Recently, Nigerian hospitals witnessed a series of deaths from routine treatments that triggered national outrage. But without reforms that foster private participation, accountability, and innovation, this problem will remain a constant feature of the system.

In Lagos, renowned author Chimamanda Ngozi Adichie lost her 21-month-old son, Nkanu Nnamdi, to alleged over-sedation during a private clinic’s diagnostic procedure. Adichie accused the hospital of negligence and demanded accountability.

Similarly in Kano, Aishatu Umar died after surgeons at Abubakar Umar Urology Hospital accidentally left surgical scissors inside her abdomen during a kidney procedure. Chimezie Ihemedu, 47, also died from a ruptured appendix after a government hospital wrongly told him to “eat fruits and vegetables” and left him untreated for 24 hours. These misfortunes highlight a Nigerian healthcare system collapse described as tragically familiar, caused by a system that immunes practitioners  accountability and renders the patients powerless.

Even though the Nigerian healthcare system is not purely monopolised, it operates within constrained and fragmented markets where both public dominance and weak competition limit accountability. This clouds the hospitals with little or no pressure to improve service delivery, leaving patients to bear the brunt of the stigma.

Kelechi Ohiri, the Director General of the National Health Insurance Authority, revealed only 10 percent of Nigerians are covered by any health insurance, leaving the remaining 90 percent to pay out-of-pocket on all hospital visits. This system breeds delay, as in Owerri where a patient’s relatives had to deposit money and buy all medications while his condition deteriorated until his death. The “pay-first” culture turns hospitals into payment booths rather than healing centres.

While some argue this affects only the poor, quality remains unreliable even when cash is available. Adichie’s son died in a reputed private Lagos hospital. Also in January 2026, entertainer Esther “Sunshine” Thomas, 26, died from post-surgery complications. Her family alleges that striking doctors at her first public hospital provided only painkillers, forcing a late emergency transfer.

These stories show that weak competition and limited transparency and accountability prevent Nigerian hospitals from disciplining poor outcomes. In this environment, profit incentives do not align with patient welfare, creating fertile ground for unpunished neglect and inertia.

A report from the Nigerian Association of Resident Doctors indicates one doctor attends to 9,083 patients, with health funding rarely exceeding 5 percent of the budget. The Nigerian Medical Association warned of a “national emergency,” urging President Tinubu to constitute the Medical and Dental Council. They explained that this failure leaves nobody empowered to discipline negligent doctors. Ultimately, the broken regulatory framework ensures negligence happens without recourse.

These failures all occur due to distorted incentives. It is expected that when patients lack choices, providers will do as they want and face no consequences. The absence of accountability and competition makes revenue collection the only incentive available. The tragic result is captured by one grieving husband who lost his wife to preventable childbirth complications caused by her consultant. The consultant hastily delivered the baby and walked away, leaving her bleeding, insisting all was fine, until it was too late.

The Way Forward  

The solution to this problem lies in bringing more competition, ensuring accountability and choice icons for consumers of healthcare services. A cursory look at what is obtainable in other countries reinforces this argument. India made access to healthcare service easy through a growing private health sector supported by innovation and the largest insurance in the world. The sector delivers over 70 percent of outpatient care in the country. While Rwanda also has a community-based health insurance model, Mutuelle de Sante, that has a mix of public oversight and private delivery. This model improves access and reduces out-of-pocket spending. A look at these examples suggests that healthcare systems are liable to perform better when competition is expanded, insurance coverage is strengthened and patients are empowered to make choices.   

A similar approach can transform healthcare in Nigeria. The government should permit and empower multiple private clinics and diagnostic centers, especially in rural areas. Telemedicine should also be encouraged with health-tech startups that allow rural patients remote consultations. Of utmost importance, insurance should be expanded, so that care can be prepaid. This will shift the incentive from revenue collection towards preventive and timely treatment. 

On an accountability level, hospitals should disclose basic outcomes and patient feedback. Instead of just punishing malfeasance after tragedies, regulators should help foster patients’ choices. For instance, having an information portal where Nigerians can see and compare the mortality rates and wait times of various hospitals. This will force hospitals to raise standards. The presence of affordable insurance will also ensure patients are not denied treatments.

The recent healthcare disasters are not inevitable. They are the result of policies that concentrate control, limit choices and weaken accountability.  By expanding choice, encouraging private participation, and ensuring accountability, the healthcare system can be improved.

This article is published as part of the Liberalist Centre’s Next Advocates Liberty Project supported by the Institute of Economic Affairs through her Whetstone Freedom Fund.