When sickness meets poverty

Illness is a shared human vulnerability, but in Nigeria the experience of sickness is profoundly shaped by social class. Disease does not ask whether a citizen is rich or poor before striking, yet the consequences of falling ill are brutally unequal. For millions of Nigerians, sickness is not merely a health challenge; it is an economic catastrophe, a social dislocation, and sometimes a quiet death sentence.

The intersection where ill-health meets poverty has become one of the most enduring, yet least confronted, injustices in the Nigerian state. I say this because, beyond the videos that I have watched of such scenarios, I recently witnessed one firsthand through the ailment of a niece. This niece, who is about forty years old, had never saved up to one million naira in her life before she recently fell ill. She visited the local general hospital accessible to her for treatment, but her condition degenerated there to the extent that she was placed on oxygen to breathe.

Within a short period, she slumped into a coma and was ultimately transferred to the state general hospital, where she encountered constraints of space, coupled with Doctors’ strike and was consequently rerouted to a private facility within the same hospital complex. The immediate family was requested to deposit, without delay, the sum of two million, five hundred thousand naira, which they borrowed to pay. Forty-eight hours later, a further deposit was demanded, and by the fourth day, over seven million naira was said to have been incurred and required to be paid before further treatment could continue.

It bears repeating that the patient had never, in her entire lifetime, seen one million naira before this illness. Herein lies the quagmire of how to fund a mounting medical bill of such magnitude. This experience birthed the conversation I am now engaging in. The truth is that hundreds of patients fall into this category daily, without rescue from any quarter. These are avoidable deaths. Nigeria’s health crisis is often discussed in abstract terms, mortality rates, budgetary allocations, doctor-to-patient ratios, but behind these figures lie human stories of avoidable suffering and deaths. The poor Nigerian encounters sickness with fear not only because of pain or uncertainty, but because illness threatens total collapse. A single diagnosis can wipe out years of fragile economic progress.

A hospital admission can turn a self-sufficient household into dependents overnight. In this sense, sickness in Nigeria does not simply reflect inequality; it deepens and reproduces it. Central to this tragedy is the structure of healthcare financing in the country. Out-of-pocket expenditure remains the dominant mode of payment for health services. This means that access to care is determined at the hospital gate by the contents of a patient’s pocket.

Where health insurance exists, its reach is narrow and its protective value often limited. Large sections of the population, especially those in the informal sector, which constitutes the majority of Nigeria’s workforce, are excluded from meaningful coverage, largely due to the cost of procurement. Even among those enrolled in insurance schemes, benefit packages frequently exclude major ailments, advanced diagnostics, and long-term treatments.

The cruel irony is that insurance often works for minor illnesses but collapses precisely when the illness becomes serious. The further contradiction is that due to the wretched state of these people, they are exposed to the harsh conditions of life, thus pushing them into the realm of the major ailments. The result is a cycle of delayed care and catastrophic expenditure.

Many Nigerians postpone seeking medical attention until symptoms become unbearable, not because they underestimate their conditions, but because they cannot afford consultation fees, laboratory tests, or prescribed drugs. By the time care is finally sought, conditions that were once manageable have progressed into emergencies. This delay increases mortality, raises treatment costs, and overwhelms already strained facilities. Poverty thus converts treatable illnesses into fatal outcomes.

Public healthcare institutions, which should serve as buffers against inequality, are themselves victims of systemic neglect. Chronic underfunding has left many public hospitals without basic equipment, essential drugs, or functional diagnostic tools. Health workers operate under immense pressure, with inadequate remuneration and infrastructure.

That explains the recurrent health sector strikes, just as the ongoing one that further forced the victim alluded to above into unaffordable private facility. Patients are routinely asked to procure consumables, drugs, and even basic medical supplies from private vendors. In effect, the cost burden is transferred back to the patient, eroding the very purpose of public healthcare. For the poor, this often results in abandonment midway through treatment or discharge against medical advice.

Geography further entrenches inequality. Urban centers attract specialists, tertiary hospitals, and private clinics, while rural and peri-urban communities are left with skeletal primary healthcare facilities. These facilities, where they exist at all, are often understaffed, poorly equipped, and irregularly funded.

