A right to universal health coverage in Nigeria?: a transformative proposal from a comparative perspective

Utilising comparative legal methodology, this thesis develops a framework for transforming the health system of Nigeria through the right to health. It argues that by conceiving the right to health as a set of legal positions to universal health coverage and applying this framework across the international, constitutional, policy and legislative,and judicial domains, the health system of Nigeria can be transformed to achieve better health outcomes. It conceptualises better health outcomes as significant reductions in the mortality and morbidity ratio, in the incidence of communicable and non-communicable diseases; and improvements in underlying determinants of health. Informing the thesis problem is the marginal position of health and the poor treatment of the right to health in Nigeria. This is evidenced by way the right has been poorly engaged with at the international level, the weak framing of the right in the constitution, the nonenforcement of legislative provisions guaranteeing the right, and the reluctance of the courts to interpret the right in a way that secures its legal effect. In addition, health outcomes in the country, as revealed by key health indicators kept by the World Health Organisation and other international institutions, show that the health system of Nigeria performs poorly when compared to those of Brazil, India and South Africa, which serve as comparators to Nigeria. Using the mixed-method approach to examine a variety of data sources, the thesis finds that the health outcomes recorded for Nigeria and the comparators largely reflect their level of engagement with the right to health in the international, constitutional, policy and legislative, and judicial domains. Brazil and South Africa, which show better levels of engagement with the right to health than Nigeria and India, also achieve better health outcomes. The significance of this finding is that it shows that by strengthening the right to health across these four domains, better health outcomes are likely to be achieved in Nigeria. The thesis maps a blueprint for transforming the Nigerian health system by bolstering engagement with the right to health across these domains.