Dr Tosin Oshinubi oversees Salient’s Advisory and Partnership Teams, where he works with governments, life sciences companies, donors and global health agencies to drive transformations in health systems across Africa with a focus on technology. In this interview with SADE OGUNTOLA, he speaks to the unsustainable aid-driven models for health and their inefficiency and the changes required in Nigeria’s health sector to support universal health coverage for all. Excerpts:
What are the challenges we are likely to face with aid-driven models for funding healthcare in Nigeria? Do you think it is sustainable?
Conversations about aid-driven models are especially important for Nigeria’s public health sector, given the global shifts we’re seeing in development assistance. These models came about because many governments, including Nigeria’s, have struggled to meet the full budget needs for healthcare. Over the years, aid has served as a lifeline, helping to sustain critical programmes for HIV, malaria, family planning, and tuberculosis. Unfortunately, whenever domestic funding falls short, the result is often seen in rising illness and death rates.
In the short term, aid has been a lifeline. But in the long term, it’s actually inefficient and unable to build that long-term systemic capacity that we require for true health resilience. So, the challenge has been overdependence on aid. That is why when there’s a policy or political change or an economic downturn in those particular countries, it immediately impacts us here in Nigeria.
As long as we continue to depend on aid from foreign donors, including countries like the United States, we will never truly develop our own funding mechanisms. It will not allow for creative thinking on how to build our health financing mechanism. It’s also not going to incentivise the government to put the needed amounts of funding in the health budget. According to the Abuja Declaration by African Union member states, countries committed to allocating at least 15 per cent of their national budgets to the health sector.
Moreover, there’s misalignment between the programmes of these donors and our own national health priorities. This often results in vertical programmes that are not coherent with the national health strategy. The honest truth is that running vertical programmes makes things more expensive and unsustainable.
In 2023, Nigeria launched a Sector Wide Approach (SWAp), and this was designed to align donors’ funding with country priorities by pulling funding to a locally set agenda. This is also to ensure that Nigeria drives things. We’ve started this, but it still needs to be strengthened.
How do you see Nigeria best directing the additional $200 million it allocated to address funding shortfalls in malaria, HIV and vaccine deliveries to create long-term sustainable impact?
The truth is that this fund isn’t going to meet or fill the void left by the US government aid, but it’s a step in the right direction. What I believe Nigeria can do is also quickly use it to catalyse a number of initiatives that will push us further in the right direction. For example, we’ve never been able to get it right with our health financing mechanism. We can use a portion of this fund to strengthen social health insurance and ensure that we have effective and transparent implementation of the Basic Healthcare Provision Fund (BHCPF). In Nigeria, the bulk of healthcare spent has been out of pocket, and this has actually driven many into poverty. But with social health insurance, like we see in countries like Rwanda and other countries, we’ll be able to cushion this.
The second one is digitising our health systems and service delivery. This will help leapfrog the challenges that we have. We recently visited Enugu State to understand how they have been able to digitise a sizable number of their primary health care facilities, leveraging the Elephant Operating System (ElephantOS). The system is helping them track and connect data on supply chains, service delivery, and financing all in one place. One of the things we saw in Enugu was that because they had digitized, they were able to identify which drugs were about to expire and prioritize using those first. They were also able to minimise stockoutsacross those digitised facilities. Additionally, with digitised primary health care facilities, patients can move from one centre to another while maintaining continuity of care. They no longer need to start afresh or repeat previous tests, as doctors can easily access their medical history through the digital system. They can also predict disease outbreaks, monitor drug stock levels, and manage health worker deployment more efficiently because they can see all those things in real time. So digitisation is key.
One of the biggest issues we’re having with this cutting of aid to Nigeria is that we’re experiencing stockoutsof essential drugs and medical supplies in some programmes. A significant portion of the donor aid in many countries, including Nigeria, goes into the procurement of drugs and medical supplies. So, more of this funding should also go into strengthening the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC), which the federal government set up 2 years ago to help catalyse local manufacturing of drugs and medical supplies.
