Nigeria is young. Our health systems are being built as if they weren’t

Nigeria’s median age is about 18.

Sit with what that really means. Most of the people our health system exists to serve are young. They live on their phones; they are quick, they are resourceful, and they will try almost anything digital before they will sit in a clinic queue. And yet, when I look honestly at how we design health systems in this country, we too often build them as though young people are an afterthought, a group to be reached later, rather than the population we are actually serving now.

I spent time last week in a room trying to change exactly that. It was a high-level roundtable convened by the Digital Transformations for Health Lab, the Healthcare Federation of Nigeria, the Federal Ministry of Health and the Nigeria Digital in Health Initiative that gathered to stress-test a new framework for building digital health around young people. The government was in the room. The private sector was in the room. And, importantly, young people were in the room too, not as a photo opportunity, but with real seats at the table.

What stayed with me is a shift in how we talk about young people. We tend to describe them as the users of digital health, the audience for whatever we build. But that framing is silently wrong. Young people are not the audience. They are the co-authors. And the evidence for treating them that way is not sentimental; it is practical.

Consider what we now understand about digital itself. For this generation, the phone is not a side channel to health; it is a determinant of it. Where they get their information, what they trust, how they think about their bodies, their mental health, and their choices – all of it is shaped by what happens on a screen. A health system that ignores that reality is not neutral. It is already behind.

Yet much of our policy has not caught up. One of the analyses behind the framework discussed in that room found that most national digital health strategies around the world barely mention young people at all, and where they do, it is usually in broad strokes around child and maternal health, not the specific realities of adolescents and young adults. That is a significant gap. And it is not one we can fund our way out of after the fact. It has to be designed from the beginning.

But trust is the word that deserves the most attention, because it is where this generation is least forgiving. Young people are digital-first, which means they are also acutely aware of what happens to their data. They want to know who owns it, who can see it, and whether a system built in their name will actually protect them. This is not paranoia; it is literacy. The legal scaffolding to earn that trust is beginning to emerge across the continent, from Nigeria’s Data Protection Act to similar laws in Kenya and Rwanda. The gap now is not ambition; it is implementation, and it is designing privacy and consent from the start rather than bolting them on at the end.

None of this means young people should be handed the whole system tomorrow. It means their participation has to be institutionalised, built into how we govern and decide, not reduced to a one-off consultation after the important choices have already been made. The most encouraging moment of that entire roundtable, for me, was not the framework itself, as strong as it is. It was watching a young woman take a real seat at the table and tell leaders and agency heads plainly what trust, privacy and inclusion actually mean to her generation and watching the room lean in.

“Nothing about them, without them” is a phrase we hear often, usually as a nice principle. But for a country this young, it is not a courtesy. It is the whole strategy. A health system designed for a generation it does not include will keep producing tools that young people silently walk past, and we will keep wondering why adoption lags and why our best ideas never quite scale.

The work ahead is not to build for young people faster. It is to build with them, and with the government and communities around them, from day one. If we get that right, we are not just designing better technology. We are designing a health system for Nigeria that actually exists: young, digital, impatient, and full of people entirely capable of helping us build it well.

Ota Akhigbe is director of partnerships and programmes at eHealth Africa, where she works at the meeting point of global capital and African institutions to build digital health systems that last. With over seventeen years across the health and development sector, she focuses on partnerships, financing, and designing systems that are built with the people they serve – including the young people who make up most of the continent. She writes and speaks regularly on leadership, institutional trust, and Africa’s digital health future.