By N’Mazi Obiomah O. Igbokwe
Healthcare in Nigeria today is profoundly disturbing. It is not merely that our hospitals are inadequate, our equipment obsolete, our health workers overstretched, or our medical infrastructure decaying. For decades, Nigerians have been speaking about these problems while those entrusted with fixing them appear to be speaking a completely different language.
It has become a dialogue of the deaf.
The Nigerian citizen says: Our hospitals are dying. Government responds: We are investing in healthcare. The patient says: I cannot afford treatment. The response is: We have introduced another programme.
The doctor says: We are leaving the country because the system is failing us. The answer is: We are concerned about the brain drain. The nurse says: There are not enough hands. The bureaucrat says: A committee has been established.
Meanwhile, people continue to die. That is the tragedy.
Healthcare should be one of the clearest expressions of the social contract between a government and its people. When a citizen pays taxes, obeys the law and contributes to the economy, there is an implicit expectation that the state will provide, among other necessities, a reasonable level of security, education and healthcare.
But what happens when the citizen reaches the hospital and discovers that the institution designed to save his life has itself become a victim of neglect?
What happens when a pregnant woman enters a public hospital and essential equipment is unavailable?
What happens when a child requires urgent medical attention and the family is first asked to purchase drugs, gloves, syringes or other basic consumables?
What happens when a patient is referred from one hospital to another because the equipment to diagnose or treat him does not exist?
And what happens when the final destination is not the hospital but death?
These are not abstract questions. Nigerians confront them every day.
A HEALTHCARE SYSTEM IN DISTRESS
Nigeria has some of the finest medical professionals in Africa. Nigerian doctors, nurses, pharmacists, laboratory scientists and other health professionals continue to distinguish themselves around the world.
Our problem, therefore, is not a shortage of intelligence. It is a failure of systems.
We have built a healthcare environment in which exceptional human beings are expected to compensate for exceptionally poor infrastructure.
A doctor may possess the knowledge and skill to save a life, but knowledge cannot replace unavailable drugs or a ventilator.
A surgeon cannot operate effectively without functioning theatre equipment. A nurse cannot provide quality care to an impossible number of patients. A laboratory scientist cannot produce a reliable result without appropriate equipment and reagents. A pharmacist cannot dispense medicines that are not available.
And a hospital cannot provide modern healthcare when its infrastructure is deteriorating around its professionals.
This is the fundamental contradiction of Nigerian healthcare: we produce professionals and place them in a system that often doesn’t give them adequate tools with which to work.
THE HOSPITALS ARE SPEAKING—BUT WHO IS LISTENING?
Walk into some public hospitals and the story is written on the walls.
Peeling paint.
Broken facilities.
Overcrowded wards.
Insufficient beds.
Unreliable power.
Water challenges.
Ageing equipment.
Poor sanitation.
Inadequate diagnostic capacity.
Long waiting times.
And, in some cases, an exhausted workforce struggling heroically against overwhelming odds.
Yet healthcare infrastructure is not about buildings.
A modern hospital is an ecosystem. It requires reliable electricity. It requires water. It requires oxygen. It requires laboratories, imaging equipment, theatres, pharmacies, blood banks, emergency services, information systems, waste management systems and properly maintained medical equipment.
It requires something as basic as a functional maintenance culture.
Nigeria has repeatedly demonstrated that we can commission magnificent buildings. The harder question is whether we can keep them functional ten, fifteen or twenty years later.
Too often, the answer is uncomfortable.
We build, commission, celebrate, Photograph, and then we neglect.
The infrastructure gradually deteriorates until another government announces another rehabilitation project. And the cycle begins again.
THE DOCTOR IS LEAVING
Perhaps the loudest alarm bell in the healthcare system is the continuing migration of health professionals.
A country spends years educating a doctor or nurse, only for another country to benefit from that investment.
There is nothing inherently wrong with Nigerians seeking better opportunities abroad. People have the right to pursue professional fulfilment and better living conditions.
The question is: why has Nigeria made leaving so attractive and staying so difficult?
When doctors complain about remuneration, working conditions, equipment, insecurity, training opportunities and professional development, they are not merely asking for personal comfort. They are describing the healthcare system.
The doctor who works a long shift without adequate support is part of the infrastructure.
