Nigeria’s life expectancy stagnates at 63yrs under decade-long underinvestment

A decade of underinvestment in healthcare and public services has left Nigeria’s life expectancy stagnating at 63 years.

BusinessDay’s World Health Organisation (WHO) data analysis shows that life expectancy grew by 22.6 per cent from 51.7 years in 2014 to 63.4 years in 2021 and has stagnated until 2024.

Nigeria allocated a minor portion of its national health budget (N1.14 trillion) to capital health expenditure within this period.

According to the Budget Office of the Federation, the larger portion (N3.39 trillion) was allotted to recurrent expenditures on staff salaries and overhead costs.

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As if that weren’t bad enough, just N417 billion was released from the meagre N1.14 trillion earmarked for capital projects.

Again, only 70 per cent (N294 billion) of those releases were utilised, with the budget office tying the funds to construction, rehabilitation, and equipment procurement across federal health institutions over the 10 years.

This funding represents 25.7 per cent of a total allocation of N1.14 trillion to capital healthcare projects and expectedly, the correlation of these expenditures to improved life expectancy is hardly seen, analysts say.

Going by capital spending, this implies Nigeria spent N1,416 per capita for an average population of 207.5 million.

Although the value of the naira has plummeted from N157 per dollar in 2014 to nearly N800 to N850 as of 2023, Nigeria has consistently fallen short of the Abuja Declaration target of allocating and spending at least 15 per cent of government expenditure on health.

South Africa achieved and sustained this goal from 2014 to 2020, driving its life expectancy to 65.3 years, according to the WHO African Region Health Expenditure Atlas 2023.

BusinessDay found that about 30 per cent of the inadequate funds released for Nigeria’s capital expenditure were returned during the period.

Meanwhile, public health threats such as malaria, HIV/AIDS, and tuberculosis continue to pose significant risks, particularly to children and pregnant women, further exacerbating the nation’s health challenges.

Akin Osinbogun, a professor of Public Health at the University of Lagos said Nigeria should ideally aim at a life expectancy of 80 years as obtained in developed countries, even if it takes improving healthcare expenditure and improving the efficiency of resources.

In terms of efficiency, the N294 billion spent over the last 10 years would have been sufficient to buy 50 brand-new linear accelerators at an average cost of $3.5 million each.

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Linear accelerators (LINACs) are advanced medical devices widely used in radiation therapy for cancer treatment.

As of recent assessments, Nigeria has approximately nine operational LINACs spread across a few treatment centres, primarily in cities like Lagos and Abuja.

The International Atomic Energy Agency (IAEA) recommends that countries like Nigeria have at least one radiotherapy unit per 1 million people, that is 223 LINACs.

Japan has the highest life expectancy rate at birth with an average of 84 years, followed by 83 in Australia and 82 in Italy, WHO data shows.

South Africa has an average of 65, Egypt 72, India 71, Indonesia 71, China 77, Argentina 76, and Brazil 76.

“If you look at the federal budget for health over the years, it has always been below five percent. If you look at the volume, it appears as if it is increasing but inflation is also increasing, so the actual value has not improved,” Osinbogun told BusinessDay on a phone chat.

“The second point is that you can only spend what you have. While our GDP per capita is about $2,000, the GDP per capita for the United States is about $50,000. So, we have less money than those countries. Even with the less money we have, we allocate a low percentage to health. And we know that the more a country spends on health, the better its health outcomes.”

The professor added that some countries can be more efficient in the use of resources, spending less to achieve more results.

To achieve such results, Osinbogun said the government must improve the use of resources and invest more in health.

According to a World Bank analysis, Nigeria spends just $15 per capita on healthcare.

The limited health funds that are allocated are primarily directed toward secondary and tertiary care, focusing heavily on curative services in higher-level hospitals.

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This spending strategy neglects preventive measures, public health initiatives, and primary healthcare, which are more cost-effective and impactful in improving overall health outcomes.

The report highlights the negative consequences of this skewed approach: it not only depletes resources that could be used for prevention and health promotion but also results in high out-of-pocket expenses for patients.

Professor Abubakar Bello, former president of the African Organisation for Training and Research in Cancer said for a population of 223 million people, the mandatory health insurance of the National Health Insurance Authority must be fully operational to raise life expectancy.

“That is an important policy,” he said. “With the way things are in terms of the economy of the country, the government coming in will significantly reduce the difficulties that patients go through as it is today,”

Ele Peter, Tep Foundation, a health advocacy group, called for routine medical checkups to be institutionalized alongside lifestyle modification efforts to shore up life expectancy in Nigeria.

Citing Singapore’s use of policies to make unhealthy food and car driving more expensive and harder to get, she said individuals must do what they can within limited resources.

“The state of our country is enough to reduce life expectancy but we must try to prioritise routine medical checks, walk more, and eat healthily,” Peter.

Nigeria historically faces 317 new cases of malaria per 1,000 people but could drop to 101 cases per 1,000 people if health systems are strengthened and innovations in malaria prevention and treatment, according to the 2022 Goalkeepers Report by the Bill and Melinda Gates Foundation.

Additional data from the WHO shows about 68 million Nigerians suffer from malaria yearly, with 194,000 killed by the disease. However, the country can hard afford prevention or vaccines to adequately protect children from the disease.

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An estimated two million Nigerian adults and children live with HIV in Nigeria, with Benue having the highest prevalence at 5.7 per cent. Jigawa has the lowest prevalence at 0.3 per cent.

The Nigerian Health Demographic and Health 2024 indicates that 63 per cent of women and 69 per cent of men have never been tested for HIV in the country.

The survey also shows that over the three consecutive five-year periods leading up to 2023, the neonatal mortality rate was 41 deaths per 1,000 live births, the infant mortality rate was 63 deaths per 1,000 live births, and the under-5 mortality rate was 110 deaths per 1,000 live births.