Nigeria’s healthcare system faces a fundamental challenge: millions of Nigerians still struggle to access affordable, quality healthcare, while the country’s public health infrastructure remains unevenly distributed and heavily dependent on out-of-pocket payments. In contrast, Brazil has built one of the world’s largest universal public healthcare systems through the Sistema Único de Saúde (SUS).
Nigeria does not currently have a single, universal public healthcare system equivalent to Brazil’s SUS. Instead, healthcare is delivered through a fragmented combination of federal, state and local government facilities, private hospitals and clinics, health insurance, community-based initiatives and traditional healthcare providers. The National Health Insurance Authority (NHIA) has sought to expand health coverage, but achieving universal access remains a major challenge, particularly among people working in the informal economy.
Brazil’s experience therefore offers Nigeria an important opportunity for reflection. Nigeria does not have to copy the SUS exactly, because the two countries have different political structures, economies, populations and historical experiences. However, Nigeria can learn from the principles that made universal healthcare possible in Brazil: healthcare as a right, strong primary healthcare, public financing, decentralization, community participation and coordinated national planning.
One of the most important lessons from Brazil is the decision to constitutionally recognize health as a fundamental right. Brazil’s 1988 Constitution established the principle that health is a right of everyone and a duty of the State. This created the foundation for the SUS and transformed healthcare from something primarily dependent on individual financial capacity into a public responsibility.
The significance of this principle cannot be underestimated. A person should not have to decide whether to buy food, pay school fees or seek medical treatment. A mother should not lose her life during childbirth because her family cannot afford a hospital bill. A child should not be denied vaccination because his parents cannot pay. An elderly person should not be forced to abandon treatment because the cost of medication is beyond the family’s income.
This is the philosophy that makes universal healthcare fundamentally different from a system based primarily on individual payment. Nigeria could begin a similar transformation by strengthening the principle that access to essential healthcare is a responsibility shared by the State and society.
The Sistema Único de Saúde is Brazil’s publicly funded healthcare system. It provides services ranging from basic primary healthcare and vaccination to emergency treatment, surgery, cancer care, maternal healthcare, mental-health services, epidemiological surveillance and highly specialized procedures.
Its philosophy is based on three important principles: universality, integrality and equity, supported by decentralized management and social participation. Universality means that healthcare is intended for everyone. Integrality means that healthcare should not be limited to treating diseases after they become serious. It should include prevention, diagnosis, treatment, rehabilitation and health promotion. Equity recognizes that different populations have different needs. A remote rural community may require a different strategy from a major urban center.
This framework provides Nigeria with an important conceptual lesson: a national healthcare system should not merely be a collection of hospitals. It should be an integrated public health network.
One of Brazil’s most important experiences is its emphasis on primary healthcare, particularly through the Family Health Strategy. Rather than expecting citizens to travel long distances to major hospitals, multidisciplinary healthcare teams work within communities, focusing on prevention, vaccination, maternal and child health, chronic diseases and early diagnosis.
Nigeria has thousands of primary healthcare facilities, but many communities continue to experience shortages of doctors, nurses, medicines, equipment, electricity, water and other essential resources. The solution is therefore not simply to construct more buildings. Nigeria needs to make existing primary healthcare centres functional.
Every community should have access to a reliable first point of contact with the healthcare system. Community health workers, nurses, midwives, doctors and other professionals should be properly trained, paid and equipped. A functioning primary healthcare system can prevent many illnesses from becoming emergencies and can reduce the pressure on expensive tertiary hospitals.
Nigeria’s healthcare inequality is also geographical. Major cities such as Lagos, Abuja, Ibadan, Port Harcourt and Kano have substantially greater access to hospitals and medical professionals than many rural communities.
Brazil has also faced enormous geographical inequalities, but its SUS demonstrates how a national system can organize services across a vast territory. Nigeria could develop a stronger community-based healthcare model in which healthcare workers are assigned to specific populations and communities rather than being concentrated almost entirely in major urban hospitals.
Mobile clinics, community health workers, maternal-health teams, vaccination campaigns and telemedicine could complement permanent primary healthcare centres. The objective should be simple: wherever a Nigerian lives, there should be a basic level of healthcare available within reasonable reach.
Brazil’s SUS operates through cooperation among the federal government, states and municipalities. Local governments play a significant role in delivering healthcare services, while national and state institutions provide coordination, standards and financing. Nigeria already has a three-tier government structure: federal, state and local. The problem is not necessarily the absence of administrative levels. The problem is coordination, financing, accountability and implementation.
Nigeria could learn from Brazil by giving Local Government Areas greater responsibility and predictable resources for primary healthcare while establishing clear national standards. Local authorities understand their communities better. They know where maternal deaths are occurring, where malaria is prevalent, where clean water is lacking and where healthcare workers are absent.
But decentralization must come with accountability. Money allocated for healthcare must reach the facilities for which it was intended. Procurement must be transparent, health workers must be paid, and communities must be able to monitor the services they receive. Perhaps the most important economic lesson is the need to reduce dependence on direct payment by patients. When healthcare is primarily financed at the point of service, poor families are disproportionately affected. A medical emergency can rapidly become a financial emergency.
Nigeria’s health insurance system can play an important role in addressing this problem, particularly through the NHIA. But universal coverage cannot depend exclusively on formal employment or insurance contributions, especially in a country with a huge informal economy.
