Why We Need a New Specialist for the Nigerian Patient

By Kola A. Oyediran and Sunday Odeleke

If Nigeria were a patient walking into a clinic today, the initial presentation would be paradoxical. The patient is massive—the “Giant of Africa”—standing tall, boisterous, and bursting with visible energy. But a trained eye would spot the tremors immediately. The patient is sweating profusely, breathing shallowly, and complaining of chronic fatigue despite constant consumption.

For decades, we have shuttled this patient between hospitals, attendedto by various specialists:

• The Political Scientist prescribed Democracy, but the patient remains weak.
• The Economist prescribed Subsidy Removal and Forex Reforms, but the fever only spiked.
• The Engineer prescribed Infrastructure, yet the patient collapses on the few good roads we have built.

We have been treating the symptoms, not the underlying pathology. It is time we consulted the specialist we have ignored for 60 years: The Demographer.

Demography is not merely about counting heads during a census. It is the clinical science of human populations—analyzing their structure (age and sex), their movement, and their trajectory.

Similar to human being, a nation must pass through specific stages of population change to achieve stability. If we treat Demography as the primary physician, we can finally read the vital signs of our national health accurately. And right now, the doctor’s report is terrifying.

The Chief Complaint: A Paradox of Wealth and Poverty

Every Nigerian knows the symptoms of our national illness. You see them in the go-slow on the Third Mainland Bridge, where thousands of productive hours burn away in traffic. You feel them in the heat of inflation in the market. You hear them in the stories of friends selling their cars to buy a one-way ticket to Canada, the UK, or South Africa in search of greener pastures.

We are a country of paradoxes. We have the largest economy in Africa, yet we host some of the world’s poorest people. We have millions of able-bodied youths, yet we import almost everything we consume.

Why?

The answer lies in simple physiology: The body of Nigeria has grown faster than its heart (the economy) can pump blood.

Nigerian population curve has consistently outpaced our economic productivity. When a body outgrows its heart, the result is heart failure. The Political Economist will tell you this is a failure of leadership. The Demographic Physician will tell you it is a failure of structure.

The X-Ray: Reading the Pyramid                       

When a physician needs to understand a hidden fracture, they order an X-ray. For a country, that X-ray is the Population Pyramid.

To the untrained eye, a population pyramid is just a chart. To the Demographer, it is a diagnostic map that reveals the hidden structural stress on a nation.

As shown in the comparison above, if you look at the X-ray of a developed country like Japan or Germany, you see a column or a vessel—narrow at the bottom and consistent to the top. This indicates an older, stable population with fewer dependents.

Now, look at the X-ray of Nigeria. You see a perfect, wide-based pyramid.

• The Base: A massive foundation of millions of children (0–14 years).
• The Middle: A struggling, pinched waistline of working adults.
• The Top: A tiny peak of elderly people.

The Diagnosis: This wide base indicates a Median Age of roughly 18 years. This means half of all Nigerians are teenagers or children. While politicians like to call this our “future strength,” a doctor calls it Acute Dependency Syndrome. The working “waistline” is simply too thin to support the massive weight of the children at the bottom.

The Pathology: The Heavy Backpack

Let us examine the lab results for a crucial marker: the Dependency Ratio.

In economic physiology, this ratio measures the stress placed on the productive cells of the body. To understand it, imagine the national economy is a man walking up a steep hill.

In a country like South Korea or China, that man is carrying a small handbag. The vast majority of the population are adults who work and feed themselves. They are net contributors; they add muscle to the climb.

In Nigeria, that same man is strapped to a 100kg backpack.

For every 100 working-age Nigerians (those lucky enough to find employment), they must support nearly 80 to 90 dependents. These dependents—mostly children—require food, school fees, healthcare, and clothing, yet they produce zero economic output.

The Metabolic Consequence This explains why your personal finances feel strained. It explains why the government is perpetually insolvent. It is not just corruption (though that is a cancer of its own); it is simple biology.

No runner can win a marathon carrying a refrigerator on their back. We are structurally exhausted because our “demographic metabolism” is consuming all our caloric energy just to keep the dependents alive, leaving zero reserves for muscle growth or infrastructure investment.

The Symptoms: Why the Patient is Bleeding

If we ignore the X-ray (the population structure) long enough, the symptoms eventually become impossible to hide. In Nigeria, these symptoms are manifesting in three critical ways.

Symptom 1: The ‘Japa’ Hemorrhage

In medicine, a hemorrhage is the rapid loss of blood from a damaged vessel. In Nigeria, we are bleeding our most vital cells: our professionals.

According to recent data, over 4,000 doctors emigrated in 2024 alone. In the last two decades, we have lost nearly 19,000 physicians.

As the chart above demonstrates, the disparity is lethal. The World Health Organization (WHO) recommends a safety standard of 1 doctor for every 600 patients. In Nigeria, we are sliding toward a ratio of 1:5,000.

The Biological Cause: Why are they leaving? It is a biological rejection. When a host body (the nation) cannot nourish its cells (the citizens), the cells migrate to survive. Our doctors, engineers, and tech talents are not unpatriotic; they are simply responding to a primal survival instinct. They are transplanting themselves into host bodies—like the UK, Canada, or the US—that have the metabolic capacity to sustain them.

