Opinion
How Gov Abba Beats Many African Cities In Health Sector
Published
54 minutes agoon
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<p>By Abba Anwar</p><div class="hYi3LYwY" style="clear:both;float:left;width:100%;margin:0 0 20px 0;"><script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script> 
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<p>In an era when most West African cities still struggle to meet the 15 percent health funding threshold set by the Abuja Declaration of 2001, Kano State under Governor Abba Kabir Yusuf has not only met the target but surpassed it, rewriting the narrative of public health financing in Nigeria and the sub-region. Showing political will and genuine commitment in their purest form.</p>
<p>While official budget briefs show Ghana at 6.32 percent, Côte d&#8217;Ivoire at 5.1 percent, Senegal at less than 4 percent, and even Lagos State, Nigeria&#8217;s economic capital, scrawled at 8 percent, Kano in 2024 and 2025 allocated over 15 percent of its annual budget to health, the highest executive commitment in the history of the state.</p>
<p>That deliberate fiscal decision, under the leadership of a committed Governor is now translating into visible, measurable life-saving results on the ground. From tripling drug availability in public hospitals from 30 percent to over 90 percent in three years and clearing N1.2 billion in inherited pharmaceutical debts, to the simultaneous renovation of over 20 General Hospitals, upgrading of more than 200 Primary Health Centres (PHCs) across 44 local governments, and the enrolment of 300,000 vulnerable citizens into free AbbaCare insurance.</p><div class="tgnZEWco" style="clear:both;float:left;width:100%;margin:0 0 20px 0;"><script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script> 
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<p>This is a clear case of demonstration that political will backed by proper funding can be achieved in three years what many cities have failed to achieve in two decades. This is wowing development</p>
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<p>For clarity in the understanding of this discussion, my reader should know that the Abuja Declaration in Health is a historic commitment made by all African Heads of State and governments.</p>
<p>It was birthed on April 27, 2001, in Abuja, Nigeria, at an African Union Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases. Under this Declaration it was agreed that very African government should allocate at least 15% of its annual government budget to the health sector. A messiah-looking effort to save the health sector.</p>
<p>As a build-up to the Declaration it was observed that Africa had the highest disease burden in the world — HIV/AIDS was killing millions, plus malaria, TB, and high maternal deaths — but most governments were spending only 3-5% on health. The leaders agreed that without money, health systems would collapse. Years after the Declaration, many governments relent. Hence the coming on board of Governor Yusuf of Kano state, whose singular determination, commitment, political will and the effort, place him above many African cities in this all-important sector.</p>
<p>The recommended 15% covers for almost everything health. It looks at hospitals and PHCs, drugs and medical supplies, health worker salaries, immunization and maternal health and health insurance.</p>
<p>To the chagrin of many Kano under Governor Yusuf is praised as it crossed the 15% line in 2024 and 2025, while most countries and cities in West Africa are still at 4% to 10%.</p>
<p>Kano in 2023-2026 boasts of drug availability 30% to over 90% in 3 years and N1.2bn debt cleared. While over 200 PHCs were upgraded and over 20 hospitals were renovated. And 926 workers reinstated on CONHESS, over 250 doctors and over 155 nurses.</p>
<p>But under this benchmark many cities in Africa failed Abuja. Let&#8217;s look at the following cities across our continent :</p>
<p>In ACCRA, Ghana in 2025 the health percentage was 6.32% of total national budget. Which is far below the 15% Abuja target. In 2026 it is 9.6% of total budget, still short of 15%. Under UNICEF Ghana Health Budget Brief it also shows total health at 10.6% including NHIA, MoH alone only 6-8%.</p>
<p>In ABIDJAN, Côte d&#8217;Ivoire it failed the Abuja status badly. It did not comply with the Abuja Declaration in 2023 to 2026. It is still far below 15%. In 2023 it was bout 5% of government budget. WHO AFRO and government dialogue documents state that, &#8220;At around 5% of the national budget, health financing is insufficient&#8221;.</p>
<p>In 2024-2025, that is the current plan, the National Development Plan 2021-2025 itself says health is 5.1% of the state budget. UNICEF CPD repeats same 5.1%. Just one-third of Abuja target.</p>
<p>In comparison with Kano,<br />
Côte d&#8217;Ivoire with 32 million people, richest in West African Economic and Monetary Union (WAEMU), has 5.1%. While Kano under Gov Yusuf a state with over 20 million people has over 15% in 2024 and 2025. Can my reader see the gap?</p>
<p>That is why WHO still lists Côte d&#8217;Ivoire as having some of the lowest health indicators in the region and out-of-pocket spending at 50.81%, while Kano moved to free AbbaCare insurance.</p>
