Nigeria’s life expectancy is among the lowest in the world, and the way we finance and deliver healthcare helps explain why. Too much spending goes towards treating diseases after they become serious, while too little is invested in preventing them, detecting them early and making routine healthcare accessible. The consequences are measured not only in lives lost, but also in household poverty, lost productivity and the cost of managing conditions that could have been addressed earlier.
There is a particular kind of silence that falls over a Nigerian family when a doctor says “Stage Four”. It is the silence of a story that, in retrospect, everyone half-knew was coming. The headache dismissed as stress. The swelling attributed to age. The blood pressure reading taken once at a pharmacy counter and never checked again. By the time the disease becomes impossible to ignore, it may have been developing for years.
Nigeria must make prevention an affordable, accessible and routine part of healthcare delivery, with government leadership and meaningful private-sector participation. This requires more than asking people to take their health seriously. It requires changing the system within which they make decisions about their health.
The number we cannot ignore
United Nations data released in 2025 put Nigeria’s life expectancy at birth at 54.9 years, compared with a global average of 73.7 years. Nigerian men can expect to live an average of 54.3 years, while women can expect 55.9 years. The gap between Nigeria and the global average is nearly 19 years.
One reason is that healthcare remains heavily oriented towards treating disease after it appears, often when treatment is more complicated and expensive. Prevention requires regular screening, early diagnosis, follow-up care and sustained management of conditions that may not produce obvious symptoms.
A blood pressure check that identifies hypertension early may prevent a stroke years later. Routine blood glucose testing may reveal diabetes before serious complications develop. Detecting cancer before it spreads can improve treatment options and survival. Yet these interventions are not consistently integrated into everyday healthcare.
Why Nigeria keeps paying for rescue
The structure of healthcare financing makes this shift difficult. Out-of-pocket spending accounts for approximately 71 per cent of total health expenditure in Nigeria, while government health spending remains well below the commitment African governments made in the 2001 Abuja Declaration to allocate 15 per cent of their national budgets to health.
National health insurance covered an estimated 21.7 million Nigerians by 2025, fewer than one in ten people in a population exceeding 242 million.
When families must pay for most healthcare themselves, routine screening can seem like an expense they can postpone. A hospital visit may mean transport costs, time away from work and consultation fees, followed by additional spending if tests reveal a problem. For households already struggling to meet basic needs, delaying a check-up is often a consequence of financial pressure, not indifference to health.
Emergency treatment, by contrast, becomes unavoidable when symptoms can no longer be ignored. Families then face larger bills and more complicated treatment. The system consequently spends heavily on rescue while leaving too many people without preventive services that could reduce the need for it.
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The arithmetic of prevention
Hypertension illustrates the financial and human costs of waiting. According to the 2017 REMAH nationwide survey, roughly 38 per cent of Nigerian adults live with hypertension, representing more than 50 million people. Only 12.4 per cent have their blood pressure under control.
Uncontrolled hypertension can damage the heart, kidneys and brain without producing obvious symptoms for years. By the time complications develop, the cost of care can be substantial.
A primary-care programme based on the World Health Organization’s HEARTS model, including screening, service delivery and medication, has been estimated to cost approximately $27 to $49 per patient annually. At the exchange rate used in the original analysis, that is about ₦36,000 to ₦65,000 a year, although actual costs vary with medication prices and delivery models.
Compare that with kidney failure. Dialysis in Nigeria can cost between ₦50,000 and ₦80,000 per session, with advanced patients typically requiring two or three sessions each week. Annual costs can reach ₦6 million to ₦10 million, excluding related medicines. A kidney transplant may require ₦25 million to ₦30 million upfront, followed by the continuing cost of medicines and clinical care.
Over five years, the illustrative cost of hypertension prevention and control is approximately ₦178,000 to ₦323,000 per patient, compared with ₦30 million to ₦50 million for five years of dialysis. These figures are not directly interchangeable for every patient, and not every case of kidney failure is caused by hypertension. They nevertheless demonstrate the scale of the financial exposure that effective prevention can help reduce.
Extending a HEARTS-style programme to Nigeria’s approximately 52 million hypertensive adults would cost an estimated ₦2.6 trillion for one year. This would require careful planning, reliable medicine supplies, trained personnel and sustainable financing. But the investment must be considered alongside the enormous costs of advanced cardiovascular and kidney disease borne by families and the health system.
Diabetes presents a similar challenge. Only about three per cent of Nigerian adults have diagnosed diabetes, representing roughly three million people. Yet the International Diabetes Federation estimates that 73 per cent of diabetes cases in Africa go undiagnosed. Nigeria’s actual burden is therefore likely to be considerably higher than its diagnosed population suggests.
Many people discover they have diabetes only after developing complications, including diabetic foot disease, cardiovascular problems or kidney failure. Routine screening, early diagnosis and consistent treatment can help prevent or delay some of these outcomes.
Cancer and the cost of late diagnosis
Nigeria recorded 127,763 new cancer cases and 79,542 cancer deaths in 2022. Late presentation remains a major challenge, with multiple Nigerian hospital studies from 2018 to 2023 finding that roughly three-quarters of breast cancer patients presented at Stage III or IV.
American Cancer Society figures show five-year relative survival for breast cancer at above 99 per cent when the disease is localised, about 87 per cent when it has spread to nearby tissues or lymph nodes, and approximately 32 per cent when it has spread to distant organs.
