The roots of this dysfunction trace back to colonial times. British administrators established a medical system not to serve Nigerians, but to protect the interests of the colonial regime. The result was a curative, urban-centered model that excluded the vast majority of the population, particularly in rural areas. Upon gaining independence, Nigeria inherited this system but failed to reform it in a way that served the health needs of all citizens. Rather than redesigning the framework for equitable access, successive governments continued with a structure that was inherently elitist and inefficient.
The Nigerian Constitution provides a clear division of responsibilities in a three-tier healthcare system: Primary Healthcare under local governments, secondary care under state governments, and tertiary care under the federal government. This design was meant to bring clarity, accountability, and functionality. However, successive administrations have ignored this structure, operating in chaotic overlap, often without professional input or strategic coordination. The absence of a disciplined, constitutional approach to healthcare management is one of the most critical systemic failures facing the sector today.
These foundational lapses have culminated in a present-day catastrophe. Nigeria is losing its most skilled health professionals at an alarming rate. While the World Health Organization recommends a doctor-to-patient ratio of 1:500, some parts of Nigeria have just one doctor for every 100,000 people. The reason for this brain drain is clear. Nigerian doctors can earn more than twenty times their local salaries abroad, with specialists in the United States earning an average of $316,000 annually. By 2023, over 12,000 Nigerian doctors were practicing in the UK alone. This exodus has been hastened by persistent underfunding. Despite Nigeria’s commitment to the Abuja Declaration in 2001—which pledged 15% of the national budget to health—the actual allocation has consistently fallen below 5%. This underinvestment affects all levels of care, especially Primary Healthcare Centres (PHCs), which remain grossly under-equipped, understaffed, and unable to meet the basic needs of the communities they serve.
The cost of this neglect is not theoretical. In Maiduguri, Borno State, the crisis takes the form of young women suffering from Vesico-Vaginal Fistula (VVF)—a condition often caused by prolonged, obstructed labour without timely medical intervention. Many of these women are barely out of childhood, physically and emotionally damaged by circumstances that a functioning health system should have prevented. What’s most tragic is that VVF is both preventable and treatable with basic maternal health services and timely surgical care. That these women remain in pain, isolated, and stigmatised is a direct indictment of a system that has failed its most vulnerable. It is a haunting reminder that while billions are spent on elite foreign healthcare, Nigerian women are condemned to suffer from entirely curable conditions due to institutional neglect.
Nowhere is the failure of financing more evident than in the story of the National Health Insurance Scheme (NHIS). Conceived as a sustainable model to ensure healthcare access for all Nigerians, the scheme has barely scratched the surface, covering less than 10% of the population after nearly two decades. As a result, about 70% of Nigerians rely on out-of-pocket payments, often with devastating financial consequences. The NHIS has been hamstrung by poor governance, limited drug availability, inefficient service delivery, and a fundamental lack of public trust. Though recently replaced by the National Health Insurance Authority (NHIA), the success of this transition depends entirely on a willingness to break from the dysfunctional practices of the past and embrace transparent, efficient management.
But perhaps the most dangerous threat to Nigeria’s health system is corruption. It infects everything from procurement and billing to regulatory enforcement and drug safety. The trafficking of counterfeit medications has become rampant, often aided by the very institutions meant to protect public health. One striking example is the political pressure faced by the Director-General of NAFDAC, who resisted attempts by lawmakers to compromise her agency’s integrity. Her rare show of courage highlights a broader reality: regulatory agencies are frequently undermined by vested political interests, leaving citizens exposed to preventable harm.
Beyond corruption, another internal rot eats away at service delivery: professional rivalry. With over 120 specialist groups in the health sector, endless conflicts over roles and authority often derail hospital operations and patient care. Instead of collaboration, the system is marred by infighting and power struggles. It bears repeating that hospitals exist to serve patients, not professional egos. Governments must ensure that these disputes never supersede the delivery of quality care. The patient must always come first.
All of these challenges pale in comparison, however, to the sheer scale of resources lost to medical tourism. That $1.2 to $1.3 billion annual exodus—sanctioned and often funded by the state—is perhaps the clearest indicator of Nigeria’s healthcare dysfunction. This is not just a figure on paper; it is the physical manifestation of abandoned potential. With $25 million, Nigeria can build and equip a world-class, 120-bed hospital. That means the annual medical tourism bill alone could fund 48 to 52 such hospitals every single year. Over a decade, that would amount to nearly 500 state-of-the-art tertiary centres across the country—enough to place a major hospital in most local government areas.
This math is not abstract; it is brutal and revealing. Nigeria is not a poor country incapable of building a functioning health system—it is a misgoverned one that chooses to export its wealth and its sickness. The continued approval of state funds for overseas treatment, while Nigerian hospitals rot, is not just negligent governance. It is a deliberate choice against national development, and a betrayal of public trust.
To root out corruption, Nigeria needs more than a new law; it requires a comprehensive, system-wide strategy. This should include strong whistleblower protection, mandatory transparent procurement systems—like Open Contracting for Health—and independent regulatory enforcement with zero tolerance for political interference.
Simultaneously, the NHIA must break from its predecessor’s failures. Its operations must be radically transparent and culturally competent, reflecting the realities of Nigerian communities to ensure mass enrollment. Public trust will not be granted; it must be earned through performance, equity, and accountability.
Reversing the brain drain is equally urgent. Nigeria must genuinely value its healthcare workforce through competitive pay, reliable equipment, safe working conditions, and a culture of respect. Professional rivalries must be deemphasized through institutional policies that promote teamwork, not territorialism. As one experienced doctor rightly put it, “Human resources require good motivation to commit themselves to lifelong service.”
Perhaps the boldest, yet most necessary action is to curb state-funded medical tourism. A law must be enacted to prohibit public officials from using government money for treatment abroad. When leaders are compelled to rely on the same hospitals as the citizens they govern, the urgency to improve these facilities will become personal and immediate. The billions saved should be directly reinvested into building and equipping hospitals across the country, creating a virtuous cycle of trust, service, and national pride.
The prognosis for Nigeria’s health sector is dire, but it is not terminal. Every day, citizens die from preventable diseases, fake drugs, and inaccessible care. Yet the remedy is clear. This is not a crisis of capability or resources, but of governance and political courage. If we can redirect the wealth currently sent abroad, restore constitutional health management, confront corruption, and invest in the people who make health systems work, Nigeria can build a system worthy of its people.
The cure is known. What remains is the will to administer it.Hassan Husaini mni wrote from Abuja
