By Sola Ogundipe, Health Editor

DURING the 2023 campaign, President Bola Tinubu promised to tackle some of the deepest problems in Nigeria’s healthcare system under the Renewed Hope Agenda.

The pledges included expanding health insurance, rebuilding neglected primary healthcare centres, improving local drug production and slowing the wave of doctors and nurses leaving the country.

Three years later, there are signs of movement, but the strain across the system is still obvious.

Patients still arrive at hospitals with cash in hand because treatment often depends on immediate payment.

In many rural communities, renovated clinics sit without regular electricity, water or enough workers to keep services running properly.

The Bola Tinubu administration had promised to push health insurance coverage to at least 40 per cent of Nigerians through the National Health Insurance Authority within two years. That goal is nowhere close.

At a stakeholders’ forum in Abuja NHIA Director-General, Dr. Kelechi Ohiri, said enrolment rose from 16.8 million Nigerians in 2023 to about 19 million at the end of 2025. Even with that increase, coverage is still below 10 per cent of the population. And having insurance does not necessarily protect people from huge medical bills.

According to the World Bank and the World Health Organisation, Nigerians still pay more than 70 per cent of healthcare costs directly from their pockets. The World Bank’s “Nigeria Development Update 2024” observed that rising medical expenses are worsening poverty among vulnerable households.

A health financing researcher at the University of Ibadan, Prof. Patience Aina, noted that many patients still pay separately for scans, medicines and specialist treatment despite being enrolled in insurance schemes. “Some people hear they have health insurance and assume everything is covered. That is not the reality,” she said.

Questions also remain over the promise to use part of fuel subsidy savings for healthcare. Reviews of 2024 and 2025 budget implementation reports do not clearly show how much subsidy money went directly into health projects.

Federal officials say over 5,000 PHCs are being upgraded, under the Health Sector Renewal Investment Initiative coordinated by the National Primary Health Care Development Agency, although independent nationwide verification remains difficult. Still, many centres struggle with the basics. A 2025 WHO-supported “Primary Healthcare Performance Review” found shortages of drugs, laboratory equipment and skilled workers across several rural PHCs. In some centres, patients are still asked to buy basic medical supplies from outside before treatment can begin.