Health is not produced by hospitals. It is produced by environments and behaviours shaped long before sickness has a name. Treatment remains essential, but prevention is what makes treatment sustainable. A health system earns its greatest value when fewer people arrive at its doors in need of rescue. Building hospitals is essential, but building conditions that keep people healthy is transformative. Producing health is not an alternative to treatment. It is what makes treatment sustainable.
When Nigeria’s Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, speaks of “producing health,” he is defining a policy shift rather than a slogan. Modern healthcare, in Nigeria and elsewhere, has developed exceptional capacities in treating illnesses. It can stabilise trauma, control infectious outbreaks and manage complex conditions in ways that represent remarkable progress. Specialists can perform complex surgeries, vaccines can halt deadly epidemics and emergency units can keep critically ill patients alive long enough to recover. Yet, the pressures facing the sector today come less from emergencies and more from conditions shaped by daily living, long before a patient reaches a clinic.
|
|
Hospitals were never designed to correct years of poor nutrition, sedentary behaviour, chronic stress, harmful products or unhealthy environments. They are built to diagnose and intervene, supported by specialised professionals, regulated financing and medical technology. Their strength lies in identifying what has gone wrong and fixing it enough for a patient to survive. This design is appropriate for treating disease, but it has limited influence over the behaviours and exposures that cause disease to become common. Medication can control hypertension, but it cannot provide a lifetime of healthier dietary choices. A cardiac procedure can restore blood flow, yet it does not replace years of inactivity that led to its necessity. A patient may receive treatment, but once discharged, the same dietary patterns, environmental pressures and commercial influences remain intact.
This is the context in which “producing health” becomes significant. It reflects a recognition under the Nigeria Health Sector Renewal Investment Initiative (NHSRII) that expanding facilities, training personnel and strengthening financing are not, on their own, enough. They will improve treatment, but they will not reduce the rising burden of preventable illnesses. Chronic diseases, often classified as Non-Communicable Diseases (NCDs), such as diabetes, heart disease, certain cancers and neurodegenerative disorders are not reversed by medical care. Treatment helps control their consequences, rather than eliminate their causes. These illnesses build silently across years, fuelled by diets dominated by processed food and by industries that profit from harmful consumption — alcoholic beverages, spirits, cigarettes and recreational drugs. They are reinforced by unmanaged stress and habits that no medical system can live out on behalf of its population.
|
|
|---|
Within the NHSRII, producing health sits alongside two other stated aspirations, which focus on saving lives and reducing physical and financial pain. These dimensions of the reform agenda are already producing measurable results. Skilled birth attendance is now above 90 per cent nationally, with a 33 per cent increase in priority local government areas, demonstrating that frontline capacity and financial protection can change maternal survival outcomes. Primary healthcare utilisation has grown from about 10 million to 45 million visits between early 2024 and the second quarter of 2025, showing that more Nigerians are seeking care early, rather than waiting for catastrophic illness. In 172 targeted local government areas (LGAs), maternal deaths have fallen by 17 per cent and newborn deaths by 12 per cent, supported by the revitalisation of more than 435 primary health care facilities and the recruitment of about 15,000 community health workers.
A reform agenda focused solely on building more hospitals or delivering more procedures will always fall short without action on the products and commercial practices that fuel chronic disease. The same system that is saving lives must also reduce and sometimes counter exposure to harm. This explains the growing push for stronger regulation of alcohol, tobacco and sweetened beverages. Reducing their aggressive marketing and widespread availability is not moral policing.
Financial protection has also improved. Health insurance coverage has expanded to approximately 12 per cent in two years, and roughly 4,000 free caesarean sections have been delivered through the National Health Insurance Authority. These are women who would otherwise have faced catastrophic costs, possibly delaying treatment or turning to unsafe alternatives. These gains show that health systems reduce suffering when they are accessible, affordable and staffed by capable workers. They demonstrate that investment, accountability and delivery are beginning to save lives and protect households financially.
Yet, they also highlight why treatment is not enough. A reform agenda focused solely on building more hospitals or delivering more procedures will always fall short without action on the products and commercial practices that fuel chronic disease. The same system that is saving lives must also reduce and sometimes counter exposure to harm. This explains the growing push for stronger regulation of alcohol, tobacco and sweetened beverages. Reducing their aggressive marketing and widespread availability is not moral policing. It is an economic and health imperative, as these products drive preventable illness, raise household spending on care and increase the burden on the very system that taxpayers are investing in to save lives. Recent legislative proposals to introduce a kind of “sin tax” reflect this urgency, including the move to replace the current ₦10 per litre sugar-sweetened beverage excise duty, with a percentage levy tied to retail price, and to earmark at least 40 per cent of the proceeds for nationwide health promotion and disease prevention programmes, especially against diet-related non-communicable diseases.
Even the strongest health systems can only treat disease; it cannot live well for its citizens. It cannot exercise, eat healthy foods or manage stress on behalf of the population. It cannot reduce daily salt and sugar intake in homes, replace inactivity with movement or remove the emotional strain that triggers unhealthy coping behaviours. Those actions remain the most powerful determinants of long-term health. They determine not only who becomes ill, but at what age, with what severity and at what cost to families and the nation.
Producing health, therefore, implies a broader view of reform. It involves health education that influences behaviour, policies that shape consumer choices, communities designed to support physical activity and regulation that discourages harmful products. It requires primary healthcare that guides individuals before they fall ill, rather than only managing conditions after they appear.
Producing health, therefore, implies a broader view of reform. It involves health education that influences behaviour, policies that shape consumer choices, communities designed to support physical activity and regulation that discourages harmful products. It requires primary healthcare that guides individuals before they fall ill, rather than only managing conditions after they appear. It also calls for inter-sectoral collaboration, because the drivers of chronic disease lie as much in agriculture, trade, urban planning and education, as in hospitals. Food systems determine what people can afford to eat. Transport and urban road infrastructure design determine whether cities encourage walking or force sedentary living. Advertising and family orientation shape what children grow up consuming. Schools and workplaces influence daily routines more than outpatient clinics ever will.
Under the NHSRII, Nigeria has an opportunity to move toward a model in which treatment is strong but does not carry the full burden of national well-being. Health can be created long before sickness asks to be treated. The success of the reform agenda will depend not only on how many facilities are upgraded or how financing improves, but on whether fewer Nigerians reach the point where clinical intervention becomes their only option.
Health is not produced by hospitals. It is produced by environments and behaviours shaped long before sickness has a name. Treatment remains essential, but prevention is what makes treatment sustainable. A health system earns its greatest value when fewer people arrive at its doors in need of rescue. Building hospitals is essential, but building conditions that keep people healthy is transformative. Producing health is not an alternative to treatment. It is what makes treatment sustainable. If Nigeria succeeds in this shift, the measure of progress will not only be in the number of lives saved in emergencies, but in the number of citizens who never reach that point at all.
Chinedu Moghalu is a lawyer, strategic communications expert, and public policy adviser with over two decades of leadership across government, international organisations, and development institutions. Currently, senior special adviser to Nigeria’s coordinating minister of health and social welfare.
