sub-Saharan Africa depend on foreign aid for more than a third of their healthcare expenditure. This is not without its downsides. Funding from international agencies is typically interest-driven, project-based, and short-term. All these further worsen policy fragmentation.
An economic evaluation is needed of all interventions described in the policy’s objectives.
There should be a cost-effectiveness analysis for each intervention. Health economists can generate cost data and other model inputs from systematic literature reviews and reviewed databases.
They should also run a robust deterministic and probabilistic sensitivity analysis and use the output to generate a cost-effectiveness acceptability curve (CEACs). Finally, they should prioritise these interventions using a specified incremental cost-effectiveness ratio (ICER) threshold.
Economic evaluations like these are useful in making projections and defining expectations. For example, CEACs measure the uncertainty of the cost-effectiveness of health interventions. They can inform policymakers of the risks behind accepting or foregoing interventions. ICER thresholds set a cost-benefit benchmark that can help policymakers engage in explicit rationing and prioritisation, useful tools in resource-constrained settings like Nigeria.
Nigeria’s recent policy on health workforce migration has the potential to strengthen its health system. However, the stakes are high in converting this potential into reality. Low cost-effectiveness analyses for rationing and prioritisation can increase the odds of successful policy implementation.
Photo credit: Commonwealth Secretariat used with permission CC BY-NC 2.0
This is insightful. What do you think is the way forward for new funding for the health sector in Nigeria?