In July 2016, I lost my beloved wife, Amaka, to a preventable asthma crisis. Her untimely death was a tragedy that shattered my world and changed my life forever. But from that devastating loss, I found purpose. I established the Amaka Chiwuike-Uba Foundation (ACUF) to honor her memory and to ensure that no other family would suffer such an avoidable heartbreak. Our mission at ACUF is to support individuals living with asthma and to advocate for policies that will transform asthma care in Nigeria and Africa.
By Prof. Chiwuike Uba
This year’s World Asthma Day, themed “Make Inhaled Treatments Accessible for ALL,” is a global call to action that resonates deeply with us. The theme, chosen by the Global Initiative for Asthma (GINA), underscores a central truth: the ability to breathe freely should not be a privilege reserved for the wealthy or urban elite. Inhaled corticosteroids—the cornerstone of effective asthma management—must be available, accessible, and affordable to all.
In Nigeria, this is far from the reality. Asthma is becoming increasingly prevalent, with studies indicating a general prevalence ranging from 5.12% to 14.7%, and some projections expecting this rate to rise even further by 2025. Africa as a whole is seeing a significant increase in asthma cases, with estimates ranging from 1% to 53% across various populations and age groups. Urbanization and rising levels of air pollution are key drivers of this trend.
According to the World Health Organization, over 250,000 deaths annually worldwide are attributable to asthma, with low- and middle-income countries accounting for over 80% of this toll. In Africa, asthma mortality rates are among the highest in the world due to underdiagnosis, poor management, and lack of access to essential medications. In Nigeria, while comprehensive nationwide data remains limited, estimates suggest that asthma accounts for about 5–10% of all emergency room visits and contributes significantly to morbidity, particularly among children and young adults. Recent clinical studies and hospital data indicate that asthma exacerbations lead to frequent hospital admissions, increased disability-adjusted life years (DALYs), and a troubling rise in mortality rates—especially in under-resourced regions. In some urban tertiary hospitals, asthma-related deaths have been recorded at rates as high as 6% among admitted patients.
Beyond the numbers are the heartbreaking stories of people silently struggling to breathe. These are children who miss school due to frequent asthma attacks, parents who must choose between feeding their families and buying medication, and elderly people in remote areas unable to access even basic healthcare. Their pain and resilience often go unnoticed, hidden beneath the surface of national statistics. These silent battles must be brought to light if we are to make lasting change.
The cost of managing asthma in Nigeria has skyrocketed, placing essential medications out of reach for the vast majority of patients. A basic short-acting beta-agonist (SABA) inhaler, commonly used to relieve acute asthma symptoms, now costs between ₦5,000 and ₦8,500. Inhaled corticosteroids (ICS), which are critical for long-term asthma control, are often unaffordable for many. Combination inhalers that include both ICS and long-acting beta-agonists (LABA)—recommended for moderate to severe asthma—can range from ₦34,500 to ₦70,000 per unit.
For context, Nigeria’s national minimum wage is ₦70,000 per month. Expecting a person to allocate an entire month’s salary—or more—on a single inhaler is not only unjust, it is inhumane. For clarity, these medications include examples such as salbutamol for SABA, budesonide or beclomethasone for ICS, and formoterol combined with ICS for combination therapies. These are not brands but standard pharmacological agents essential for effective asthma management.
The reasons behind this crisis are complex but not insurmountable. The depreciation of the Naira has made imported medicines significantly more expensive. The exit of major pharmaceutical companies like GSK has further reduced market competition, creating scarcity and inflating prices. Nigeria’s heavy reliance on imported medications also exacerbates costs, with high operational expenses compounding the problem.
These issues are unfolding in a country where poverty is widespread. The World Bank has revealed that 75.5% of rural dwellers in Nigeria live below the poverty line, alongside 41.3% of the urban population. More than 133 million Nigerians live in multidimensional poverty. When individuals must choose between feeding their families and purchasing asthma medication, the result is delayed treatment, deteriorating health, and, in too many cases, death.
The lack of healthcare infrastructure and investment further deepens the crisis. Nigeria has approximately 40,400 hospitals and clinics, of which 34,385—or 85.1%—are classified as Primary Health Care (PHC) facilities. Alarmingly, over 80% of these PHCs are not functional, due to poor infrastructure, inadequate staffing, and lack of essential medical supplies. Only about 12% of practicing physicians work in these PHCs, while 74% are concentrated in private hospitals, which make up just 27% of total health facilities. This disparity results in millions of Nigerians, particularly in rural areas, having limited access to professional healthcare.
The quality of available care is another concern. Many PHCs lack the essential equipment, medicines, and trained personnel needed to manage chronic conditions like asthma. The essential medicines list (EML) in Nigeria is outdated, continuing to include oral salbutamol and corticosteroids, which are not recommended by the World Health Organization (WHO) due to their adverse side effects. Oral salbutamol, for example, is associated with tremors, cardiac arrhythmias, and a higher risk of asthma exacerbation and mortality. Yet, it remains more readily available than modern inhaled therapies, likely due to a combination of cost, ignorance, and outdated prescribing practices.
Moreover, Nigeria currently lacks a comprehensive national guideline on asthma management. In the absence of standardized, evidence-based protocols, healthcare providers often rely on outdated or inconsistent treatment methods. This gap in policy and guidance contributes to poor disease control, increased health disparities, and unnecessary suffering. Establishing and disseminating national asthma management guidelines must be treated as an urgent health policy priority.
