By Favour Nankpak Binchang        

I remember the day clearly. I had gone to the University of Benin Teaching Hospital (UBTH) to donate blood for someone in need, an ordinary act of solidarity that many of us do without thinking twice. But what I witnessed at the Accident and Emergency (A&E) unit that day has stayed with me since. A man, clearly a victim of a road accident, lay in visible agony, while the attending staff insisted on a police report before they would touch him. I have always had a frail heart for such sights, and I could not bring myself to watch what felt like an inevitable tragedy unfold, so I left. But I carried the image away with me, and a cold thought crept in on the walk home: what if that were me? What if the difference between living and dying in this country came down to how quickly someone could produce a document, rather than how quickly a doctor could reach for a scalpel?

The fear was not new to me. Long before UBTH, there was the quieter, more familiar frustration of student life at the University of Benin. Every session, students pay alongside their tuition fee into the Tertiary Institutions Social Health Insurance Programme (TISHIP), trusting that it means something when we fall ill. And it is not as though I was walking in with some rare or fatal condition; almost every single time I visited the school health centre, the diagnosis was the same, tediously familiar culprits, malaria and typhoid, the kind of illnesses that a functioning, well-stocked clinic should be able to treat in its sleep. Yet more times than I care to count, a visit would end the same way: diagnosis given, prescription written, but no drugs on the shelf to dispense. You leave the centre you already paid to access, and head to the nearest pharmacy to pay again, out of one’s pocket, for medicine an insurance scheme was supposed to provide. For students already over stretched their little allowance across food, transport, and textbooks, any new unplanned expense is not a minor inconvenience. It is often the difference between treating an illness early and letting it fester until it becomes worse.

These two experiences, one at a teaching hospital regarded as one of the best in the region, the other at a university health centre meant to be a safety net for thousands of young people, are not isolated misfortunes. They are Edo State’s small, local mirror of a much larger national wound, and I have come to understand that my story is really just one drop in an ocean of similar stories, repeated in dormitories, clinics, and hospital corridors across the country every single day.

The numbers behind that wound are difficult to sit with. Nigeria’s doctor-to-population ratio hovers somewhere between one doctor for every five thousand people and one for every ten thousand, against a World Health Organization benchmark of one for every six hundred. Nurses are stretched almost as thin, roughly one for every two thousand Nigerians, where three hundred is the recommended standard. In the rural communities where most of the working population lives, that shortage widens further still; Primary Health Centres often exist more as signboards than as functioning clinics, sometimes without a single trained health worker in sight, and certainly without a reliable drug supply.

This scarcity is not an accident of geography, nor a shortage of trained hands. Nigeria produces capable doctors and nurses every year. What it fails to do is pay, equip, and retain them. Thousands of health workers have left for the United Kingdom, the United States, Canada, and the Gulf states, chasing a wage that respects their training and a workplace that does not ask them to save lives without the tools to do so. Call it brain drain if the term feels gentler; call it what it truly is, a system that trains its healers and then makes staying home for its own people financially unbearable. Every doctor who boards a flight out of this country carries with them years of scarce, publicly subsidised training that Nigeria desperately needed and could not persuade them to stay and use.

The budget tells its own quiet confession. Health received a little over four percent of the last national budget, a fraction of the fifteen percent African governments promised one another under the Abuja Declaration of 2001, a promise now nearly a quarter-century old and still unmet. Even the money allocated has a habit of disappearing before it reaches a ward, a clinic, or a school health centre like the one I depended on as a student. The Health Minister himself has admitted that of a capital allocation running into hundreds of billions of naira, only a token sum was ever actually released. Budgets written on paper do not treat malaria. They do not stock a dispensary. They do not stop a man bleeding out on a hospital floor while someone searches for a police report.

And that last image is not a metaphor either. Nigeria carries close to a third of the world’s maternal deaths, tens of thousands of women lost every year, roughly one every seven minutes, most dying not from mysterious or unstoppable illness but from complications a functioning health system handles routinely elsewhere. A child born in this country stands a crueller chance of never reaching a fifth birthday than a child born almost anywhere else on earth outside active war. These are not abstractions. They are aunties, sisters, daughters, newborns, classmates. Their deaths were, in the coldest sense, preventable, and in the truest sense, political.

Because this crisis has authors, it was not handed down by nature. It is the fruit of decades of neoliberal system, underfunding by governments, military and civilian, PDP and APC alike, that have chosen debt servicing, security votes and the comfort of the ruling class over the health of the people who put them in office. It is the fruit of a system where politicians and their families fly abroad for treatment, spending hundreds of millions of dollars yearly on medical tourism, while steering ordinary citizens toward hospitals those same politicians would never trust with their own lives. When health workers strike, seeking nothing more than the payment of allowances owed to them and conditions fit for the seriousness of their work, they are met with the same tired accusation: that they are heartless, that they have abandoned their patients. But a nurse cannot conjure drugs out of thin air, and a doctor cannot heal on an empty stomach and unpaid rent. The blame for an empty dispensary or an understaffed ward belongs first to those who starved it of resources, not to the hands still trying to hold it together.

It is worth asking, too, why a country that produces oil, gas, and enough agricultural wealth to feed itself several times over cannot find the political will to stock a school clinic with anti-malarial drugs, or to staff an emergency ward well enough that “police report first” never has to become a matter of life and death. The honest answer is that under the present arrangement, health is not organised around need. It is organised around what can be budgeted, contracted out, or quietly underfunded without immediate political cost. The people who make that calculation are rarely the ones who will ever feel its consequences in their own bodies.

What, then, is to be done? Not another committee. Not another ministerial promise recycled every election season. What Nigeria’s working people need, from the TISHIP-covered student in Benin City to the mother in a rural Edo community without a functioning PHC, is a health system built and controlled in their own interest: one where funding meets and exceeds international benchmarks rather than falling laughably short of them; where doctors, nurses, pharmacists, and allied health workers earn a living wage and hold a real say in how their hospitals and health centres are run, rather than being dictated to by bureaucrats who have never held a stethoscope; where healthcare is treated as a right guaranteed to every citizen from birth, not a commodity rationed according to income or an insurance card that promises more than it delivers. This means public investment in hospitals, dispensaries, and training on a scale this country has never attempted. It means resisting every scheme dressed up as “public-private partnership” that quietly turns healthcare into another arena for private profit. It means the resources currently swallowed by debt servicing and the upkeep of bloated ruling elite is redirected instead toward wards, laboratories, drug supplies, and ambulances.

Above all, it means understanding that healthcare will not be rescued by charity, by a well-meaning NGO, or by the next election cycle’s promises. It will be won by the way every gain workers have ever secured was won: through organisation, through solidarity between health workers and the wider working class, through the collective refusal to accept that some lives are worth less than others simply because they cannot produce the right paperwork in time, or because their student ID does not stretch to a second trip to the pharmacy. The doctor on strike, the student paying twice for the same drug, and the accident victim waiting on a police report before he can be touched are, in truth, fighting the same fight, against a system that treats human life as an afterthought to profit and procedure.

Nigeria does not lack the wealth to heal its people. It lacks a system that puts their lives before its balance sheets and its paperwork. Changing that is not a matter for prayer or patience. It is a matter for struggle, solidarity, and, ultimately, socialism.