These figures illustrate why earlier detection matters, but screening alone is not enough. It must be connected to diagnostic confirmation, referral and treatment. A woman who receives an abnormal screening result but cannot afford further tests or access appropriate care has not benefited fully from early detection.
The financial consequences of non-communicable diseases reinforce the point. Nigerian household research has found that affected households spend an average of ₦122,313 annually out of pocket on these conditions, while nearly 29 per cent experience catastrophic health expenditure. Among the poorest fifth of households, the proportion rises to almost 82 per cent.
A healthcare system that fails to prevent avoidable complications also exposes families to financial hardship. Prevention is therefore both a health intervention and a form of economic protection.
Prevention begins beyond the hospital
Not every preventive intervention requires a new hospital or expensive technology. Some of the most valuable measures begin in communities, workplaces, pharmacies and other places Nigerians already visit.
When an ambulance or intensive care unit is not immediately available after a cardiac arrest, stroke or serious road accident, the actions of a passerby, market trader, commercial motorcyclist or neighbour can make a difference. Yet basic first-aid and cardiopulmonary resuscitation (CPR) knowledge remains uncommon outside formal healthcare settings.
The Healthcare Federation of Nigeria (HFN) has advocated for a Good Samaritan law to protect people who provide first aid or CPR in good faith from legal liability, alongside wider community training. Through its collaboration with Health Emergency Initiative (HEI), HFN is also supporting the training of emergency first responders.
The same principle applies to epidemic preparedness. During COVID-19, HFN helped coordinate private hospitals, laboratories and pharmacies in Nigeria’s response, advocated for private-sector participation in testing, and mobilised private providers for isolation, treatment and vaccine delivery.
That experience demonstrated the importance of integrating private healthcare providers into national emergency planning before a crisis overwhelms existing capacity. HFN has advocated for stronger disease-reporting systems, staff training, quality standards and public scorecards that measure improvements in preparedness. Investing in these capabilities during periods of relative calm is more effective than attempting to build them during an emergency.
The private sector and the business of prevention
Nigeria’s private healthcare entrepreneurs have an important role to play in making preventive services more accessible.
Diagnostic networks, primary-care providers, community pharmacies, digital-health companies, insurers and health maintenance organisations can all help bring routine screening and follow-up closer to where people live and work.
Community pharmacies could offer convenient blood pressure and blood glucose checks, with referral pathways for patients who need further investigation. Employers could make periodic screening part of workplace health programmes, helping identify risks before they result in prolonged illness and absence from work. Digital-health companies could support reminders, follow-up consultations and monitoring for patients managing chronic conditions.
Insurers and HMOs could develop affordable preventive packages that encourage early engagement with healthcare, rather than concentrating benefits around treatment after a condition has deteriorated.
Government investment remains indispensable. Private innovation cannot replace public responsibility for population-wide prevention, health education, essential medicines and equitable access to care. Reaching the Abuja Declaration’s 15 per cent target remains relevant, but how health resources are spent matters as much as how much is allocated.
Preventive services must become a clear priority in health budgets, alongside the infrastructure and specialised programmes needed to treat serious illness.
HFN’s work connecting healthcare providers, advancing policy reform and advocating for greater private-sector participation in preparedness can help create the conditions in which preventive services become more widely available.
Making the healthy choice the easier choice
There is a risk in discussing Nigeria’s life expectancy as though the problem lies primarily with individual behaviour. People cannot routinely seek services they cannot afford, reach conveniently or trust to lead to effective treatment. Telling Nigerians to take their health more seriously will achieve little if screening is costly, follow-up care is unavailable and insurance coverage remains limited.
Government must prioritise prevention in financing and policy. Providers must make routine screening and early intervention part of ordinary service delivery. Insurers and employers must help spread the cost, while communities need access to practical health education and emergency-response training.
Closing the nearly 19-year life-expectancy gap will require sustained investment, stronger primary care and a change in how the country thinks about healthcare spending. The goal should not simply be to expand capacity to treat people when they become seriously ill, but also to reduce the number of people who reach that point unnecessarily.
A blood pressure check at a pharmacy instead of years of unmanaged hypertension. A cancer diagnosis before the disease spreads. A trained first responder who can act before an ambulance arrives. A private diagnostic centre connected to national surveillance before an outbreak goes unnoticed.
These are practical changes that require financing, coordination and political commitment, but they also offer a better return on the resources Nigeria already spends on health.
Our life expectancy is not a verdict on the Nigerian people. It is a measure of the outcomes our systems currently produce.
If we want that number to change, we must stop treating prevention as an optional extra and make it a foundation of healthcare delivery.
Nigeria’s life-expectancy crisis demands a shift in priorities: investing in keeping people healthy, identifying illness early and ensuring that the healthy choice is also the affordable and accessible one.
This article is a partnership between the Healthcare Federation of Nigeria (HFN) and BusinessDay to highlight policies and programmes to promote the rebuilding of Nigeria’s health sector. As a private sector-led coalition, HFN advocates for policies and partnerships to strengthen healthcare delivery. This partnership aims to spark meaningful discussions and drive transformative change in Nigeria’s health sector.
This article was authored by the HFN Editorial Team, including Njide Ndili (President, Healthcare Federation of Nigeria, and Country Director, PharmAccess), Dr. Benson Ayodele Cole (First Vice President, HFN), and Dr. Fola Adebowale (Founder, Recon Health Media).