Environmental pollution further exacerbates the asthma crisis. Nigeria faces some of the worst air quality levels in the world, particularly in urban centers like Lagos, Port Harcourt, and Kano. Vehicle emissions, industrial pollutants, and the widespread use of biomass fuels for cooking contribute to dangerously high levels of particulate matter in the air. Compounding this is the persistent practice of gas flaring in the Niger Delta, which releases massive amounts of harmful pollutants including sulfur dioxide, nitrogen oxides, and volatile organic compounds. These pollutants not only worsen asthma symptoms but also contribute to the development of respiratory diseases in previously healthy individuals. Addressing pollution—especially through stricter environmental regulations and the enforcement of anti-flaring laws—is essential to reducing the asthma burden in Nigeria.
The result is tragically predictable: poor asthma control, frequent and severe symptoms, activity limitations, and preventable deaths. The Global Asthma Report 2022 identifies out-of-pocket expenses as a significant barrier to effective asthma management in Nigeria. Because asthma medications are not subsidized, the cost often becomes catastrophic for households.
Worse still, funding for Non-Communicable Diseases (NCDs) remains alarmingly low. While the government has committed to strengthening the PHC system, comprehensive NCD care is frequently excluded from the Minimum Package of Health Services. As a result, diseases like asthma remain underdiagnosed, undertreated, and largely ignored by national health strategies.
International and regional commitments like the Sustainable Development Goals (SDGs), the Addis Ababa Action Agenda, and the Abuja Declaration have all recognized the importance of investing in health. SDG 3 aims to ensure healthy lives and promote well-being for all at all ages, with Target 3.8 specifically calling for universal health coverage (UHC) that includes access to essential medicines and financial protection. Yet, Nigeria’s public spending on health remains abysmally low.
Despite pledging under the Abuja Declaration to allocate at least 15% of national budgets to health, Nigeria has consistently fallen short. In fact, only Tanzania has met this target. In the 2025 Nigerian budget, ₦2.48 trillion is allocated to the health sector, which is 5.2% of the total budget. This allocation is significantly less than the 15% commitment made in the 2001 Abuja Declaration and falls short of the World Health Organization’s (WHO) recommendation. Between 2015 and 2025, Nigeria has consistently underfunded its health sector, averaging around 5% of the national budget.
As of 2018, government spending on health in Nigeria accounted for just 14.9% of total health expenditures. The burden is instead shifted onto individuals, with out-of-pocket expenses accounting for 76.6% of total health spending. External aid makes up 7.86%, while health insurance contributes a meager 0.76%.
The National Health Insurance Scheme (NHIS), now under the National Health Insurance Authority (NHIA), has failed to deliver widespread coverage. Since its launch in 2005, less than 3% of Nigerians have been covered. At the same time, health insurance contributions have dwindled, while out-of-pocket expenses continue to climb.
To address these urgent challenges, Nigeria must undertake a series of systemic policy reforms. First, the national Essential Medicines List must be updated to align with WHO recommendations by removing outdated oral asthma treatments and including inhaled corticosteroids and combination therapies. These medicines should be subsidized and incorporated into the benefit package of the NHIA to ensure they are affordable or even free for vulnerable populations.
Additionally, Nigeria must develop and implement national asthma management guidelines based on the latest scientific evidence, ensuring consistent and high-quality care across all health facilities. Investment in the revitalization of PHCs is critical, including the recruitment and training of healthcare personnel, provision of diagnostic tools and medicines, and deployment of telemedicine where appropriate.
Beyond healthcare delivery, Nigeria must create an enabling environment for the local production of asthma medicines through incentives for pharmaceutical companies, public-private partnerships, and regulatory reforms. This would reduce reliance on imports and stabilize medication prices. Efforts must also be made to address environmental triggers of asthma through strict enforcement of environmental laws, ending gas flaring, and promoting the adoption of cleaner fuels and technologies for households and industries.
Finally, increasing public spending on health is paramount. Nigeria must commit to meeting its Abuja Declaration obligations by allocating at least 15% of its national budget to health and expanding health insurance coverage through strategic pooling of resources and innovative financing mechanisms.
The tragedy of losing my wife Amaka to asthma is one I would not wish on any family. But from that pain has come a commitment to lasting change. Through ACUF, we will continue to advocate for policies that prioritize access to asthma care, support patients and caregivers, and push for the transformation of Nigeria’s healthcare landscape.
On this 2025 World Asthma Day, let us reaffirm our collective commitment to equity, dignity, and the fundamental right to breathe. Let us make inhaled treatments accessible for all. We call on the Nigerian government, national and state legislatures, civil society organizations, the private sector, and well-meaning individuals—especially wealthy Nigerians and corporate organizations—to rally behind this cause. Asthma does not discriminate. Ironically, we only seem to discover how many of our politicians are asthmatic when they are arrested. Let them be part of this movement now—not out of compulsion, but from compassion and foresight.
Because no one should die simply because they cannot afford to breathe. The time to act—for the air we breathe, the health we deserve, and the lives we can still save—is now. God is with us!
Prof. Chiwuike Uba, Ph.D., CPA, FCMA
PFM, is a Public Policy Analysis & Governance I Organisational Development. He can be reached at +234 803 309 5266 and Skype: chiwuike