Symptom 2: The Youth Bulge as Inflammation

A Youth Bulge sounds positive, like a muscle developing. But in physiology, if a muscle has no bone to attach to, it becomes a mass—a tumor.

Every year, our universities and polytechnics release roughly 500,000 to 600,000 graduates into the labor market. However, the economy creates only a fraction of the jobs needed to absorb them.

As the chart above highlights, the gap between “graduates produced” and “jobs available” is widening annually. What happens to the surplus?

• Underemployment: Masters degree holders riding Okada or driving Uber.
• Cybercrime: The pivot to Yahoo Yahoo as a vocation.
• Militancy: Recruitment as foot soldiers for bandits or insurgents.

In medical terms, this is systemic inflammation. A large population of idle, frustrated young men creates the perfect breeding ground for social unrest. The insecurity in the North-East and North-West is not just an ideological war; it is a demographic crisis fueled by idleness. This insecurity is spreading like wildfire, exploited by unemployed youth who have turned to kidnapping for survival.

Symptom 3: Infrastructure Organ Failure

Have you ever wondered why, despite building new roads and buying new transformers, the lights still go off and the traffic still jams? It is because the patient is growing faster than the treatment.

If Lagos State builds a road for 10 million people, by the time the road is finished, the population has grown to 12 million. We are playing catch-up with a runner who is faster than us. Our infrastructure organs—power, water, transport—are in a state of chronic failure because demand eternally outstrips supply. We are trying to hydrate a patient who is dehydrating faster than we can pour the water.

The Prognosis: 2050 is Tomorrow

One of the superpowers of the Demographic Physician is the ability to see the future. The stock market is unpredictable; demography is not. We know exactly how many 25-year-olds will be looking for jobs in 2050—because they were born last week.

The World Bank recently projected that Nigeria will add another 130 million people by 2050. We are on track to become the third most populous country on Earth, overtaking the United States, but squeezed into a landmass the size of Texas.

The Doctor sees two possible futures (Prognosis) for this patient:

Prognosis A: The Miracle Recovery (The Dividend) This is the path taken by the Asian Tigers (South Korea, Taiwan, etc.). They turned their youth bulge into a Demographic Dividend. How? They reduced their family size drastically. This lowered the backpack weight. Suddenly, families had extra money to save. The government had fewer children to educate, so they improved the quality of education. These educated youths flooded the factories, and the economy boomed. If Nigeria takes this path, we become the industrial engine of the world.

Prognosis B: The Terminal Decline (The Bomb) This is the path of the Demographic Disaster. We continue to reproduce at current rates (a fertility rate of over 4.0). The population doubles, but the economy does not. Poverty deepens. The inflammation of youth unemployment turns into an explosion of civil war or total state collapse. The Giant of Africa becomes a bedridden invalid, dependent on foreign aid just to feed its children.

The Prescription: The Bitter Pill

A diagnosis is useless without a treatment plan. The Demographic Physician has written a prescription. It is not sweet. It requires discipline. But it is the only way to save the patient.

1. The Preventive Medicine: Family Planning

We need to have a hard, honest conversation about family size. This is not a conspiracy by the West to reduce our numbers; it is simple economics. In the North, where cultural and religious sensitivities are high, we must frame this correctly: Child Spacing is Child Survival. We must empower our women. When a girl stays in school until age 18 or 20, she naturally chooses to have fewer, healthier children.

• The Dose: Government must make contraceptives free and accessible, not just in Abuja, but in every Primary Healthcare Centre (PHC) in every village.

2. Education as a Vaccine

We are currently feeding our youth junk food education. We hand out certificates that have no value in the market. We need a vaccine against unemployability. This means pivoting from Grammar Schools to Technical and Vocational Education (TVET). We need fewer sociologists and more welders, coders, agronomists, and solar technicians.

• The Dose: Declare a state of emergency on the curriculum. If a degree does not lead to a skill, it is a receipt, not a qualification.

3. Economic Physiotherapy (Job Creation)

You cannot tell a patient to exercise if they have no muscles. We cannot tell youth to work hard if there are no factories. The government must perform drastic physiotherapy on the economy to move it away from the oil drip. Oil is lazy money—it employs very few people. Agriculture and Manufacturing are muscle money—they employ millions.

• The Dose: Priority must be given to stabilizing the power sector. The absence of electricity stifles manufacturing, which in turn kills job creation and turns the youth bulge into a demographic time bomb. To address this, our energy mix must evolve beyond hydropower to include a constellation of renewable sources like wind and solar. We must capitalize on regional comparative advantages; for example, deploying wind and solar infrastructure in the North-West and the Oke-Ogun region of the South-West.

Conclusion: The Doctor is Waiting

The Demographic Physician is standing by the bedside. The chart is in hand. The warning lights are blinking red.

Nigeria is not destined to fail. But biology is ruthless. It does not care about our Giant status, our Afrobeats, or our jollof rice. It only cares about the balance between mouths to feed and hands to work.

We have a choice. We can take the medicine—embrace family planning, revolutionize education, and industrialize our workforce—and walk out of this hospital as a global superpower. Or, we can ignore the doctor, keep popping painkillers, and wait for the heart attack that is sure to come.

The patient is still breathing. But for how long?

Dr. Kola Oyediran is a trained Demographer, Social Statistician, and Global Health Specialist based in the Washington, DC, USA and Sunday Odeleke is a US-based public commentator.