By ‘Lade Bandele
“How should a nation judge the performance of its health sector?”
Public life has an odd way of allowing the loudest questions to eclipse the most important ones. A claim is made, a rebuttal follows, familiar positions harden, and attention gradually drifts from the matter under discussion to the argument surrounding it. Before long, the debate acquires a life of its own, and the original subject begins to disappear beneath the weight of opinion.
Something of that sort has entered recent discussions about Nigeria’s health sector.
Public scrutiny is neither an inconvenience nor an intrusion. It is one of the disciplines by which democratic societies hold themselves accountable. Governments should expect it, and those entrusted with public institutions should never shrink from it. Confidence in public administration is sustained not by official assurances but by a willingness to submit claims of progress to public examination. Scrutiny asks what has changed, what has resisted change, where institutions have grown stronger and where they continue to fall short.
Few areas of government deserve that discipline more than health. Almost everyone, at some point in life, will depend upon a nurse, a primary healthcare centre, an ambulance, a vaccine or a hospital whose competence may determine whether anxiety gives way to reassurance or to grief. Health is one of the few places where government ceases to be an abstraction and becomes something profoundly personal.
Across contemporary public health thinking there is remarkably little disagreement about how health systems should be judged. Strong systems are distinguished less by the number of initiatives they announce than by the institutions they leave behind. The World Health Organization frames that proposition in terms of governance, financing, workforce, service delivery and resilience. Put simply, a health system earns public confidence by delivering better care, more consistently, to more people than before.
Those standards alter the terms of the present discussion. They shift attention away from personalities and towards performance; away from political exchanges and towards institutional capacity. The question is no longer whether a minister has attracted criticism or praise. Public office has always attracted both. The more consequential inquiry is whether the institutions responsible for protecting life are becoming stronger, whether they inspire greater public confidence than before, and whether the ordinary experience of seeking healthcare is steadily improving.
Those are the questions worth asking. They are also the standards against which Nigeria’s present reforms should be judged.
Looking at the Record
Measured against those standards, the Nigeria Health Sector Renewal Investment Initiative is best understood not as a collection of programmes but as an attempt to correct a structural weakness that had frustrated health reform for decades. Financing, planning, service delivery, workforce development, disease surveillance and accountability too often advanced in parallel rather than together. Individual interventions produced important gains, yet the system itself changed far more slowly.
The Health Sector Compact was designed to address that fragmentation. Adopted by the Federal Government, the thirty-six states, the Federal Capital Territory and development partners, it established a common framework for planning, financing, implementation and accountability. The Sector-Wide Approach translated that commitment into operational discipline, aligning governments and partners behind shared priorities, common performance measures and collective accountability. In a federation as large and complex as Nigeria, that alignment is itself a significant reform. Strong health systems are strengthened not simply by introducing new programmes but by enabling institutions to work towards common objectives.
The results are becoming visible where Nigerians encounter the health system most often. Revitalisation has commenced in 4,161 primary healthcare centres, with 3,158 already completed. Functional primary healthcare facilities have increased by 59 per cent, while more than 14,000 now meet nationally defined functionality standards. More than 8,000 facilities receive direct financing through the Basic Health Care Provision Fund, complemented by investments in solar power, water supply, essential medicines, equipment and digital performance monitoring. Taken together, these reforms point to a primary healthcare system that is becoming more reliable, more functional and more trusted than it was only a few years ago.
The same trajectory is evident in maternal and child health. Across the 172 Local Government Areas covered by the Maternal Mortality Reduction Innovation Initiative, maternal mortality has fallen by 17 per cent and newborn mortality by 10 per cent. More than 40,000 women have received free Caesarean sections through the National Health Insurance Authority, while over 4,000 women living with obstetric fistula have undergone restorative surgery. Antenatal attendance has increased, skilled birth attendance has risen by more than 30 per cent, and over 300,000 pregnant women have been identified and linked to care. These figures represent more than programme outputs. They reflect lives saved, families spared avoidable loss and growing confidence that childbirth need not carry the risks it once did.
Prevention provides another measure of progress. More than 17 million girls have received protection against cervical cancer through HPV vaccination. Over 102 million children have been vaccinated against measles and rubella, while almost 800,000 have received the malaria vaccine. Nigeria has sustained its wild polio-free status through successive nationwide vaccination campaigns and became the first country in Africa to deploy the Mpox vaccine. During recent outbreaks, millions more Nigerians were protected against diphtheria, cholera and cerebrospinal meningitis. Together, these developments point to a health system placing increasing emphasis on preventing illness rather than merely responding to it.
The reforms are equally changing the economics of healthcare. Approximately twenty-two million Nigerians are now covered by health insurance, around six million more than in 2023, while more than ₦70 billion has been channelled through the Basic Health Care Provision Fund to strengthen frontline services and expand care for vulnerable populations. For too many families, illness has historically brought not only suffering but financial hardship. A system that reduces both is delivering social protection as well as healthcare.