The nurse who attends to dozens of patients because there are insufficient colleagues is part of the infrastructure.
The radiographer working with obsolete equipment is part of the infrastructure.
The medical laboratory scientist struggling with inadequate reagents is part of the infrastructure.
Human resources are healthcare infrastructure. When they leave, the infrastructure leaves with them.
HEALTHCARE SHOULD NOT BE A LUXURY
Another dimension to this crisis is that Nigerians rarely discuss the economics of illness with urgency.
For the wealthy, poor healthcare can be inconvenient. For the poor, it can be fatal.
A wealthy Nigerian can travel to London, Dubai, India, South Africa, France or another country for treatment.
A middle-class family may sell property, borrow money or empty its savings. A poor family may watch a loved one die.
This creates two Nigerias.
One Nigeria can purchase healthcare abroad.
The other Nigeria waits in overcrowded hospitals and hopes the doctor, nurse, equipment and drugs will be available.
This is not equitable healthcare. It is healthcare determined by purchasing power. And once healthcare becomes a function of wealth, poverty itself becomes a health risk.
THE POLITICS OF ANNOUNCEMENTS
Nigeria does not lack healthcare policies.
We have policies, strategies, programmes, endless committees, task forces, agencies and very wonderful plans.
What we often lack is continuity, accountability and execution.
The Nigerian healthcare system has suffered from what might be called the politics of announcements, where an intervention sometimes receives more attention than the measurable outcome.
A government announces the construction of hospitals. Another announces their rehabilitation. Another announces equipment procurement. Another announces a new health insurance initiative. Another announces a new programme.
But Nigerians want to know something simpler: How many lives did it save? How many maternal deaths were prevented? How many children received treatment? How many hospitals actually functioned better? How many communities gained access to primary healthcare? How many health workers were retained?
How much was spent?
What was delivered?
Who was responsible?
And what happened when the promised result did not materialise?
These questions should dominate the national conversation.
PRIMARY HEALTHCARE: THE FOUNDATION WE CONTINUE TO NEGLECT
A modern healthcare system cannot be built entirely around teaching hospitals and tertiary institutions.
The first point of contact should be a functional primary healthcare system. We had them, but unfortunately they have died like others.
The village health centre should not be a building with a signboard. It should be a functioning institution. It should have trained personnel, essential medicines, basic diagnostics, maternal and child healthcare, immunisation, health education, referral systems, clean water, electricity and reliable communication.
If primary healthcare works, many diseases can be detected and treated before they become emergencies.
If primary healthcare fails, patients arrive at tertiary hospitals with advanced illnesses that are more expensive and more difficult to treat. The result is a vicious cycle. Weak primary healthcare increases pressure on secondary and tertiary hospitals. Overcrowded tertiary hospitals produce poorer patient experiences. Poor outcomes increase the financial burden on families.And the system becomes progressively more expensive without necessarily becoming more effective.
WHERE IS THE MONEY GOING?
Nigeria’s healthcare crisis cannot be discussed honestly without discussing financing.
Healthcare costs money.
Hospitals cost money.
Medical equipment costs money.
Training costs money.
Medicines cost money.
Research costs money.
Maintenance costs money.
But money alone is not enough.
The critical question is whether healthcare expenditure produces healthcare outcomes.
Nigeria must move beyond asking:
“How much did we budget?” and begin asking: “What did Nigerians receive for the money?”
Every major healthcare project should have measurable outcomes. Every major procurement should be transparent. Every hospital rehabilitation project should have a maintenance plan. Every piece of expensive medical equipment should have a lifecycle plan covering installation, training, servicing, spare parts and eventual replacement.
Otherwise, we are simply purchasing expensive machines to become expensive monuments to neglect.
THE PRIVATE SECTOR CANNOT CARRY THE ENTIRE BURDEN
Nigeria’s private healthcare sector has performed an important role in filling gaps left by the public system.
But private healthcare is not a substitute for a functioning national healthcare system.
Private hospitals must remain economically viable. Their costs must ultimately be borne by patients, insurers or employers.
The government therefore cannot outsource its constitutional and social responsibility to private operators. What Nigeria needs is a public-private healthcare ecosystem in which government creates the enabling environment, establishes standards and provides essential public infrastructure, while private capital, technology and management expertise supplement public investment.