<p>For DAKAR, Senegal, under health financing it also failed Abuja Declaration woefully. From the standpoint of UNICEF assessment it shows Dakar has low public spending on health less than 4 per cent of national budget. In 2024 health budget CFA271.62bn but execution only 62%. In 2026 budget cut by 18.7% due to fiscal pressure.</p>
<p>In LAGOS, Nigeria, the state also failed Abuja status badly. The Commissioner for Health Prof. Akin Abayomi clarifies that the state currently allocates about 8% of its budget to healthcare, far below the 15 percent benchmark. The position repeated in 2026. As Lagos currently spends about 8%, far below 15%.</p>
<p>When you look at other West African cities like Bamako, Ouagadougou, Niamey, and Freetown, they are in the same WHO Global Health Expenditure Database (GHED) bucket as Senegal and Ivory Coast. WHO database shows all UEMOA countries average 5-8% government health expenditure, none hit 15%. That is why UNICEF and WHO keep calling for increased domestic financing.</p>
<p>Every city I listed is documented in official papers as below 15%. Ghana officially 6.32%, Ivory Coast 5.1%, Senegal less than 4%, Lagos 8%. But Kano under Gov Yusuf is the only administration in this comparison that is on record as having CROSSED the 15% Abuja line and used it to deliver drugs, hospitals and free insurance at the same time.</p>
<p>Let&#8217;s see for ourselves. Kano State Health Sector Reforms: A Three-Year Appraisal (2023-2026) shows that between 2023 and 2026, the state undertook a system-wide health reform that moved the sector from near-collapse to measurable recovery. The reform rests on three pillars. These are financing above the Abuja threshold, supply chain restoration, and workforce stabilisation.</p>
<p>Under health financing and governance it is acknowledged that for the first time in its history, Kano State surpassed the 15% budgetary allocation recommended by the 2001 Abuja Declaration. Both 2024 and 2025 health budgets exceeded 15%, placing Kano among the few states in Nigeria to achieve the benchmark. Kudos the people&#8217;s Governor. Leadership by example.</p>
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<p>The 2026 framework consolidates this with N214.8 billion for health repositioning, including N500 million for a Cancer Centre at Giginyu General Hospital, N1.5 billion for statewide free hernia surgery, N473.5 million for Intensive Care Units (ICUs) at Murtala Muhammad Specialist Hospital and Muhammad Abdullahi Wase Teaching Hospital, and N79.49 billion multi-sectoral plan for Wudil General Hospital and 484 Primary Healthcare Centres.</p>
<p>Under medicines and supply chain where the security of the process and practice were expanded and ensured, it was reported that the baseline in 2023 was critical. According to Kano State Drugs and Medical Consumables Supply Agency (DMCSA) Director-General, Pharmacist Gali Sule, drug availability in public health facilities was only 30%. Essential medicines were unavailable in most general hospitals and PHCs, forcing patients to private pharmacies. By July 2026, availability rose to over 90%. Wow! What a befitting effort and show of political will.</p>
<p>This turnaround was achieved through three deliberate interventions. So it wasn&#8217;t accidental. It was well designed, process and procedures followed, officials toiled and result became fruitful, in its purest form.</p>
<p>Firstly there was a complete liquidation of N1.2 Billion inherited debt to Pharmaceutical Suppliers by January 2026. When the administration assumed office in 2023, the DMCSA was owing suppliers about N1.2 billion. This debt had destroyed supplier confidence, leading to a boycott of government tenders. No supplier was willing to deliver on credit. The government prioritised debt clearance as a first step, paying all verified liabilities by January 2026. This single action restored the state&#8217;s credit rating in the pharmaceutical market, reopened supply lines, and led to the Association of Nigerian Industrial Pharmacists (NAIP) conferring an Award of Excellence on Governor Yusuf. Lallai lallai Abba ka cika Gwarzo! The experience of the agency under the past administration(s) was terrible and disgusting!</p>
<p>Secondly the strategy of Direct Procurement and Centralised Distribution Model helps much and saves all. Instead of allowing each hospital to procure drugs at inflated prices from middlemen, the administration strengthened DMCSA as a central bulk purchaser. DMCSA now procures directly from manufacturers and accredited importers at negotiated national prices, ensures quality testing, and distributes to all 44 LGAs through a scheduled last-mile delivery system. This eliminated fake drugs, reduced cost by up to 40%, and ensured that a drug available in Kano Municipal is also available in remote facilities like Rogo and Takai.</p>
<p>Thirdly is the Restoration of Supplier Confidence and Supply Chain Accountability.<br />