People remain the foundation of every health system. More than 78,000 frontline health workers have received additional training. Nearly 20,000 doctors, nurses, midwives and other professionals have been recruited into federal tertiary hospitals, while states are being supported to recruit over 19,000 skilled birth attendants. Two cohorts of the National Health Fellows Programme—774 young professionals in each cohort, representing every Local Government Area—are already supporting implementation across the federation and have delivered more than 1,500 community improvement projects. The reform is therefore investing not only in today’s workforce but in the leadership that will sustain tomorrow’s health system.
The same long-term perspective is evident elsewhere. NEMSAS is strengthening emergency medical response through better referral systems and ambulance networks. More than 500 infrastructure and equipment projects have been completed across federal tertiary hospitals, while new oncology centres are expanding access to specialised cancer care. Through the Presidential Initiative for Unlocking the Healthcare Value Chain, MEDIPOOL, expanded clinical research and incentives for local pharmaceutical manufacturing, healthcare is also becoming an instrument of industrial development, investment and national resilience. Commitments of €1 billion from the European Investment Bank and US$1 billion from Afreximbank reinforce that ambition.
No single statistic proves that a health system has been transformed. Health reform is cumulative. Yet these developments point in the same direction: a system that is becoming better coordinated, better financed, more capable and more responsive than it was only a few years ago. That is the record against which the present reforms should be judged.
Leadership and Institutions
Evidence can demonstrate that institutions are changing. It cannot, by itself, explain how change was organised, sustained or given direction. That is where leadership enters the story.
Institutional reform rarely announces itself. More often, it becomes associated with the people entrusted with leading it. That is inevitable. Leadership attracts responsibility, responsibility attracts scrutiny, and scrutiny often settles upon individuals even when the work itself is institutional. Yet institutions outlast those who lead them. They remain the enduring measure of public stewardship.
The reforms now underway in Nigeria’s health sector illustrate that distinction. Their significance lies not in any single programme, but in the attempt to bring planning, financing, service delivery, workforce development, emergency preparedness and accountability within a common framework. The evidence suggests a health system that is becoming more coherent than before. That coherence is itself one of the reform’s most significant achievements.
It is also one reason health has occupied such a central place in President Bola Ahmed Tinubu’s Renewed Hope Agenda. Few areas of public policy touch the lives of citizens more directly. A stronger health system saves lives, relieves physical suffering, protects families from financial hardship, strengthens human capital and restores confidence in public institutions. It reaches into every community and every stage of life. For an administration committed to improving the everyday welfare of Nigerians, health offers one of the clearest opportunities to translate policy into lived experience.
Seen in that context, the Nigeria Health Sector Renewal Investment Initiative becomes more than a health-sector reform. It is one of the administration’s principal instruments for advancing the broader objectives of the Renewed Hope Agenda. Revitalised primary healthcare centres, expanded financial protection, stronger emergency response systems, investments in the health workforce, local pharmaceutical manufacturing and more resilient public institutions are not separate ambitions pursued in parallel. They are different expressions of the same governing philosophy: that development is measured ultimately by improvements in the lives of citizens.
It is within that wider framework that Professor Muhammad Ali Pate’s stewardship should be understood. As Coordinating Minister of Health and Social Welfare, his responsibility has been to translate that vision into an institutional programme capable of being implemented across a complex federation. The proper measure of that stewardship is not the volume of public debate surrounding it, but whether the institutions emerging from the reform are becoming stronger, more coherent and better able to serve Nigerians than those that preceded them.
That is the standard by which leadership should be judged. It is also the standard by which this administration’s health reforms will ultimately be remembered.
The Questions That Remain
No health system is ever finished. New diseases emerge. Expectations rise. Demographic pressures change. Resources remain finite. The measure of reform is therefore not whether every problem has been solved, but whether a country has become better equipped to confront the problems that remain.
That is why the present debate should not end with competing claims. It should end with a clearer standard of judgment. Where reforms fail, the record should say so. Where institutions weaken, citizens are entitled to demand answers. Where public resources produce little public value, scrutiny should be unrelenting. But where the evidence points in the opposite direction—towards stronger primary healthcare, wider financial protection, safer motherhood, more effective prevention, a better prepared workforce and institutions that function with greater coherence—those gains deserve to be recognised as part of the national record.
Perhaps the most constructive consequence of recent public debate is that it has encouraged more Nigerians to look beyond assertion and examine the evidence for themselves. Democracies are strengthened when governments are required to account for their stewardship through facts, and when criticism is held to the same standard. Public scrutiny performs its highest service not by amplifying opinion but by demanding proof.
That returns us to the question with which we began: How should a nation judge the performance of its health sector?
Not by the volume of political disagreement it generates. Not by the prominence of the personalities associated with it. But by whether it leaves behind stronger institutions, healthier citizens and greater confidence that public service is improving everyday life. That is how governments are remembered.
That is how President Bola Ahmed Tinubu’s Renewed Hope Agenda in health will ultimately be judged.
That is the standard by which Professor Muhammad Ali Pate’s stewardship should be assessed.
And that is how history renders its verdict.
‘Lade Bandele, a public affairs analyst, writes from Abuja.
