In this interview, a physician and researcher who has worked with national and international donor-linked initiatives like the United States President’s Emergency Plan For AIDS Relief, Global Fund, and the World Health Organisation, Dr. Okikiolu Badejo, speaks with LARA ADEJOROon HIV policy, epidemic preparedness, vaccine equity, among others
How would you rate the government’s current health system governance, especially regarding transparency, accountability, and citizens’ engagement?
There has been renewed policy energy under the current administration, especially since Professor Muhammad Pate became the Coordinating Minister of Health in 2023. His tenure has brought greater structure and ambition to health system reform, from the revitalisation of the National Health Act through the Health Sector Renewal Investment Programme, to the roll-out of the National Policy on Health Workforce Migration. These are encouraging developments that signal intent to move away from business-as-usual. But policy ambition is not the same as systems change. Persistent governance challenges continue to constrain impact, particularly in transparency and accountability. We still lack a digitised architecture for tracking health budgets, service delivery outcomes, and procurement processes, especially at the sub-national level. Without such tools, it becomes difficult to monitor where funds go, how efficiently they’re used, and whether citizens are getting value for money. Citizens’ engagement also remains limited. While decisions may be well-intentioned at the federal level, the mechanisms to gather structured input from local communities or to hold decision-makers accountable are still weak. One promising initiative is the National Health Fellows Programme, which is training young champions across Nigeria’s 774 LGAs to engage with their communities. This could help strengthen the connective tissue between policy and public participation, but much more is needed to embed citizen voice in health governance. In short, while the direction of travel is encouraging, implementation remains to be seen. Bridging the gap between policy and practice, particularly through transparency, real-time data systems, and community accountability, will determine whether current governance reforms reach the people they are meant to serve.
Health worker migration is draining Nigeria’s health sector of experienced professionals. Beyond salary increases, what systemic reforms could make the country’s health workforce more likely to stay and thrive?
This is arguably one of the defining health crises of our time in Nigeria as the “Japa” wave continues to hollow out our frontline health system. That’s why I consider the launch of the National Policy on Health Workforce Migration last year a major step forward, offering real incentives like rural bonuses, diaspora reintegration support, and interest-free loans for private practice. It even proposes bilateral agreements with countries like the UK to ethically manage recruitment flows that protect both Nigeria’s investment and workers’ rights abroad. But the real test is implementation. Salary is important, but it’s not the whole story. Many doctors and other health professionals I speak to are leaving in droves, not just for higher pay, but for professional dignity, work-life balance, tools that work, and systems that reward competence. A junior doctor earning N200,000 per month in a facility with no oxygen, constant strikes, and poor mentorship will not stay because of a 20 per cent raise. We need to build a healthier work environment, more support for mental well-being, realistic work hours, reliable equipment, and transparent promotion pathways. If we can’t pair technical investment with a cultural shift in how we value and retain our workforce, we will continue to lose them.
With your experience in epidemic preparedness, is Nigeria ready and well-prepared to respond to future pandemics based on current policies and investments?
We are more aware, yes. But I wouldn’t say we are ready. The COVID-19 pandemic has taught us that epidemic readiness is not just about emergency response; it is about consistent investment in primary health care, surveillance systems, supply chains, and workforce capacity, all of which we have not been doing very well. One thing we need to address urgently is our reliance on foreign supply. We need enough and consistent research and development investment and local manufacturing capacity to reduce dependence on foreign supplies during outbreaks. There has been some promising movement on this front, like the local production of HIV rapid test kits and the Jawa International Pharmaceutical Facility for antibiotics.
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