Foreign aid has historically supported access to essential medicines but has often limited the growth of local pharmaceutical manufacturing, as it frequently came with imported supplies that were cheaper than locally produced ones. While this improved access in the short term, it also weakened local capacity. Today, however, this experience presents an opportunity to strengthen our local supply chains, build manufacturing resilience, and better withstand external shocks like those experienced during COVID-19.
Additionally, last year, Nigeria established MediPool to aggregate the purchase of healthcare supplies on behalf of the government and various programmes. This is a step in the right direction, but it can be further strengthened by linking it to global procurement platforms to ensure access to quality-assured and pre-negotiated healthcare products.
Another critical area for investment is primary health care infrastructure and the frontline workforce, particularly community health extension workers (CHEWs). Nigeria has a much larger pool of CHEWs compared to doctors, nurses, and pharmacists, making them a practical foundation for expanding access. It’s easier and faster to train CHEWs and equip them with digital tools that enable them to deliver essential primary health care services. With the right support, they can bridge critical gaps and ensure communities receive consistent, quality primary health care.
Can all these work given the emigration of health workers, power outages and insecurity problems in Nigeria?
These are perennial issues in the health sector. Brain drain is a symptom of a deeper problem, some of which are poor working conditions, inadequate remuneration and inadequate professional development opportunities. So, how can we help the healthcare workers we already have in Nigeria become more efficient? One way is through the adoption of technologies that make their work faster and easier. For instance, medical transcription tools that reduce the time spent documenting patient cases, AI-powered clinical decision support systems that speed up diagnosis, and telehealth services that expand access to care.
The power challenge isn’t unique to the healthcare sector. It’s something we see across the board. But one practical way forward is to deploy off-grid solar solutions to ensure our health facilities have reliable power. I understand that a committee within the Federal Ministry of Health is already working on this issue, which is encouraging. I often reference Enugu State because of the progress they’ve made in digitising their health system. The truth is, if you digitise without stable power or internet connectivity, you won’t get far. What we’ve seen in Enugu is that they’ve put several alternatives in place, including installing solar panels at some of their facilities. Running generators on petrol or diesel is simply too expensive to sustain. This is also where stronger collaboration with the private sector becomes critical. Some companies can step in and support this as part of their Environmental, Social, and Governance (ESG) Initiatives, helping to power healthcare, quite literally.
There’s no doubt that this $200 million alone cannot solve the challenge of achieving universal health coverage. Universal health coverage is a journey, not just for Nigeria, but for every nation striving to build equitable and resilient health systems. It is a long-term goal that requires sustained and strategic investment, not just a one-off cash injection. So this amount they’re bringing in is a catalyst; it is a step in the right direction, but we need to do more. The government needs to increase its budget for healthcare.
With the hindsight of your work at Salient Advisory, which you represent to create awareness on African-led solutions that can strengthen healthcare systems, how do you see AI coming in to transform our health systems?
AI is revolutionising every sector, not just the healthcare sector. However, AI is a tool to solve problems. It’s not a goal in itself. We can deploy AI when we understand the problems. AI has been transforming what we do in healthcare, including transcription for clinicians and predictive disease surveillance. It is able to analyse a vast amount of data from hospitals and everywhere to quickly predict and detect disease outbreaks even before they become large-scale.
AI can also help to improve diagnostics, providing clinical decision support. For example, there are AI-powered diagnostic tools that can analyze CT scans to determine the type of stroke a patient has had and identify its location. AI enhances supply chain management through advanced analytics and accurate demand forecasting. It improves inventory management, optimizes procurement and distribution, and helps prevent stock-outs and wastage, thereby making supply chains more efficient and resilient.
Going forward, how best can individuals and the government tap into technology to cope with the trying times ahead in the health sector?
The government needs to continue its efforts to digitise our public health institutions. Digitisation brings greater transparency, reduces inefficiencies, and improves visibility across the supply chain. It also provides reliable data for better decision-making and planning within the health system.
