The family of renowned Nigerian author Chimamanda Ngozi Adichie has accused a private hospital in Lagos of negligence over the death of her 21-month-old son, who died tragically earlier this month. The hospital has denied wrongdoing, and investigations are ongoing.
My daughter is also 21 months old, and I live in Nigeria, too. So, when I read about this loss it was not abstract, or distant. It was too close to home.
Nigeria is among the most dangerous places in Africa to be a child. Roughly one in every ten children born in Nigeria dies before their fifth birthday, placing the country among the worst in Africa for child survival. This is not a natural disaster; it is a system failure. While I cannot prejudge the facts of this particular case, Nigeria’s health system too often enables negligence and impunity – what many Nigerians simply call “anyhowness.”
Most Nigerian children do not die from rare or mysterious illnesses. They die from premature birth, infections, malaria, pneumonia, diarrhoeal disease caused by unsafe water and poor sanitation, or malnutrition. These are conditions the world already knows how to prevent and treat.
Nigeria is Africa’s most populous country and fourth-largest economy. Yet despite its vast oil wealth and booming megacities like Lagos and Abuja, more than 40 per cent of the population lives in extreme poverty.
Nigeria has long allocated a relatively small share of its federal budget to health, consistently falling below international norms. Health spending as a proportion of overall government spending has fallen from 7 per cent in 2015 to 4.3 per cent last year, even as health investment rose in nominal terms. As a comparison, in the UK, health represents around 18 per cent of total government spending in a given year.
The message is unmistakable: health received more money, but less priority.
Political success measured by child survival
This trajectory leaves Nigeria far below both the Abuja Declaration’s 15 per cent target and the World Health Organization’s 13 per cent benchmark for public health spending. Nominal increases have created the illusion of progress, while real political commitment has steadily eroded. On paper, budgets have grown. In practice, health remains structurally underfunded – and Nigerians continue to pay the price.
But this crisis is not only about spending in a system riddled with leakage. More money does not automatically translate into better care. Corruption and weak accountability also ensure that the most vulnerable are left holding the shortest end of the stick. Clinics without drugs, maternity wards without oxygen, poor emergency responses and families forced to pay for what should be public services are not accidents – they are the visible symptoms of this failure. Citizens are routinely forced to pay out of pocket for this substandard care. Three quarters of spending on health in Nigeria is direct at the point of care.
To avoid the danger of a single story, it is important to acknowledge Nigeria’s innovators who are trying to close these gaps. For example, Virtue Oboro developed Crib A’Glow, a portable, solar-powered phototherapy device that treats newborn jaundice in settings without reliable electricity. It demonstrates that Nigerian solutions exist. What is missing is not innovation, but system-wide adoption, maintenance, and accountability.
Organisations such as The ONE Campaign, alongside Nigerian civil society groups and clinicians, are pushing for a future in which African countries can finance their own health systems while reducing out-of-pocket costs for families. For Nigeria, this would mean saving tens of thousands of children every year. But these goals will remain words on paper without sustained political commitment from leaders, health professionals, innovators, civil society, and citizens.
The deeper problem is that Nigeria still offers too few political and institutional incentives to fix a system that repeatedly fails its children. We must ask far harder questions of our leaders. What will it take for governors and elected officials to be judged not by rhetoric, but by whether Nigerian children live to see their fifth birthday?
In Nigeria’s federal system, states are responsible for primary health centres, while the federal government oversees tertiary care. With nearly 30,000 primary health care facilities nationwide, these centres should be the backbone of child survival. Instead, many remain unequipped, understaffed, or non-functional, forcing families to rely on pharmacies and costly private clinics for basic care.
How many more funerals must we attend before child survival becomes a political priority?
While resources are scarce and more than 30 African countries pay more to service their debt than invest in health or education, money alone will not solve this crisis. The utilisation of the funds must deliver tangible results. Funds allocated do not always translate into lives saved.
Nigerians must insist that child survival becomes a measure of political success. Budgets must be tracked, facilities inspected, deaths audited, and leaders held publicly accountable for outcomes – not promises.
Serah Makka is the Executive Director for Africa at the ONE Campaign