Collateral Consequences of President Tinubu’s Healthcare Reforms
By Okey Akpa
Few aspects of President Bola Ahmed Tinubu’s reform programme have attracted more public attention than the economy. Debate has centred on fiscal policy, exchange-rate reforms, inflation, taxation, investment and the cost of living. These are the measures by which governments are usually judged because they shape economic confidence and influence the daily lives of citizens.
Healthcare has occupied a different place in that conversation. Discussion has focused on access to care, the condition of public hospitals, maternal and child health, health insurance, the availability of medicines and the performance of primary healthcare. Those remain the principal measures by which the success of health sector reforms should be judged.
They are not, however, the only ones. Some of the most significant effects of the reforms are unfolding beyond hospitals and clinics. As access to healthcare improves, the sector is also attracting investment, expanding domestic manufacturing, strengthening scientific capability, developing skilled human capital and creating new opportunities for enterprise.
A sector long regarded primarily as a consumer of public expenditure is becoming a productive sector capable of generating investment, innovation, industrial growth and skilled employment.
That wider economic significance has received far less attention than it deserves. Yet it may ultimately prove to be one of the administration’s most consequential achievements.
The Reform That Changed the Market
The changes across Nigeria’s health sector are the product of a reform programme designed not simply to improve individual initiatives, but to reorganise the sector itself.
That process began on 12 December 2023, when President Bola Ahmed Tinubu launched the Nigeria Health Sector Renewal Investment Initiative (NHSRII) under the Renewed Hope Agenda and secured the endorsement of the Health Renewal Compact by the Federal Government, the thirty-six states and the Federal Capital Territory, together with development partners. Implemented through the Sector-Wide Approach (SWAp), the initiative replaced fragmented interventions with a common plan, shared priorities, coordinated execution and a stronger framework for accountability. Under the leadership of the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, that framework has been pursued with sustained discipline and consistency, translating presidential direction into coordinated action across the health sector.
The significance of that reform extended well beyond governance. Markets become investable when demand is organised, financing is predictable and institutions inspire confidence. Fragmented systems rarely create those conditions. Coherent systems do.
The effects are already evident. Since 2023, more than six million Nigerians have entered organised health insurance, expanding the market for healthcare services and essential commodities. More than 4,100 primary healthcare centres are under revitalisation, with over 3,100 already completed, while reforms to the Basic Healthcare Provision Fund are making frontline financing more reliable. Investments in the health workforce and specialist care are expanding the system’s capacity as utilisation of essential health services continues to rise.
Taken together, these reforms are creating something larger than a better organised health system. They are creating a health economy that is larger, more predictable and increasingly attractive to long-term investment. That transformation provides the foundation upon which the wider economic consequences of the reforms are beginning to unfold.
Capital Follows Confidence
Markets expand as demand grows. They attract investment when confidence grows with it.
That is precisely what is now happening in Nigeria’s health sector. For decades, unmet healthcare needs alone were insufficient to attract sustained investment because demand was fragmented, financing uncertain and long-term production commercially risky. The reforms are changing those fundamentals by creating a larger, more organised and more predictable market.
The Presidential Initiative to Unlock the Healthcare Value Chain (PVAC) has become the principal instrument for translating that confidence into investment. Together with the Presidential Executive Order on local manufacturing and related reforms to procurement, regulation and market shaping, it has lowered many of the structural barriers that once discouraged long-term investment while signalling a growing recognition that healthcare is not only a social sector but also a productive sector of the economy.
The response has been substantial. More than ninety investment projects, representing a pipeline valued at over US$5 billion, are under development across pharmaceuticals, vaccines, diagnostics, medical oxygen, medical devices and related industries. Afreximbank’s US$1 billion financing platform, alongside additional financing involving the European Investment Bank, the Bank of Industry and other partners, is widening access to long-term capital, while collaboration between Nigerian and international manufacturers are expanding domestic production, accelerating technology transfer and strengthening industrial capability.
The significance of these developments extends beyond the value of the investments announced. They demonstrate that investors respond where policy is credible, institutions are strengthening and markets offer the prospect of sustained growth. The growing flow of capital into Nigeria’s health sector therefore reflects confidence not only in individual projects, but in the direction and durability of the reform programme itself.
That confidence is already beginning to influence the wider economy. New investment is strengthening manufacturing, expanding domestic supply chains, supporting research, encouraging innovation and creating opportunities for Nigerian enterprise. A sector once regarded largely as a destination for public expenditure is steadily becoming a platform for productive investment, industrial expansion and long-term economic growth.
Making More at Home
Every economy reaches a point at which it must decide whether to remain principally a consumer of other countries’ production or become a producer in its own right. For many years, Nigeria’s health sector belonged firmly in the former category. Medicines, vaccines, diagnostics, medical devices and other essential health commodities were largely imported, leaving the country exposed to external supply disruptions while much of the economic value created by domestic demand accrued elsewhere.
The current reforms are beginning to change that equation.
The ambition extends beyond producing more medicines locally. It is to build an integrated healthcare manufacturing ecosystem capable of serving a growing domestic market while positioning Nigerian firms to compete across regional and global value chains. The Presidential Executive Order on local manufacturing, market-shaping interventions, pooled procurement through Medipool and strategic partnerships with Nigerian and international manufacturers are all directed towards that objective
The results are already evident. Investment is expanding pharmaceutical manufacturing, oxygen production, diagnostics, rapid diagnostic tests, treated bed nets and medical technologies. Companies that once viewed Nigeria primarily as a destination for imported products are increasingly investing in local production, assembly and technology partnerships, while established manufacturers are expanding operations in response to a market whose long-term direction has become clearer.
