A public health expert, Dr Ganiyu Jamiyu has an extensive background drawing from international exposures and research competence. You cannot miss Dr Ganiyu on the 9th floor of the Federal Ministry of Health, for he is lively and friendly in disposition to all. Actively engaging with live and open to inquiries. Dr Ganiyu, the Chief Consultant Epidemiologist, and I did not meet before the interview. However, I didn’t look for him among the ministry staff. On the cool morning of that Friday of my appointment with him, my guest was convivially discussing with his colleagues. Although I arrived around two hours earlier, I waited for the exact time of the appointment. So, I walked straight to him at the balcony of the imposing structure and introduced myself, immediately he hugged me in his natural manner beaming with smiles. An introduction has started. He ensured he introduced me to his colleagues and other senior staff of the ministry. Dr Ganiyu was not done. Immediately after we finished the about 2 hours interview, he took me to the next floor and continued the introduction, greeting and exchanging pleasantries in his characteristic nature, as we ascended and descended the stairway.
John Nwokocha, Editor
Can you give an overview of Nigeria’s Health Sector from your vantage position?
For years, health funding in Nigeria has been insufficient. Despite the Abuja Declaration, where African nations agreed to allocate 15% of their annual budgets to healthcare, Nigeria has yet to meet this target. This chronic underfunding has left the healthcare system overstretched and under-resourced. Insurance coverage is another area of concern. While countries with strong health systems have robust insurance schemes, Nigeria’s health insurance coverage remains low, around 20%, and largely benefits public sector employees. This leaves vulnerable populations, such as rural market women and informal workers, without adequate coverage.
Access to healthcare is another critical issue. High out-of-pocket expenses, which account for over 70% of healthcare costs, create barriers for many Nigerians. Such expenses often push families with chronic illnesses into deeper poverty. This phenomenon, known as catastrophic health expenditure, undermines efforts toward universal health coverage (UHC). UHC aims to make healthcare accessible, affordable, and acceptable. But Nigeria’s current system struggles to meet these goals. Without affordable options, many resort to traditional medicine or low-quality treatments, endangering their health further.
The gaps in the health system are evident in areas like maternal mortality, which remains alarmingly high, with over 1,000 deaths per 100,000 live births. Policies such as free cesarean sections could reduce maternal deaths if implemented effectively.
Additionally, cancer rates are rising, and while the Minister of Health has made commendable efforts in advocating for cancer care and expanding treatment centers, more work is needed to strengthen the system.
Could throw light on the nation’s Health Insurance Coverage?
Nigeria’s health insurance coverage remains low, around 20%. Ultimately, Nigeria’s healthcare system is fragile. It lacks sufficient funding, insurance coverage, infrastructure, and a motivated workforce. Addressing these issues requires a comprehensive approach that includes increased funding, expanded insurance coverage, improved infrastructure, and better support for healthcare workers. Without these changes, the country will continue to face significant challenges in achieving universal health coverage and improving the health outcomes of its citizens.”
“One of the fundamental necessities for any health facility providing care is access to water. It is impossible to effectively manage patients without it. For instance, hand sanitizers are important, they are only suitable when hands are not visibly soiled with bodily fluids like blood. In cases where there is contact with patient sweat or minor physical examinations without visible contamination, hand sanitizers can suffice. However, when visible contamination occurs, water is indispensable for proper hygiene.
You spoke about a lack of water or boreholes or other water infrastructure. Can you expatiate on this?
Even if a health facility lacks a borehole or other water infrastructure, alternative measures, such as fetching water in buckets, must be implemented. However, access to clean water remains a significant challenge. In many areas, such as Kuje and other local councils around Abuja, there is no functional urban water system. This lack of access to water, combined with poor environmental sanitation, contributes to recurring health issues like cholera outbreaks. Open defecation, inadequate waste disposal, and the absence of proper toilets in homes exacerbate these risks. Despite government promises to reduce open defecation, the problem persists, posing a continual threat to public health.
Lack of funding always comes up in conversations about improving the healthcare system. Do you think financing is critical? How can the financial burden of seeking medical help be resolved?
Many people hesitate to seek medical help because of the financial burden. If someone hasn’t had a proper meal in days, paying for healthcare can seem impossible. This reflects the broader issue of a weak healthcare system, which is ill-prepared to handle major outbreaks like COVID-19 or Ebola. Such outbreaks would overwhelm an already fragile system, further worsening the situation.