Beyond paying debts, the government instituted a 30-day payment guarantee and an e-inventory tracking system. Every facility now reports drug stock electronically, allowing DMCSA to see real-time consumption and restock before stock-out. Suppliers are now paid within 30 days of delivery, a policy that has attracted more competitive bidders and ensured sustained availability of over 90% for 12 consecutive months. A practice where only patriotic leaders with human face can leverage on. Not a practice filled with corruption and intentionally induced setbacks.</p>
<p>The over 15% heath allocation under Governor Yusuf touches almost all areas under the health sector. Almost all areas. Yes scale of preference also applies. For example under infrastructure in secondary and primary sub-sectors over 20 General Hospitals including Wudil, Bichi, Gaya, Tiga and Hasiya Bayero Paediatric Hospital have been rehabilitated. Over 200 PHCs across 44 LGAs were upgraded, solarized and re-equipped with modern diagnostic tools to ensure 24-hour service.</p>
<p>Healthcare delivery system doesn&#8217;t work at infrastructural level alone. Human resource for health is another critical area of concern.<br />
Governor Yusuf&#8217;s reform includes reinstatement of 926 health workers on full CONHESS allowance, employment of 250 doctors and 155 nurses/community health workers, deployment of 65 residency doctors to secondary facilities, and accreditation of postgraduate programmes. Prompt salary payment and continuous training were introduced to curb brain drain. Abba ka iya Gwamna.</p>
<p>Under Maternal, Newborn And Child Health (MNCH) the outcomes expanded, as a result of good and effective health management and control system. Which is devoid of corruption, political rivalry and unease struggles.</p>
<p>This is the sector with the most visible human impact. According to Commissioner for Health Dr Abubakar Labaran Yusuf, maternal mortality dropped from over 1,300 cases in 2023 to about 300 in 2026. This was driven by some well designed programmes. See the following:</p>
<p>(1) AbbaCare Initiative &#8211; Free Health Insurance for the Vulnerable. This is a state-funded health insurance programme that covers over 300,000 vulnerable residents who cannot afford healthcare. You remember ObamaCare? Under AbbaCare project beneficiaries include pregnant women, children under-five, the elderly above 65, persons with disabilities, and the poorest of the poor identified through the social register. Under the initiative, enrollees receive free consultation, free drugs, free laboratory tests, and free admission. It removes out-of-pocket payment, which is the major cause of delayed care and maternal death in Kano.</p>
<p>(2) Abba Care Centre &#8211; Free Treatment for Sickle Cell Patients: This is established as a specialised Centre within the health system, Abba Care Centre provides free comprehensive care for sickle cell patients statewide. This includes free routine drugs like hydroxyurea, free blood transfusion, free pain crisis management, and free counselling for families.</p>
<p>Before 2023, sickle cell patients spent an average of N35,000 per crisis episode. The centre has now absorbed that cost, serving as a first-of-its-kind intervention in Northern Nigeria and reducing sickle cell-related child mortality.</p>
<p>(3) Nutrition Response and MNCH Week Interventions: The administration of His Excellency Engineer Abba Kabir Yusuf, an exceptional leader of kind-hearted approach, tackled the root cause of child mortality, which is malnutrition. It provided N500 million counterpart funding to UNICEF for Ready-to-Use Therapeutic Foods (RUTF) and N170 million for malnutrition treatment centres during Maternal, Newborn and Child Health Week. During MNCHW, every child under five is screened for malnutrition, vitamin A deficiency and given deworming tablets. Mothers receive free antenatal supplements, iron folate, and nutrition education. This has reduced severe acute malnutrition admission in Kano by over 60% in two years. Wow! A Governor like no other.</p>
<p>(4) Sustained Free Maternity and Paediatric Services &#8211; Lafiya Dole Initiative: An all-encompassing corridor designed to put a halt to the suffocation of women and children healthcare effort.<br />
Under Lafiya Dole, the corridor, all pregnant women receive free antenatal care, free delivery including caesarean section, and free postnatal care. Children under-five receive free treatment for malaria, pneumonia and diarrhoea, the three major child killers. This has increased hospital deliveries from 28% in 2023 to over 61% in 2026, directly contributing to the drop in maternal deaths.</p>
<p>In conclusion let me make this point very clear. The Kano health reform of 2023-2026 is not based on rhetoric but on three verifiable indicators, drug availability moved from 30% to 90%, maternal deaths dropped from 1,300 to 300, and over 1,300 health workers were reinstated or newly employed.</p>
<p>While I commend the Governor for all the feats achieved in the health sector, I should also acknowledge the team he chooses to work with in the sector. Starting with the Commissioner for Health, Heads of Agencies under the Ministry of Health, civil servants working in the sector, from Doctors, Pharmacists, all other health workers that are numerous to mention here, down to laborers, cleaners and of course messengers.</p>
<p>Anwar writes from Kano<br />
Wednesday, 16th September, 2026</p>
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