Health is a human right, yet many individuals, institutions, and organizations downplay the importance of health to the overall wellbeing of society. According to the World Health Organization’s constitution, health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmities. The United Nations (UN) recognises the right of all individuals to a non-discriminatory healthy life and as stated in its Fact Sheet No. 31, human health needs to be a matter of daily concern. Every individual has the right to standard physical and mental health and wellbeing and as such, governments are charged with enacting laws that assure general access to quality healthcare services.

The right to health implies the available opportunities for every individual to enjoy a series of goods and services, as well as facilities and environments that ensure the attainment of safe and healthy living. On December 16, 1966, the General Assembly resolution 2200A (XXI) adopted the International Covenant on Economic, Social, and Cultural Rights, which enshrined the right of every individual to a safe and healthy life in both private and public space. The resolution also calls on the United Nations member countries to develop “rights-compliant, effective, gender transformative, integrated, accountable health systems and implement other public health measures that improve the underlying determinants of health, like access to water and sanitation.” By 1979, the need to protect gender in healthcare necessitated the adoption of a resolution, the “Convention on the Elimination of All Forms of Discrimination against Women (CEDAW),” at the New York (December 18) general assembly meeting.

The United Nations’ stand on universal health led to the adoption of the Declaration of Geneva by the second general assembly in 1948. This signifies the UN’s readiness to support the World Medical Association’s (WMA) agenda of promoting and encouraging standard health practices across the globe. The UN’s legislation on standard health practices was the driving factor behind the creation of the World Health Organization (WHO) in 1948. It also encompasses the following “rights” – 

• to a system of health protection providing equality of opportunity for everyone to enjoy the highest attainable level of health; 
• to prevention, treatment, and control of diseases; 
• to essential medicines; maternal, child, and reproductive health; 
• equal and timely access to basic health services; 
• provision of health-related education and information; and 
• participation of the population in health-related decision-making at the national and community levels. 

The efforts of the UN to ensure the right to health for all individuals led to a series of successes in global public health. However, despite the provisions of the United Nations to protect the right of individuals to a healthy life, there are still factors affecting the achievement of a healthy way of life at the national level.

Nigeria and the Challenges of Healthy Living

The UN launched the Universal Health Coverage (UHC) initiative in 2012. UHC means that all people have access to quality healthcare services when and wherever they may need them, without any form of financial constraints. It encompasses the total range of vital healthcare services, like health promotion and campaigns, disease and viral prevention, treatment/care, rehabilitation/recuperation, and palliative care or management across life courses. The idea behind the UHC was also represented in the Sustrainable Development Goals (SDGs), introduced in September 2015. Ever since, the UN has assidiously pursued policies and agendas structured to promote the third goal, “ensure healthy lives and promote well-being for all at all ages.” 

In a bid to promote the UHC agenda, Nigeria introduced a series of health reforms, like the 2014 National Health Act, which aimed to eradicate all forms of financial hurdles that the poor and vulnerable face in trying to access primary healthcare. Nigeria also introduced Primary Health Care Under One Roof (PHCUOR) to promote effective delivery of primary healthcare and access to quality health infrastructure and commodities. Nigeria also tried to promote the achievement of SDG 3. According to the Centre for Impact in Global Health, through generous donations and aid from the United States (US), the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund), the World Bank, the United Kingdom (UK), Gavi, the Vaccine Alliance (Gavi), and European Union (EU) institutions, Nigeria recorded significant improvements in its fight against human immunodeficiency virus (HIV), acquired immuno deficiency syndrome (AIDS), tuberculosis, and malaria. 

Also, the UN reported in 2014 that, through the collective efforts of both private and public institutions, polio was no longer endemic in Nigeria. Consequently, in 2020, Nigeria was declared polio free, marking a landmark in Nigeria’s health sector history (however, this victory was shortlived, as 1028 cases were recorded in 2021). Other major health breakthroughs in Nigeria occurred during the eradication of Ebola and the COVID-19 virus. Due to Nigeria’s timely efforts and its public health response strategy that led to a success in the Ebola battle, Nigeria received commendation from the Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), and the WHO. Also, due to its success during the COVID pandemic, which led to the erradication of the virus in the country, Nigeria earned the 4th best COVID-19 response globally, according to the WHO.