To mitigate these risks, we must strengthen the healthcare system, ensure access to clean water, improve environmental sanitation, and address the socio-economic barriers that prevent people from seeking care.
Do you agree that Nigeria is unprepared for any emergency in the health sector?
The journey of public health preparedness in Nigeria has been transformative since the country encountered its first case of Ebola. At the time, there were limited human resources, funding, and infrastructure to respond effectively to epidemics. However, lessons from that experience prompted significant advancements, including the establishment of the Nigeria Centre for Disease Control (NCDC). The creation of the NCDC addressed the need for a dedicated agency to streamline epidemic preparedness and response, reducing bureaucratic bottlenecks and improving efficiency.
While the NCDC operates under the supervision of the Federal Ministry of Health, the ministry continues to play a critical role in providing policy direction, reviewing guidelines, and offering technical oversight. Since its inception, the NCDC has contributed significantly to building capacity in several areas: training health workers, recruiting competent personnel, and developing infrastructure. For instance, Nigeria now boasts molecular laboratories across all 36 states, including the Federal Capital Territory, and has made substantial progress in health security, surveillance, laboratory services, and antimicrobial resistance management.
Outbreaks
Before these advancements, outbreaks required federal teams from Abuja to support states directly. Now, states have been empowered with the skills, infrastructure, and personnel needed to respond independently to health threats. This decentralization allows states, led by public health directors and epidemiologists, to effectively address outbreaks such as Lassa fever, cholera, heavy metal poisoning, and other communicable and non-communicable diseases.”
The NCDC’s work is integrated with a broader “One Health” approach, which involves multi-sectoral collaboration to address zoonotic diseases—those transmitted between animals and humans, such as monkeypox. This approach ensures that outbreak response efforts involve all relevant sectors, including agriculture, environment, finance, communication, and security. Emergency Operations Centers (EOCs) are established at national, state, and local levels to coordinate responses, with input from various stakeholders and partners.
How would you evaluate the impact of Japa syndrome?
Despite these successes, challenges remain. The current economic situation and high emigration rates among health workers, often called the “Japa syndrome,” have significantly impacted the health workforce. Many trained personnel have left the country or joined non-governmental organizations, creating gaps in the system. This issue underscores the need for sustained efforts to retain talent and maintain the progress achieved in public health preparedness and response.
How deadly is Hepatitis?
“Hepatitis remains a significant public health issue in Nigeria. As of 2018, 20 million people were living with hepatitis, including 26 million with hepatitis B and 4 to 5 million with hepatitis C, according to the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). One of the major challenges is the lack of free treatment for hepatitis, unlike HIV, which has accessible treatment options. This has led to catastrophic out-of-pocket spending for those affected.
Hepatitis B and C share similar transmission routes with HIV, including sharing needles, mother-to-child transmission, unprotected sexual intercourse, and infected blood transfusions. Despite these similarities, hepatitis continues to be a neglected issue. One of the critical gaps is inadequate screening. While facilities often screen for HIV, syphilis, and hepatitis B and C during blood transfusions, many laboratories lack the standard equipment needed for accurate testing.
The minimum reliable test for detecting hepatitis is the Enzyme-Linked Immunosorbent Assay (ELISA), yet many facilities rely on less sensitive Rapid Diagnostic Tests (RDTs). While RDTs are sufficient for HIV detection, they are inadequate for hepatitis because they rely on detecting antibodies, which may not be present in adequate quantities if the viral load is low. This limitation can lead to false-negative results. Hepatitis B or C viruses often hide in the liver, only advanced testing like Polymerase Chain Reaction (PCR) can confirm their presence. The continued reliance on RDTs means that infected blood is sometimes transfused, perpetuating the spread of hepatitis.
I have observed that discussions around Hepatitis are sketchy. And this is troubling. Do you agree?
Many people with hepatitis do not know how they contracted it. In some cases, blood transfusions are the source. Hepatitis is also more transmissible than HIV, with the risk of contracting hepatitis B being approximately 16 times higher than HIV. Without proper precautions, such as avoiding shared needles, sharp objects, or utensils, entire households can become infected.
As a healthcare provider, I have witnessed families where every member has hepatitis due to these transmission routes. If Nigeria does not prioritize hepatitis as a public health challenge, the problem will worsen in the future. Increased awareness, proper screening with ELISA or PCR, affordable treatment options, and preventive measures are essential to addressing this growing crisis.”
