February 27, 2022, marked exactly two years after the first case of coronavirus disease (COVID-19) was discovered in Nigeria. Kudos to the astute attending physician who promptly notified the necessary health authorities of the first case. As of June 13, 2022, Nigeria has confirmed 256,000 cases and recorded 3,114 deaths, but it does not appear that the country learned lessons in its efforts to strengthen its health system in preparation for future infectious diseases and health emergencies.

The 2022 SBM State Health Preparedness Index (HPI) is coming after the restrictions imposed to curb the spread of the virus have been lifted. The restrictions, which were first imposed in 2020, included rules governing travel and social gatherings, mask-wearing, and self-isolation for those affected by the virus.

States in Nigeria are moving on as if they were never hit by the pandemic, considering the infrastructural and personnel deficit in the country’s health sector, coupled with the country’s weak economy. Many of the states that were active in the fight against the virus, increasing their budget for health, appeared to have slowed down in the period that followed the lifting of restrictions hitherto placed.

Only two states, Osun and Imo, in their 2021 appropriation bills, budgeted more funds for the health sector compared to the year 2020. Both states allotted 17.30% and 7.31% of their budgets in 2021, respectively. In the preceding year, both states allotted 12.10% and 6.18%, respectively. It is possible that other states that allotted fewer funds to the health sector decided to do so because the number of reported COVID-19 cases has reduced to near zero when compared to last year at the height of the pandemic. Last year, states had to cut their budgets for other sectors to meet the pressure of the coronavirus on the health sector.

Put together, the 36 states spent an average of 4.65% of their budgets on healthcare in 2021. This is compared to the 2020’s budget, where the states spent over 11%. Only Osun (17.30%) and Ondo (10.28%) states allotted more than 10% to healthcare in 2021. The number dropped compared to 11 states last year. Lagos State, despite its huge budget in 2021, allotted only 2.76% to the health sector. This implies that compared to last year, there is a significant drop in how the states are investing in the health sector.

The most important factors in arriving at the state’s Health Preparedness Index (HPI) 2022 include the state’s health budget (per capita), the ratio of doctors to patients, infant mortality, and the Human Development Index.

Ogun State leads the 2022 HPI with 39.91 points, followed by Bayelsa with 38.40 points. These two states, in last year’s HPI, were in the 4th and 11th positions with 26.95 and 22.89 points, respectively. Lagos, which led last year’s HPI with 28.56 points, drops to 5th position in 2022 with 26.89 points. Delta and Anambra occupy the 3rd and 4th positions in this year’s HPI with 29.93 and 27.02 points each. These South-Southern and South-Eastern states were in 10th and 3rd positions last year with 23.02 and 27.45 points, respectively. Kebbi maintains its previous position on the state HPI with 9.28 points having dropped from the 10.6 points it recorded last year. While most of the states at the bottom of the HPI table are from the northern part of the country, it is noteworthy that Kebbi State is lagging in prioritising its health sector, particularly primary health care.

Many states lack the political will to implement state health insurance and other health schemes fully, and this is a matter of concern. Most of these states would rather prefer to be responsive to collective national health challenges like COVID-19 than be proactive about health issues concerning their states. There’s a need for all the states to implement primary health care under an umbrella.