By: Abdullahi O Haruna Haruspice
Nigerians can be forgiven for being skeptical. In a country where healthcare has long been synonymous with delay, despair, and debt, news of a government-funded emergency treatment programme sounds almost too good to be true. Yet, in what appears to be a rare moment of administrative resolve, President Bola Ahmed Tinubu’s government has launched an ambitious intervention that could fundamentally change the way emergency care is accessed and delivered. The National Emergency Medical Service and Ambulance System (NEMSAS), under the stewardship of Professor Muhammad Ali Pate, the coordinating minister of health and social welfare, promises every Nigerian free emergency care for the first 48 hours of hospital admission.
The initiative, quietly piloted and now expanding across the country, forms a key pillar of the president’s Renewed Hope Agenda in the healthcare sector. It has already found institutional expression in the Jos University Teaching Hospital (JUTH), which has aligned fully with the directive. At JUTH, emergency care has been integrated across departments—Accident and Emergency, Emergency Pediatric Unit, Psychiatry, and Gynecology—ensuring that patients in dire need are no longer turned away for lack of immediate funds. That is no minor feat. For decades, the inability to pay upfront has condemned many Nigerians to suffer or die unattended, while hospitals, faced with underfunding, have felt little choice but to demand payment first and care later.
There is a quiet revolution in the making here. The NEMSAS model goes beyond ambulances and bandages. It is a systemic framework, marrying logistics with healthcare delivery. From pre-hospital care to triage and initial stabilization, the programme aims to rewire the country’s approach to emergency medicine. Its success will depend, in part, on how well hospitals document patient records and track interventions, since only documented treatments will be reimbursed under the 48-hour free care window. But the bigger triumph may be ideological: it signals that for once, a Nigerian government sees healthcare not as a charity but as an obligation.
The vision is not confined to urban centers. In Nasarawa State, the Federal Government has approved a parallel programme—the Rural Emergency Service and Maternal Transport (RESMAT) initiative—which focuses on hard-to-reach communities. It offers free emergency medical services and transport for pregnant women and children under five across all 13 local government areas of the state. Here, the intervention is both urgent and strategic. Nigeria has one of the highest maternal mortality rates in the world, with rural women often paying the heaviest price for the country’s broken health referral system. The RESMAT model, backed by the Basic Healthcare Provision Fund, removes financial and geographical barriers. Ambulance tricycles—more reliable on rugged terrain than conventional vehicles—are to be deployed to 30 selected Primary Healthcare Centres (PHCs). These facilities will be upgraded as part of the rollout, embedding emergency readiness where it is most needed.
The approach bears resemblance to models adopted elsewhere. Rwanda, with its famously lean health sector reforms, dramatically reduced maternal deaths by decentralizing emergency obstetric care and ensuring rapid transport for rural patients. Brazil’s SAMU—an acronym for its national mobile emergency service—has brought lifesaving interventions to both favelas and highways, while in India, the GVK Emergency Management and Research Institute handles hundreds of thousands of emergency calls each day under a public-private partnership. In each of these cases, scale and institutional clarity were critical. So too was political will. In this, President Tinubu deserves more credit than he is likely to receive. In an era of tough economic reforms—subsidy removals, currency unification, and a public clamour for quick wins—the temptation to delay or dilute health spending would have been strong. Instead, his administration has chosen to lead with compassion, using policy to cushion the inevitable shocks of reform.
Free emergency treatment for 48 hours will not fix Nigeria’s ailing health sector overnight. But it introduces a fundamental shift: the notion that the state has a duty to intervene when life is on the line. That is no small philosophical victory in a country where hospitals routinely demand money before inserting a drip or administering oxygen. This is not simply about saving lives; it is about restoring dignity.
Implementation, of course, remains the programme’s Achilles heel. The Nigerian bureaucracy has an uncanny ability to drain ambition from even the noblest policies. Health workers will need to be trained, systems modernized, and accountability enforced. Corruption lurks in procurement chains and reimbursement processes. Already, there are murmurs in some quarters that the initiative could be hijacked or misapplied by unscrupulous actors. Yet these risks, while real, are not sufficient reason to abandon course. They are, rather, reminders that vigilance must accompany vision.
For the policy to work, the public must be involved. Awareness is currently low, particularly in rural and underserved communities where the impact could be greatest. Civil society groups, religious institutions, and local media should play a greater role in disseminating accurate information about the programme. Citizens should be encouraged to report any deviation from its guidelines, including illegal fees or denial of care. The public’s watchdog role, if properly exercised, could serve as the initiative’s greatest form of quality control.
There are deeper lessons to be drawn from this. One is that emergency care can serve as a litmus test for broader reforms in public health. Unlike chronic care, which requires long-term funding and behaviour change, emergency medicine offers quick, visible wins. A life saved from a road accident or a birth complication is a story that spreads. If trust in the system is built here, it can be leveraged to expand services in maternal care, child health, and chronic disease management. The infrastructure being set up for NEMSAS—dispatch centres, referral coordination, record-keeping—could become the skeleton upon which universal health coverage is eventually built.
The timing is also politically savvy. With elections years away and a reform agenda already underway, the government has space to build credibility through social programmes that touch ordinary lives. Tinubu’s Renewed Hope Agenda has often been viewed with cautious optimism. This initiative offers a concrete example of what hope can look like in practice.
Sceptics may argue that the policy is too narrow, or that 48 hours is too short a window. But in emergency care, minutes matter. Stabilizing a patient quickly often determines long-term outcomes. Even in richer countries, early intervention saves costs in the long run. Nigeria spends billions annually on medical tourism—money that could be redirected toward building a healthcare system worth staying for. A well-executed NEMSAS could reduce the pressure on tertiary hospitals, restore some faith in public facilities, and keep citizens alive long enough to receive further care.
Some praise must also go to Professor Pate, a seasoned technocrat who appears determined to match rhetoric with results. Under his watch, the Ministry of Health has been recalibrating its priorities around delivery, rather than dogma. The alignment between policy and implementation, seen in JUTH and the Nasarawa pilot, suggests a level of inter-agency coordination that has eluded previous efforts. Still, the scale-up will be the real test.
The real genius of this intervention, however, may lie in its subtle redefinition of national obligation. For a long time, Nigeria’s social contract has felt broken, with citizens providing for themselves in health, education, and security. By offering free emergency care, the government is signalling a renewed willingness to protect its most fundamental asset—human life. That message, if amplified and acted upon, could restore a measure of trust between state and society.
What remains is for Nigerians to seize the opportunity. This policy belongs not to one party or administration, but to the people it is designed to serve. It must not be allowed to rot from disuse or be eroded by cynicism. It is, quite literally, a second chance at life—for patients and policymakers alike.
If this initiative survives the turbulence of Nigerian politics and the entropy of its institutions, it could be remembered as the moment the country finally decided that life should not come with a price tag—at least not in the first 48 hours.
and then