Billionaire philanthropist and Chair of the Bill & Melinda Gates Foundation, Bill Gates, has voiced deep concern over Nigeria’s low investment in healthcare, warning that the nation’s current health budget is insufficient to tackle its growing maternal and child mortality crisis.
Speaking at a media roundtable in Lagos on Wednesday ahead of the Goalkeepers event, the first of its kind to be held in Nigeria, Gates offered a sobering assessment of the country’s health system. He described Nigeria’s health spending as “very, very small” in comparison to the needs on the ground.
“The amount of money Nigeria spends on health care is very, very small,” Gates said. “So, I don’t know why you would have expected that number [maternal mortality] to go down.”
He added that underfunding is a key reason Nigeria continues to rank second globally in maternal and child deaths, trailing only behind India. With over 50,000 Nigerian women dying annually from pregnancy-related causes, the country contributes significantly to global maternal mortality figures.
Gates highlighted the dangers of home births, especially in under-resourced areas such as northern Nigeria. “In northern Nigeria, about half the births are at home, and even in some facilities, C-sections aren’t possible. That means a mother facing delivery complications has limited or no chance of survival.”
He compared Nigeria’s situation to India’s, where significant investments have been made to ensure that deliveries occur in well-equipped health facilities. “What countries like India do is that they drive delivery into centres where they can give C-sections but that takes money,” Gates explained.
Despite Nigeria’s repeated commitments to health reform, its budget allocations continue to fall short of the 15% target agreed to under the Abuja Declaration—an African Union commitment aimed at improving health funding.
In 2024, Nigeria allocated ₦1.23 trillion (5.46%) of its ₦22.65 trillion national budget to health. While this marked a nominal increase from 2023’s ₦1.17 trillion, it represented a dip in percentage terms from the previous year’s 5.8%.
For 2025, the allocation has been raised to ₦2.48 trillion. However, this accounts for just 5.18% of the proposed ₦47.9 trillion national budget—still far below the Abuja benchmark.
These allocations have mainly focused on expanding health insurance coverage and reinforcing primary healthcare services through the Basic Health Care Provision Fund (BHCPF). Yet, Gates stressed that the investments remain far too limited to drive the kind of systemic change needed.
The situation is further complicated by a steep decline in global health funding, particularly from the United States. Following his inauguration, former U.S. President Donald Trump signed an executive order to review and cut foreign aid under the “America First” agenda. The resulting aid freeze has created funding gaps in countries like Nigeria, which depend heavily on donor support for vaccines, maternal care, HIV treatment, and disease surveillance.
According to the United Nations Economic Commission for Africa, one in seven maternal deaths worldwide occurs in Nigeria. A 2023 joint report by WHO, UNICEF, UNFPA, and the World Bank titled Improving Maternal and Newborn Health and Survival placed Nigeria second globally in maternal and child mortality, surpassed only by India.
In 2020, Nigeria recorded roughly 540 maternal and child deaths per 1,000 births underscoring the urgent need for reform. The report pointed to persistent challenges in healthcare delivery, infrastructure, and medical training, particularly in rural and underserved areas.
“There’s no shortcut,” Gates concluded. “You have to build the systems, train the personnel, fund the infrastructure and keep going even when the headlines move on. Lives depend on it.”