Partners supporting TB and HIV are focused on funding free treatments, emphasizing the importance of investing in healthcare to achieve significant outcomes. While several countries have made progress in eliminating TB through domestic funding, Egypt is an example of a country that has achieved elimination without relying on external financing. This demonstrates the potential for sustainable health systems when governments prioritize domestic resources.
Hepatitis B is preventable, treatable, and can be managed effectively with proper immunization. A complete dose of the hepatitis B vaccine, typically three doses, offers lifelong protection. Even if a vaccinated person is exposed to the virus, they are unlikely to become infected. The vaccine is freely available for children, with four doses administered during infancy. However, adults must pay for the vaccine, which limits accessibility. Regardless of prior immunization, universal vaccination for all age groups is critical to preventing future hepatitis B outbreaks.
Hepatitis C, on the other hand, lacks a vaccine but is curable. A three-month course of antiviral treatment can achieve a complete cure. To address the hepatitis C burden effectively, adopting comprehensive strategies is essential, including making treatment accessible and affordable.
Government intervention is key to achieving these health goals. Providing free or subsidized vaccination and treatment for hepatitis B and C, regardless of age, is a crucial step toward mitigating future public health challenges.
Could you evaluate the impact of partners in Nigeria’s health sector?
“The fight against public health challenges, particularly in Nigeria, necessitates strong partnerships, as no single entity can succeed in isolation. The World Health Organization (WHO) has been instrumental in Nigeria and globally, playing a significant role in advancing public health innovations and approaches. Their ability to coordinate efforts stems from leveraging lessons learned and findings across countries, thereby identifying and promoting best practices to address health-related conditions. Similarly, other partners like the World Bank, UNICEF, and others have made notable contributions to combating diseases like HIV, tuberculosis, and malaria, which we deeply appreciate.
However, it is time for Nigeria to think beyond traditional approaches. Despite significant investments and efforts, malaria remains a leading cause of mortality, particularly among children. While tools like mosquito nets have been widely distributed, their misuse in some areas (e.g., for fishing) indicates the need for more sustainable and effective solutions. The persistent challenge of anti-malaria resistance further underscores the urgency to innovate.
Nigeria can learn from global best practices, such as the strategies employed by countries like the United States, which have effectively eliminated malaria in the past. For instance, targeted interventions in swampy areas, like draining stagnant water and improving environmental sanitation, have proven successful. Nigeria must adopt and adapt such evidence-based approaches, backed by research, to achieve similar outcomes.
Nigeria can overcome the persistent challenges of malaria by fostering collaboration, prioritizing innovation, and ensuring proper implementation of interventions. The health sector must remain dynamic, open to new ideas, and committed to translating investments into tangible results that save lives.”
How would you respond to Nigeria’s ranking on TB?
Tuberculosis (TB) ranks as the fourth leading cause of disease globally, and its burden is closely linked to HIV due to the immune suppression caused by the virus. In Nigeria, a strong TB program is in place, with TB treatment provided free of charge. The challenge lies in creating sufficient awareness to encourage people to seek care. To address this, the concept of community-based TB care has been introduced, making it easier for individuals to access services at the community level through Primary Health Centers (PHCs). With free treatment readily available, the focus should be on increasing awareness so that those affected or suspected of having TB can access care without hesitation.
Do you think adequate awareness has been created around HIV/ AIDS?
This approach also applies to HIV. Free treatment is available for anyone diagnosed with the virus, ensuring no out-of-pocket expenses for those seeking care. While progress has been made with TB and HIV, other diseases such as cancer, malaria, and Lassa fever present significant challenges. Unlike TB and HIV, cancer treatment is not free in Nigeria, creating a financial burden for patients.
Does malaria still constitute a serious public health threat?
Malaria, particularly among children under five, remains a leading cause of death. Initially, insurance did not cover malaria treatment, but it now does, offering some relief. However, drug-resistant malaria strains and the high mortality rate among children continue to be serious concerns.
Lassa fever, another critical issue, has caused numerous deaths in recent months. For example, fatalities have been recorded consistently since November 2024 and into 2025. Environmental factors, such as the presence of rats during the dry season, contribute to the spread of the disease. Rats often contaminate food and water left uncovered, creating a major transmission point. Additionally, human-to-human transmission occurs, especially in healthcare settings.