There is enormous opportunity here. Nigerian entrepreneurs, investors, foundations, pharmaceutical companies, medical technology companies and diaspora professionals can contribute significantly.
But they need predictable policies, credible regulation, and an environment where long-term investment is possible.
WE MUST STOP NORMALISING DEATH
Perhaps the most dangerous symptom of Nigeria’s healthcare crisis is not the broken equipment or inadequate buildings.
It is our growing ability to accept preventable suffering as normal. We hear that someone died because an ambulance arrived late. We hear that a patient could not afford a procedure. We hear that a hospital lacked oxygen. We hear that there was no blood. We hear that a doctor was unavailable. We hear that equipment was not functioning.
We express sympathy. And we move on until it happens to us. Then suddenly the statistics acquire a name. The nameless casualty becomes somebody’s mother. Somebody’s father.
Somebody’s child.
Somebody’s husband.
Somebody’s wife.
And somebody’s future.
That is why healthcare cannot be reduced to statistics. Every preventable death represents a human story interrupted.
FROM A DIALOGUE OF THE DEAF TO A NATIONAL CONVERSATION
The solution begins with listening. Government must listen to doctors. Doctors must listen to patients.
Health administrators must listen to nurses and other frontline professionals.
Policymakers must listen to communities.
And politicians must listen to everyone.
Nigeria needs a national healthcare conversation that moves beyond partisan politics.
We need to ask difficult questions about healthcare financing, infrastructure, workforce retention, medical education, pharmaceutical manufacturing, health insurance, primary healthcare, emergency medicine, fake and adulterated drugs, diagnostics, digital health and medical research.
We need to develop a long-term healthcare infrastructure plan that survives changes of government.
Healthcare should not be a four- or eight-year political project.
A hospital built today may serve Nigerians for fifty years.
The planning horizon must therefore extend beyond the tenure of the politician commissioning it.
THE NIGERIA WE SHOULD BUILD
Imagine a Nigeria where a woman in a rural community can give birth safely because a properly equipped primary healthcare centre is within reasonable reach.
Imagine a Nigeria where an accident victim can receive emergency care without first being asked to produce money.
Imagine a Nigeria where hospitals have reliable electricity and water.
Imagine a Nigeria where medical equipment is maintained rather than abandoned.
Imagine a Nigeria where doctors and nurses can build rewarding careers without believing that emigration is the only route to professional dignity.
Imagine a Nigeria where medical research is adequately funded.
Imagine a Nigeria that manufactures more of the medicines, equipment and consumables it needs.
Imagine a Nigeria where health insurance actually protects families from financial catastrophe.
Imagine a Nigeria where NAFDAC is properly empowered to fight substandard and fake drugs.
This is not an impossible Nigeria.
It is a question of priorities.
THE DEAF MUST BEGIN TO HEAR
For too long, Nigerians have complained.
Doctors have complained.
Nurses have complained.
Patients have complained.
Professional associations have complained.
Civil society has complained.
Researchers have complained.
The media have repeatedly reported the crisis.
And governments have responded with policies, promises and programmes.
Yet the fundamental problems persist.
That is why the metaphor of the dialogue of the deaf is so appropriate.
The citizens are talking.
The healthcare professionals are talking.
The hospitals are talking.
The statistics are talking.
The dead are, in their own terrible silence, talking.
The question is whether those with the power to change the system are listening.
Nigeria cannot build a prosperous nation on a collapsing healthcare system.
A sick population cannot sustain a productive economy.
A country that loses its doctors cannot easily build a resilient health system.
A society that allows preventable deaths to become routine gradually loses something more important than money: its sense of collective responsibility.
The time has come to end the dialogue of the deaf.
We need less rhetoric and more results.
Less commissioning and more maintenance.
Less policy production and more implementation.
Less political ownership and more institutional continuity.
Less reaction and more prevention.
And above all, we need to remember a simple truth:
Healthcare is not a favour that government grants to citizens. It is one of the fundamental investments a nation makes in its people.
The hospitals are speaking.
The doctors are speaking.
The nurses are speaking.
The patients are speaking.
Nigeria is speaking.
It is time for those who govern to listen.