Internal displacement has become an unlikely source of rapid urbanization. Specifically, as people affected by violent conflict in rural areas flee to seek refuge, they are finding cities to be an attractive destination. In Nigeria, violent conflict that leads to displacement mainly occurs in rural areas and locations where the reach of government and its institutions are limited—the seemingly ungoverned spaces enabling perpetrators of violence to operate. Cities, on the other hand, have more government presence and are able to be more resilient to sustained insurgent activities that lead to mass displacement.

Adequate health financing is a critical element of any strong healthcare system.  In Sub-Saharan Africa, financing and payment models for primary, secondary, and tertiary health care can be significant tools for improving issues of access, quality, and equity in care delivery.  While much effort is made to understand the financing approaches that may be optimal for health systems at large, little is known about financing mechanisms that may work best considering the dominance of out-of-pocket payment and, more importantly, the impact that unexpected, informal costs for care may have on health-seeking behaviour.  The abolition of user fees for public health facilities has become increasingly popular in many low-income countries, with results from numerous studies noting an increase in access and utilization for the poorest populations.  However, abolishing user fees often does not remove the cost of many goods and services related to a care episode.  Though some patients may pay no initial fees for a basic service such as an initial consultation, there are often treatment-related costs that are unknown to the patient.

Even with health insurance or under “free” social schemes, evidence suggests that many patients in Nigeria’s public health facilities still pay a significant amount of care-related costs.  The discrepancy between the expected free cost of care at public facilities and the actual cost of treatment often means that poorer patients pay as they are able to gather funds.  Abolition of user fees and fee exemptions may not effectively protect access to health services among the poor.  The majority of fee removal and exemption mechanisms have not meant an end to the existence of informal fees and other care-related costs. A better understanding is needed of the existence of fee removal mechanisms, whether they are able to increase access for the poor, or if other supplemental mechanisms may be necessary.

Quality education is a key enabler for sustainable growth and development. The 2030 Agenda rightly recognises this with SDG 4. Despite the importance accorded to education, Nigeria’s educational performance is abysmally low in terms of quality and quantity. Poor educational outcomes are illustrated by the existence of more than 10.5 million out-of-school children in 2018, which is the highest number globally (Adekunle, 2018). On the quality side, educational performance is even more worrisome. According to the World Economic Forum (2017), Nigeria ranks 124th out of 137 countries in terms of the quality of primary education.

About the SVSS project

The Southern Voice “State of the SDGs” initiative provides evidence-based analysis and recommendations to improve the delivery of the Sustainable Development Goals (SDGs). As a collaborative initiative, the program compiles a broad range of perspectives that are usually missing from international debates. This report aims to fill an existing knowledge gap. Southern Voice is confident that it will enrich the discussions on the SDGs and level the playfield with new voices from the Global South. This piece was first published here: Southern Voice

Nigeria is Africa’s most populous country, with an estimated population of 190.9 million; it also has the largest economy, estimated at $376 billion in 2017 (World Bank, 2017). The economy hinges critically on the service sector, while oil is relied upon as the main source of foreign earnings. Despite its huge potential, Nigeria has failed to translate its resource endowment and strategic economic and demographic positions into sustained economic development. In fact, the country’s performance is abysmally low with regard to key development indicators. A portion (46 per cent) of its huge population is poor by World Bank definitions, and socioeconomic outcomes remain among the worst globally (World Bank, 2017). Specifically, Nigeria has the highest number of out-of-school children in the world (13 million in 2018), coupled with high rates of infant and maternal mortality (figure 1). Furthermore, the country suffers from inadequate and dilapidated infrastructure across the energy, housing and transport sectors. This is in relation to about $30 billion in budgeted spending for the 2018 fiscal year by the federal government, which reflects the enormous development financing challenges (Federal Ministry of Budget and National Planning, 2018). Despite these poor development indicators, the country has made modest progress in improving revenue streams, with recent developments in sectors other than oil such as the agriculture and mineral sectors.

Tobacco use and control in Nigeria and other African countries have received little attention relative to other regions like Asia and Latin America. This is due to the perceived low smoking prevalence in Africa compared to the more immediate need for interventions against infectious diseases. However, the trends are changing quickly. Economic growth rate in Sub-Saharan Africa (SSA) nearly tripled from an average of 1.7 percent in 80s and 90s to about 4.8 percent in the 2000s and 2010s, with Nigeria growing more than five-fold from 1.2 percent to 6.7 percent within the same period (World Bank, 2018). On a similar trend, albeit of lesser magnitude, is the smoking prevalence in Nigeria which grew from 11.3 percent in 2000 to 17.4 percent in 2015 (World Bank, 2017). A combination of rising incomes, population growth, media-driven social trends, and targeted advertisement by the tobacco industry are the key drivers of the rising prevalence in SSA.