The solution starts with the setting up of public-private partnerships (PPP), having the tertiary hospitals being handed over to private organisations and people to run, not necessarily on a permanent basis, but on pre-agreed terms – perhaps for like 20 years. A pilot of such programme was carried out by the Olusegun Obasanjo administration…


A lot is being said about the health sector in Nigeria and what needs to be done. There seems to be an obsession with increasing the budget for every sector as a solution to its problems but quite often that is not the way to go.

There is a paradox in Nigeria: We don’t have enough doctors and so we train them at one of the cheapest rates in the world and then we are unable to utilise them. Being well trained, they are welcomed with open arms to countries that understand the role health care plays in driving the economy. We are probably one of the leading global exporters of doctors.

In essence, we are sort of a charity organisation because we train doctors with our resources and then let them go for free. And, currently, at an alarming rate. We need to begin to think out of the box to solve Nigeria’s health care problems and stop blaming the lack of funds and corruption all the time.

These are Nigeria’s health care problems:

1. Funding (for hospitals and patients);
2. Massive brain drain, due to the lack of jobs and good working environments;
3. Concentration of doctors and hence high quality health care in the urban centres and cities;
4. Lack of quality care, as tertiary hospitals are currently working as glorified secondary hospitals (and if closely examined, what is offered is far from tertiary level care).

With these issues bedevilling our health sector, unique solutions would need to be made after the proper dimensioning of the problems on ground.

What needs to be done:

1. Having more Nigerians who are able to access decent health care;
2. Moving qualified doctors closer to the patients, so that they can be reached on time;
3. Making efforts to keep our doctors on the job, as the present doctor-to-patient ratio is not good;
4. Offering high quality health care to prevent/reduce medical tourism and possibly even attract medical tourists from our neighbours.

The solution is within our reach and would come shortly but first it’s important to note how financing is done currently.

In a nut shell, the federal government takes care of tertiary health care and is presently the most attractive employer of doctors in Nigeria. Unfortunately, it has its limits and can only employ a certain number of personnel. Hence, there is hardly any other option for the doctor, which is why many health care personnel are simply leaving the country, as the federal government is stretched out in its capacity to employ due to scarce resources.

The States of the federation are currently running the secondary level care hospitals i.e. the General Hospitals, which is also challenging because these States have limited funds and can barely pay an adequate number of staff. Thus, the States only offer a fraction of what the federal government pays currently, and thus they cannot attract or keep high quality staff or run the hospitals effectively, financially.

The local government is running the primary level of health care presently and it is riddled with corruption and the lack of supervision. In summary, primary health care is next to none existent in terms of what it should properly offer, besides counselling and basic drugs. There is also the claim of the lack of funds to support all its services.

However, we need to remember that healthcare can be a booming business and industry, as we know, hospitals have the capacity to generate money and hold their own as business ventures.

The solution starts with the setting up of public-private partnerships (PPP), having the tertiary hospitals being handed over to private organisations and people to run, not necessarily on a permanent basis, but on pre-agreed terms – perhaps for like 20 years. A pilot of such programme was carried out by the Olusegun Obasanjo administration, whose privatisation of the Garki Hospital, Abuja, showed outstanding results as evidence for all to see. What happens in this situation is that the private organisations take over the system, in a manner that definitely ensures efficiency and profitability.

Some of the challenges of this model include the fact that health care would become significantly more expensive, but this would be addressed subsequently. Another challenge is that the federal government has overstretched its capacity, such that doctors in tertiary hospitals are currently more than are required to keep the hospitals functioning at full capacity. As such, some staff would need to be dropped in order to revert to efficiency. This would also be addressed later.

One of the main criticisms of the model pertains to the question of corruption. How do we ensure that officials in the local government areas would actually sponsor the people in need and not only their families or swindle the funds involved? Well, that’s why it would be strictly based on a system of referral.


What is most attractive about the PPP model is that the subventions and funds from the federal government that are currently going into these health care facilities would be freed up and can then be channelled towards other areas. And these are humongous amounts of money.

These funds should then be used to take over secondary level of health care, implying that staff who are not retained by the privatised tertiary hospitals can remain under government employment, be posted to any of the general hospitals in the State and earn their current salaries and possibly a little more as rural allowance. This means more profitable federal government work would now necessitate that doctors are moved closer to the populations that need them. Also this would include consultants of different specialties, especially general surgeons, family doctors, obstetricians and gynaecologists and paedetricians, etc. And with these consultants in these places, they could each train a number of residents, thereby opening up more slots for residencies, which are on the decline and constitute a key driving force for brain drain. Residents can then be rotated as pre-discussed in the PPP agreement for specialty postings to the tertiary centres, for the few required skilled learning. This would also open up significantly more centres for housemanship, which is currently a challenge.

This also sets up the same level of care currently offered by the teaching hospitals, while the PPP tertiary centres move on towards more sophisticated aspects of medicare, including organ transplant, minimal access surgery, stem cell research and other more technical things.

It also means that the same cost of care and the same level would still be available for Nigerians, except at a significantly closer distance to them.

The funds currently being used by the states can subsequently be channelled towards primary health care, as they take over the primary level of care. This would equally ensure closer supervision and more funds to them, and at least more doctors, even if these are medical officers and others at that level, who can administer some level of care, at the minimum. This would, definitely, be an upgrade on the current status of our health care.

What then happens to the poor who need specialist care? They would die. An average farmer who has chronic kidney disease (CKD) and requires dialysis for sustainance till renal transplant could happen, would currently die.

But this solution gives some hope. The money currently being channelled to the primary health care system at the local government level can then be used to sponsor people for health care from that local government area (LGA). And, this would be strictly on referral from the secondary health facilities i.e. General Hospitals and monitored appropriately.

One of the main criticisms of the model pertains to the question of corruption. How do we ensure that officials in the local government areas would actually sponsor the people in need and not only their families or swindle the funds involved? Well, that’s why it would be strictly based on a system of referral.

The reality is that these government hospitals will still be as inefficient as they currently are: the primary health centres will have the issues that the General Hospitals have, but what we would have done is to bring health care closer to the patient, to keep more doctors, and create high quality tertiary centres that would reduce medical tourism.

While ongoing, we would also try to find means of getting the farmer and local trader to get into an efficient insurance scheme. This would not require any additional investment to what is already being spent on our health sector, but is simply an innovative idea that seeks to solve the numerous problems that we all know exist.

Need I mention how it would tackle the problem of health unions and strikes? This is subject to modifications but certainly one would see that there is something in it, if one keeps an open mind.

But these old guys up there don’t have ideas anymore, which is why a former vice chancellor would say that doctors should leave because there is no capacity to employ them and, in addition, a minister of health would say that we should become farmers and tailors because the federal government doesn’t have money to pay everyone.

Obikili Chinedu Gee a senior registrar in department of obstetrics and gynecology at the Jos University Teaching Hospital (JUTH).