The implications extend well beyond the factory floor. Every additional stage of production retained within Nigeria strengthens domestic value chains, supports local enterprise, creates skilled employment and retains more economic value within the national economy. It also strengthens the productive base by reinforcing the network of suppliers, technical services, logistics, quality systems and specialised skills upon which competitive manufacturing depends.
This is ultimately about more than import substitution. A stronger manufacturing base, more capable regulatory institutions, expanding clinical research and a growing pool of skilled professionals are positioning Nigeria to participate more competitively in regional and global value chains. The opportunity is not simply to produce more for domestic consumption, but to build industries capable of supplying wider markets while contributing to Africa’s growing role in the development, manufacture and distribution of health products.
Seen in that light, the reforms are strengthening more than the health sector. They are reinforcing Nigeria’s industrial base and creating conditions in which healthcare can become an increasingly important driver of manufacturing, innovation, investment and long-term economic growth.
Human Capital as Economic Capital
No industry outperforms the quality of the people who sustain it. Manufacturing depends on skilled technicians and engineers. Research depends on scientists. Strong health systems depend on doctors, nurses, pharmacists, laboratory scientists and thousands of other professionals whose knowledge determines the quality of care, the pace of innovation and the competitiveness of the industries that depend upon them.
Investment in health workers is therefore more than a social obligation. It is an investment in productive capacity.
That understanding has become one of the defining features of the current reforms. Alongside investments in infrastructure, manufacturing and service delivery, equal emphasis has been placed on expanding Nigeria’s human resources for health. More than 78,000 frontline health workers have already been retrained, with a target of 120,000. Recruitment has expanded across federal tertiary health institutions, while the National Health Fellowship is preparing a new generation of public sector leaders drawn from all 774 local government areas.
The same long-term thinking is evident in the approach to health workforce mobility. Rather than treating international migration solely as a retention challenge, the reforms recognise it as a structural feature of an increasingly interconnected labour market. The policy response has therefore focused on expanding the pipeline of skilled professionals, improving working conditions, strengthening career pathways and promoting ethical international recruitment.
The economic implications extend well beyond healthcare. A larger and better-trained workforce strengthens productivity, supports scientific research, reinforces domestic manufacturing and expands the technical capabilities upon which higher-value industries depend. It also strengthens Nigeria’s ability to participate more competitively in regional and global markets for health services, research and innovation.
Viewed in that light, investment in health workers is simultaneously an investment in healthcare, education, industrial capability and long-term economic growth. Human capital is not simply an outcome of development. It is one of the principal means by which development is achieved.
Building Capability for the Long Term
Industrial development ultimately depends on more than investment. It depends on the capabilities that allow an economy to design, test, regulate, manufacture and continuously improve what it produces. Countries that lead in healthcare do so not simply because they manufacture more products, but because they have built the scientific, regulatory and institutional capacity that sustains innovation over time.
That is where the reforms are now placing greater emphasis.
Domestic manufacturing alone is not enough. Equal emphasis has been placed on strengthening the scientific, regulatory and institutional capabilities that underpin a competitive health industry. Clinical trial capacity is expanding, positioning Nigeria to play a larger role in the development and evaluation of new medicines, vaccines and medical technologies. Investments in genomics are strengthening disease surveillance, while broadening the country’s scientific capabilities. At the same time, regulatory reforms are reinforcing confidence in the quality, safety and integrity of Nigerian health products.
The reforms are also strengthening collaboration among universities, research institutions, industry and government. Those partnerships shorten the distance between scientific discovery and commercial application, encourage technology transfer and expand the innovation ecosystem upon which advanced manufacturing increasingly depends. The objective is not merely to adopt technologies developed elsewhere, but steadily to build the capacity to generate, adapt and commercialise knowledge within Nigeria.
These investments will yield their greatest returns over time. As manufacturing expands, the countries that capture the greatest economic value will be those able to innovate, meet international standards and compete in higher-value segments of global production. The capabilities now being built are therefore investments not only in today’s health sector, but in Nigeria’s future competitiveness.
For that reason, the reforms are creating assets whose significance extends well beyond healthcare. Stronger institutions, better science and more effective regulation will increasingly shape Nigeria’s ability to compete in knowledge-intensive industries, deepen industrialisation and sustain long-term economic growth.
Conclusion
Healthcare reforms will always be judged first by their impact on people’s lives. Better access to care, stronger primary healthcare, lower maternal and child mortality, improved financial protection and greater public confidence remain the standards against which any health system should ultimately be assessed.
The experience of the past three years suggests, however, that reforms on this scale can achieve more than better health outcomes. By creating a more coherent health system, attracting investment, expanding domestic manufacturing, strengthening human capital and building scientific and institutional capability, they are also contributing to the foundations of long-term economic growth.
That is an important lesson for a country pursuing the ambition of building a one-trillion-dollar economy. Economic transformation depends not only on sound macroeconomic management, but also on the strength of the productive sectors that underpin it. Increasingly, healthcare is demonstrating that it can be one of those sectors.
That may prove to be one of the least anticipated consequences of President Bola Ahmed Tinubu’s healthcare reforms. Conceived to improve the health of Nigerians, they are also beginning to reshape the productive capacity of the economy itself. Those are the collateral consequences of reform—and they deserve to be recognised as part of its enduring legacy.
Okey Akpa, PhD, is the Managing Director of SKG Pharma, a leading pharmaceutical research and manufacturing company in sub-Saharan Africa. He is also the former Chairman of the Pharmaceutical Group of Manufacturers’ Association of Nigeria and the current President of West African Pharmaceutical Manufacturers Association (WAPMA). He is based in Lagos.