Brazil demonstrates another approach: pooling public resources through taxation and government budgets to finance universal healthcare. Nigeria could gradually develop a broader public financing model in which federal, state and local resources are pooled more effectively for essential healthcare. The objective should not necessarily be to eliminate private healthcare. Private hospitals and insurance can continue to exist. The objective should be to ensure that being poor does not mean being excluded from essential healthcare.
A Brazilian-style public system would not necessarily mean that Nigeria must abolish private hospitals. Brazil itself has a substantial private healthcare sector. The important distinction is that private healthcare should complement—not replace—the public responsibility to provide essential healthcare.
Those who can afford private insurance or private hospitals may continue to use them. But a person without money should still have access to essential healthcare through the public system. This creates a two-level choice: private healthcare can offer additional options, while the public system guarantees a minimum standard of care for everyone. A healthcare system cannot function effectively if patients arrive at clinics and are told that essential medicines are unavailable. Nigeria has repeatedly faced problems involving medicine availability, affordability, supply chains and quality assurance.
Brazil’s SUS demonstrates the importance of coordinated public procurement and distribution of medicines and vaccines. Nigeria could strengthen national and regional procurement mechanisms to purchase essential medicines in large quantities, negotiate better prices and distribute them systematically to public facilities.
This would require strong regulation and transparent procurement. It would also help reduce the burden on individual patients who currently have to purchase medicines from private pharmacies even after visiting public hospitals.
Another important lesson is that healthcare should not be understood simply as treating sick people. Public health begins before illness. Vaccination, sanitation, clean water, nutrition, maternal healthcare, health education, disease surveillance and early diagnosis can prevent enormous human and economic costs.
Nigeria should therefore connect healthcare policy with education, water, sanitation, housing, agriculture and social protection. A child who has access to clean water and adequate nutrition is less likely to suffer preventable disease. A pregnant woman who receives regular prenatal care is more likely to receive timely intervention when complications arise.
Healthcare policy must therefore be broader than hospitals. One of the most valuable aspects of Brazil’s experience is the recognition that healthcare workers must become part of the communities they serve. Nigeria could establish stronger community healthcare teams responsible for defined populations. Such teams could monitor pregnant women, children, elderly people and patients with chronic diseases. They could conduct health education, vaccination campaigns, screening and early diagnosis.
This would transform the relationship between citizens and the healthcare system. Instead of waiting for people to become seriously ill before they enter a hospital, the healthcare system would actively reach into communities.
Perhaps the greatest lesson from Brazil is that universal healthcare is ultimately a political decision. Building the SUS required constitutional recognition, legislation, public financing, institutional reforms and sustained political commitment. Nigeria already possesses many of the institutions necessary to begin such a transformation. What is required is stronger coordination and a long-term national vision.
Healthcare reform cannot depend entirely on the administration in power at a particular moment. It needs to become a national project. Governments change, but citizens remain. A Nigerian healthcare system should therefore be designed around the needs of Nigerians rather than around short political cycles.
Nigeria should not simply copy Brazil. Nigeria has its own realities: more than 250 ethnic groups, hundreds of languages, enormous geographical diversity, a large informal economy, different religious and cultural traditions and significant differences between urban and rural communities. The answer is therefore not to reproduce Brazil’s SUS word for word. Nigeria needs to develop its own model inspired by the strongest principles of the Brazilian experience.
A possible Nigerian universal healthcare system could combine strong and properly funded primary healthcare centres, community-based healthcare teams, universal access to essential healthcare, stronger public financing, reduced out-of-pocket expenditure, better coordination between federal, state and local governments, transparent procurement of medicines and equipment, reliable emergency and maternal healthcare, universal vaccination and disease prevention, digital health and telemedicine, stronger regulation of private healthcare, and community participation and accountability.
Introducing a Nigerian equivalent of SUS would not be easy. Brazil’s SUS itself has challenges, including regional inequalities, funding pressures, shortages of professionals in some areas and waiting times for certain specialized services. Universal healthcare is not a magic solution that eliminates every problem.
But the existence of challenges does not invalidate the principle. The SUS demonstrates that a large, diverse country can organize healthcare around the principle that access to essential medical care should not depend entirely on personal wealth. Nigeria can learn from this experience.The country does not need to choose between public and private healthcare. It needs a strong public foundation upon which both can operate.
The fundamental question should be: What happens to a Nigerian who has no money but becomes seriously ill? A modern nation should have a clear answer. That person should not be abandoned. Nigeria has the human resources, medical professionals, universities, hospitals, pharmaceutical industry and technological capacity to build a stronger healthcare system. What is required is the political will to organize these resources around a coherent national objective.
Brazil’s SUS offers an important lesson: healthcare can be treated not merely as a commodity, but as a public responsibility and a fundamental right. Nigeria could therefore begin a national conversation about creating its own Universal Nigerian Health Service—a system adapted to Nigerian realities but inspired by the principles of universality, equity, prevention, community healthcare and public responsibility.
The goal should be simple and ambitious: whether in Lagos or a remote village in northern Nigeria, whether rich or poor, employed or unemployed, every Nigerian should have access to essential healthcare when they need it. That is not merely a healthcare policy. It is a statement about the kind of country Nigeria wants to become.