However, one of the biggest challenges we face today is fragmentation. Across the country, we’re seeing different states at various stages of digitisation, some at the primary healthcare level, others at secondary facilities, but the systems don’t speak to each other. Most national reporting still goes through the District Health Information Software (DHIS2), and much of that is still done manually because the state-level systems aren’t integrated. They’re also not connected to the National Health Logistics Management Information System (NHLMIS).
This lack of integration means that while progress is being made, the full benefits of digitisation are yet to be realised. We can’t see what’s happening in real time across facilities, which limits our ability to plan, allocate resources, and respond effectively.
To solve this, Nigeria is working on establishing a Health Information Exchange (HIE), a system that would allow health data to flow seamlessly between platforms, facilities, and institutions. And if we get this right, it could be as transformative as what happened in our banking sector.
Think back to how banking used to be in Nigeria. Everything was paper-based. Banks began digitising one by one, but transferring money between them was still a challenge. That changed when the Central Bank of Nigeria (CBN) and the Bankers’ Committee came together to establish the Nigeria Inter-Bank Settlement System (NIBSS). With the launch of the NIBSS Instant Payment (NIP) platform, Nigerians could suddenly transfer funds across banks and receive payments in real time. It completely revolutionised efficiency and trust in the financial system.
That’s exactly what a Health Information Exchange can do for healthcare. Once all our systems, DHIS2, NHLMIS, and the various state platforms, are interconnected, we’ll be able to track services, monitor supply chains, and access patient data in real time. It will make our health system far more efficient, transparent, and responsive, just as NIBSS did for the banking industry.
Of course, we recognise that the health sector is far more complex than banking, with many more players, data points, and sensitivities. But the principle of integration and interoperability is what we should learn from. If we can apply that same level of coordination and trust to healthcare, the results will be truly transformative.
Another big point for me is that the government really needs to embrace innovation more intentionally and work hand in hand with those driving it, especially our health tech innovators and startups.
Take Figorr, for example. It’s a Nigerian health tech company that has built an incredible solution to monitor the potency and safety of vaccines. The system sends alerts whenever there’s a break in the cold chain, helping to prevent vaccine spoilage and ensuring people get effective doses. Figorr is also partnering with the Nigerian government, through the National Primary Health Care Development Agency, to strengthen vaccine monitoring and distribution across the country.
But collaboration isn’t a one-way street. Health tech startups also have to think differently about how they work with the government. They need to design with government priorities in mind, engage early, and show measurable value. And their solutions have to fit seamlessly into existing health systems, not operate in isolation. Most importantly, innovators must recognise that the era of big aid is over. The future is about designing for what the government, the local market, and patients can actually pay for. Sustainability isn’t optional; it has to be built into the model from day one.
And it’s not just about the government and startups. Individuals also have a role to play. We all need to embrace technology more in our daily health decisions. Today, there are mobile apps that let you track your health, consult a doctor remotely, or even order your medication from licensed pharmacies. These tools put more power in people’s hands and make healthcare more personal and accessible.
At Salient Advisory, we believe that technology is the key to progress. Yes, Africa may lag behind developed regions in infrastructure, but we also have a unique opportunity to leapfrog through innovation. That’s exactly why we launched the Investing in Innovation Africa (i3) programme.
The i3 programme supports health-tech innovators across Africa and is delivered in collaboration with leading global and regional partners. It is coordinated by Salient Advisory alongside the Solina Centre for International Development and Research (SCIDaR), reflecting a deliberate effort to anchor the programme within Africa’s innovation ecosystems.
Through i3, innovators receive more than just funding. They get connected with investors, funders and strategic partners; they gain capacity through access to expert mentors; they receive risk-tolerant capital to help them scale; and they build credibility by getting visibility on global stages from international conferences to major media platforms.
When we invest in innovation and build stronger collaboration between the public sector, private players, and individuals, we move closer to a health system that truly works, one that is inclusive, efficient, and sustainable for the future.