Notwithstanding the success of the health sector in eradicating or reducing diseases and promoting a healthy environment, the sector is still among the worst performers in the international arena. According to the United States Agency for International Development (USAID), health indicators in Nigeria are among the worst in Africa. Nigeria has the “second largest number of people living with HIV globally and accounts for 9% of the global HIV burden. Nigeria still has the highest burden of malaria globally, which remains the top cause of child illness and death.” Also, Nigeria still struggles to improve its maternal and child health status. According to the 2023 U-Report survey, Nigeria accounts for 28.5% of all maternal deaths worldwide.

The Nigerian constitution encourages all states to painstakingly implement policies and approaches to safeguard the overall health of their people without any biases or discriminatory treatments when a health need arises. According to the National Human Rights Commission (NHRC), the right to health is among the fundamental human rights of an individual guaranteed through access to clean water, decent and balanced food, appropriate sanitation, and an all-inclusive healthcare system. In trying to domesticate the African Union's Charter on Human and Peoples' Rights and the United Nations’ CEDAW, Nigeria’s 1999 federal constitution stated that all persons are entitled to enjoy the right to the best achievable forms of physical and mental health.  

Despite the policies put in place to promote the right of people in Nigeria to health, Nigeria still struggles to promote and maintain a standard health condition. The WHO notes that uneven national progress in the advancement of health and control of diseases, especially communicable diseases, poses a great danger to the overall well-being of human society across all levels. Nigeria’s health performance figure has been discouraging in the past few years. Also, Nigeria has the fourth highest cases of tuberculosis (TB) in the world and the highest in Africa.

Although Nigeria has the second-highest population of medical doctors in West Africa, the health sector still struggles to provide the necessary infrastructure to utilize these talents. According to the Nigerian Medical Association (NMA), 75,000 licensed Nigerian doctors are registered members, and over 33,000 have already left the country for greener pastures. According to research by the Development Research and Project Centre (dRPC), the majority of Nigerian healthcare workers choose to work in the US and the United Kingdom (UK). This has posed a serious challenge for the sector that is already unstable and as a result, it is projected that it will take the country another 20 years to fill the gap that this brain drain has created. 

Another factor that threatens the promotion of the right to health among Nigerians is the mass exit of multinational health companies and producers of household medical supplies like GlaxoSmithKline Consumer Nigeria Plc, Evans Medical Plc, and Sanofi. Likewise, Procter & Gamble (P&G) decided on a transition from production to importation by the end of 2024. The implications of this trend are that the cost of obtaining basic medical products has increased by over 100%, making it more difficult for individuals to access healthcare products. 

In addition, over $1 billion goes to annual medical tourism due to a lack of standard infrastructure in the health sector. Nigeria is yet to fulfill its part of the 2001 Abuja Declaration, which it signed with the heads of state and government from other African Union (AU) member states. At the April 24-27 meeting, the AU member states pledged to allocate at least 15% of their yearly budget to the health sector. This development emanated from the Millennium Declaration of 2000, which was structured to promote socio-economic conditions in the world's poorest countries by 2015, of which a majority of African countries were categorized. The WHO recorded that 10 years later, Nigeria was among the countries that made insufficient progress in achieving the target of the Abuja declaration. In 2023, 23 years after the declaration, the federal health budget proposal only allocated 4.47% of the national budget to the health sector. This has negatively affected the delivery of standard healthcare services in Nigeria.

Conclusion

The new administration that took over power in Nigeria proposed a “Renewed Hope Agenda,” which had a series of promises. On December 12, 2023, at the World Universal Health Coverage Day event, with the theme “Health for All, Time for Action,” President Bola Ahmed Tinubu launched Nigeria's Health Sector Renewal Compact, an action plan between the Federal, the 36 state governments of the federation, and development partners. However, there is still a dire need for strategic and transformative activities in the health sector. A country with healthy people and a strong health sector is a country that protects the right to health of its people. Hence, the Nigerian government, in trying to live up to its promises of renewed hope, needs to ensure that the available health structures are rehabilitated and reconstructed. 

Providing less than one-third of the Abuja declaration commitments raises concerns for the health sector. Likewise, competitive incentives should be provided for health workers to encourage their continuous service within the shores of the country while reducing the brain drain that has eaten deep into the sector. In addition, the ease of doing business in Nigeria does not encourage foreign direct investments (FDIs) and this is a threat to the sector located in a country where over 99% of its medical supplies are imported. 

Tangible efforts need to be put in place to encourage FDIs as well as local/indigenous investments in the production of health related products. When the right structures and policies are put in place, every individual in Nigeria will enjoy their right to health.