By Agbor Neji Ebuta, MD
In 1986, one of my uncles graduated as a medical doctor. Our extended family gathered in Ikom, Cross River State, to celebrate him. It was no modest affair. We returned to our ancestral hills, a place once presided over by one of our illustrious fore-bearer a distinguished Paramount Ruler in the old Ikom Division, Chief Okim Ofu of blessed memory, the fanfare was a memorable one, and my tummy still rumble in nostalgia whenever I recollect that fateful day.
I was a child then, barely tall enough to cross my arms over my head and touch my opposite ear. But I danced as though I understood the significance of the moment. When a videographer spontaneously asked us children what we hoped to become in the future, I answered without hesitation: I would become a doctor. It seemed simple. If becoming a doctor was worthy of such honour, and could elicit community ecstasy, then it was worthy of pursuit.
Decades later, that childhood memory resurfaced during conversations with my friend and ccomrade, Dr. Nurudeen Abubakar Zauro, Technical Advisor to the President on Economic & Financial Inclusion. In his advocacy for Nigeria’s march toward a $1 trillion economy, he has consistently emphasized structure, reform, innovation, and inclusion as pillars of economic transformation.
But in our discussions, we arrived at a shared and unavoidable conclusion: A $1 trillion economy cannot stand on a fragile health system. Economic expansion without health security is like constructing a skyscraper on unstable soil. Productivity, workforce stability, investment confidence, and national resilience all depend on a robust health architecture. If Nigeria is serious about crossing the trillion-dollar threshold, then health must move to the centre of economic planning, away from the periphery of obligatory nuances.
Human Capital at Scale
Nigeria’s population now approaches 240 million and continues to grow rapidly. Yet our health workforce density remains insufficient for the demands of a modern economy.
A serious immediate to medium-term plan would require scaling and closing the gap, toward approximately 400,000 doctors in the immediate (from the disturbingly less than 60,000), with an annual net addition of about 15,000, alongside nurses, midwives, and allied professionals to achieve a minimum density of 4.45 health workers per 1,000 population. A seemingly herculean aspiration.
Training alone is not enough. Retention, motivation, competitive compensation, research support, and diaspora engagement must form part of a deliberate workforce strategy. Health professionals are not merely service providers; they are productivity multipliers. No nation has achieved sustained economic expansion while neglecting the people who keep its workforce alive and functional.
Universal Health Coverage (UHC) as Economic Infrastructure
Universal Health Coverage (UHC) should not be seen as social charity; it is economic infrastructure. If each Nigerian contributed a modest annual amount of approximately ₦22,150, pooled financing could mobilize over ₦5 trillion yearly. That scale of funding would significantly transform primary, secondary, and tertiary care delivery. Combined with existing government allocations, such mobilization would bring Nigeria closer to the 15 percent benchmark recommended under the Abuja Declaration, where African Union member states in 2001 committed to prioritizing health in national budgets.
Beyond revenue, pooled financing creates an impetus that strengthens accountability, which must be a primordial consideration. It reduces catastrophic out-of-pocket expenditure, improves equity, and institutionalizes transparency. However, scale must be matched with strong governance safeguards. Without transparency and digital traceability, increased funding could simply increase vulnerability to leakages. This must be mitigated ab-initio, with fool-proof plans, that anticipate existing fiscal weaknesses sustainably.
Rebuilding Primary Health Care
The foundation of a resilient system remains primary health care. The vision championed decades ago by Olukoye Ransome-Kuti demonstrated that community-level care is the most cost-effective entry point to national health security. Nigeria’s over 30,000 primary health centres must be revitalized with functional staffing, equipment, drug supply chains, and digital monitoring systems. Facilities should be accessible within a 5-kilometre radius or a 30-minute walk wherever feasible. Referral systems must be seamless, ensuring that complex cases move efficiently through secondary and tertiary tiers without bureaucratic paralysis.
High-end tertiary services are important, but they cannot compensate for weak foundations. Preventable diseases should not be overwhelming teaching hospitals. A policy to divest primary care from tertiary centres, will free these centres manpower, and allow focus to complex health challenges, improving specialization on one hand, while optimizing primary health centres operational efficiencies, through a public driven demand advocacy. The Hon. Minister Dr. Muhammad Ali Pate, has demonstrated grit and structure in this direction, the promise of maximum impact grinds steadily towards a desirable outcome.
Pharmaceutical Sovereignty
Nigeria currently depends heavily on imported pharmaceutical inputs. This dependence exposes the country to foreign exchange volatility and global supply chain disruptions.
A trillion-dollar economy demands pharmaceutical resilience, local manufacturing capacity, regulatory strengthening, quality assurance compliance, and long-term ambition to become a regional exporter. Strategic incentives for domestic production could simultaneously create jobs, reduce import bills, and improve national health security. Pharmaceutical sovereignty is not isolationism. It is strategic preparedness.
Prevention as Economic Policy
Health promotion and disease prevention must move beyond rhetoric. Nutrition, lifestyle modification, and locally sourced nutraceutical industries offer untapped economic potential. Countries like China and India have developed multi-billion-dollar sectors around food-based health products. Nigeria possesses similar biodiversity and agricultural capacity.
Investing in preventive health reduces long-term treatment costs and enhances workforce productivity. It is fiscally wiser to prevent disease than to manage its complications. The Nutrition 774 project, a National project, chiefly coordinated by Uju Rochas Anwukah, SSA on public health, is one of such initiatives. These amongst similar interventions should be promoted, and institutionalized.
Digital Health and Data Intelligence
Telemedicine, health informatics, and digital record systems remain underutilized across much of Nigeria. In a modern economy, citizens in a rural community should be able to access specialist consultation remotely when appropriate. Transport costs saved can be redirected toward other essential needs. Meanwhile, properly aggregated health data can provide invaluable insights into disease trends, planning gaps, and resource allocation. Data is not merely information. It is economic intelligence.
Institutions Over Individuals
Perhaps most importantly, the health system that will support a trillion-dollar economy must be institutional, not personality driven on built around an individual. It must be democratized, and inclusive. Deploying the right mix of the bottom-up and top-down strategies, as an appropriate tonic or elixir to fuel sustainability. Strong governance frameworks, transparent procurement systems, regulatory enforcement, and policy continuity across administrations are essential. Nations that endure economically are those that build durable institutions capable of surviving leadership transitions.
Health security is national security. It protects human capital, stabilizes productivity, reassures investors, and strengthens social cohesion. Nigeria’s trillion-dollar aspiration is achievable. But economic ambition without health architecture is incomplete.
The real question is not whether Nigeria can grow its GDP to $1 trillion. The deeper question is whether we will build a health system capable of sustaining that prosperity; resilient in crisis, inclusive in access, transparent in financing, and robust in infrastructure.
If we get health right, the trillion-dollar economy will not merely be a projection.
It will be sustainable reality.
● Dr. Ebuta MBBS, MWACP, FMCFM, MPH, MPA, PMc is a Consultant Family Physician