Rural dwellers must travel long distances for secondary or tertiary care, incurring transportation costs that can exceed the cost of treatment itself. In emergencies, such delays are fatal. The Nigerian poor thus suffer a spatial injustice: they are sick where care is scarce, and poor, where care is expensive.

The growing burden of non-communicable diseases has intensified this crisis. Hypertension, diabetes, stroke, cancer, kidney failure, and heart disease are no longer ailments of affluence alone. They cut across social classes, but survival outcomes differ starkly. These conditions require early detection, consistent monitoring, and sustained treatment, elements that are largely inaccessible to the poor.

Dialysis sessions, chemotherapy cycles, insulin therapy, and cardiac interventions are priced far beyond the reach of average households. Many families exhaust their savings within weeks, only to confront the unbearable choice between continuing treatment and preserving what remains of their livelihood. Women and children are disproportionately affected by this intersection of sickness and poverty. Maternal mortality remains unacceptably high, often linked to lack of antenatal care, delayed referrals, and inability to afford emergency obstetric services.

Pregnant women in poor households frequently deliver at home or in ill-equipped facilities, not out of cultural preference but economic compulsion. Children from poor families die from malaria, pneumonia, diarrhea, and malnutrition, conditions that are easily preventable and treatable. Each death is not just a personal tragedy, but an indictment of a system that has normalized preventable losses among the poor. The elderly face their own silent crisis as I earlier diagnosed in my earlier intervention on the subject. Without comprehensive pensions or social protection, many older Nigerians confront illness with dignity but little support. Chronic ailments accumulate with age, yet incomes decline.

Medical care becomes a burden shifted onto younger relatives who are themselves struggling. In such households, illness accelerates impoverishment across generations, reinforcing cycles of dependency and deprivation. Beyond the human cost, the economic implications of this health inequality are profound. A sick population is a less productive population and a liability unto a nation’s development.

Households pushed into poverty by medical bills reduce consumption, withdraw children from school, and abandon productive ventures. At the national level, every preventable illness drains human capital, increases dependency ratios, and undermines economic growth. Healthcare inequality, therefore, is not only a moral failure; it is an economic liability. Nigeria’s policy response, while evolving, remains inadequate to the scale of the challenge.

Legal frameworks for health insurance and universal coverage are important milestones, but implementation gaps persist. Coverage remains shallow, financing insufficient, and enforcement weak. States vary widely in commitment and capacity, creating a patchwork of protection in which a citizen’s health security depends largely on place of residence. The rationale of which I believe compelled the legislators to now direct the deduction of health insurance cost by employers from the employees’ salaries.

The absence of robust subsidies for the poorest households means that those most in need of protection remain the least protected. A genuine response to this crisis must go beyond expanding insurance enrolment in name. It requires deep public investment in healthcare as a social good, not a market commodity. Risk pooling must be strengthened so that serious illness does not translate into financial ruin.

Benefit packages must reflect the real disease burden of the population, including catastrophic and chronic conditions. Primary healthcare must be revitalized as the foundation of the system, capable of prevention, early detection, and referral. Special intervention mechanisms are needed for high-cost illnesses, ensuring that no Nigerian is condemned to death simply because treatment is expensive. This could take the form of a special pooled fund or a critical-needs health insurance scheme for the most vulnerable. Crucially, health reform must be integrated with broader social policies. Poverty, unemployment, poor housing, unsafe water, environmental degradation, and food insecurity all shape health outcomes.

Addressing sickness without addressing these determinants is an exercise in futility. A holistic approach, linking health, social welfare, education, and economic policy, is essential if inequality is to be meaningfully reduced. At its core, the question confronting Nigeria is ethical as much as it is technical. What does citizenship mean in a society where survival during illness is determined by income? What value is placed on human life when access to care is rationed by ability to pay? A nation’s moral compass is revealed in how it treats its most vulnerable, especially when they are weak, sick, and unable to advocate for themselves. When sickness meets poverty in Nigeria, the outcome should not be despair, exclusion, or premature death. It should be solidarity, protection, and care. Until the country confronts this cruel intersection with honesty, compassion, and sustained action, ill-health will remain both a symptom and a driver of inequality. In tolerating this reality, the nation risks normalizing suffering that should never be acceptable in a society that aspires to justice, dignity, and shared progress.