To dawn When the Chairman of the House of Representatives Committee on Health, Amos Magaji, examined the challenges facing Nigeria’s healthcare system, he proposed the privatization of Nigeria’s university hospitals, stressing that this would increase efficiency and improve healthcare delivery.
However, his proposal was widely condemned by health sector stakeholders, who said the idea was unrealistic in light of current socio-economic realities.
They noted that privatization could lead to job losses for health workers and make health care unaffordable for many Nigerians, especially the poor and vulnerable.
In an exclusive conversation with PUNCH Healthwise, they advocated for alternative solutions such as increased government funding, public-private partnerships and broader health insurance to strengthen the health system without privatizing key institutions.
The President of the Nigerian Association of Junior Doctors, Dr. Dele
Abdullahi stressed that it is not feasible for Nigeria to privatize university hospitals at this time.
He acknowledged that privatization could potentially provide relief to the government by shifting the financial burden from hospital management, but he also highlighted fundamental concerns about access to and affordability of health care.
The NARD chairman raised critical questions about whether privatization would improve the efficiency of hospitals or help the government meet its health care obligations to all citizens.
He pointed out that health care delivery remains expensive even under government management, let alone under private entities, where costs are typically higher and likely to rise further.
Abdullahi stressed that Nigeria must first ensure universal access to health care before considering privatization. He lamented that a significant portion of the population does not have adequate health insurance and continues to pay for medical care out of pocket.
The NARD president also highlighted the disparity between public and private health care, noting that privatization of university hospitals could jeopardize patient care due to operational standards and priorities.
He was concerned that if specialised health services were privatised without subsidies, they would become financially unaffordable for many Nigerians who normally could not afford such high costs.
He said: “I won’t say that privatising university hospitals is a bad idea, I will just say that it is an idea that is not viable for our current society. It is one thing to see what works in other spheres and it is another thing to domesticate it in your society.
“The ideology of privatizing federal teaching hospitals will help governments by taking the burden of running those hospitals off them. But will it make the hospitals more efficient?
“And will it help the government to achieve its obligation of efficient health care for every citizen? Those are the points we need to look at. And in this case, both answers are no. As it stands, health care is expensive, even when the government is the one delivering it. Talk more about when the private hospitals are the ones delivering it.
“We have a country that although NHIA is a law. And because of that, every citizen of Nigeria must have health insurance. But the health insurance does not even cover 20 percent of the total population of Nigeria. Most Nigerians still pay out of their own pockets.”
Abdullahi added: “Even many people who already have health insurance are still paying out of pocket. So there are so many other things that need to be achieved before you float the idea of privatizing our teaching hospitals in the spirit of universal health care.”
“I won’t say that what they suggested is totally wrong. I will just say that Nigeria is not prepared for that kind of idea in any way. And it is best not to bring it up at any time now.”
Regarding the impact on medical training, the NARD president acknowledged that training programs may continue under privatization, but he expects a drastic increase in training costs, which could put further pressure on government finances.
To improve the delivery and efficiency of health care, he advocated for more government funding to improve infrastructure, equipment and compensation of health care workers in hospitals.
He stressed that it is critical to strengthen the financing of federal institutions, especially given the inadequate staffing and functional challenges facing many primary and secondary health care facilities in Nigerian states.
Abdullahi concluded with a call to prioritize universal health coverage before exploring options that could potentially increase the financial burden on helpless patients and jeopardize access to health care for the broader population.
“To be clear, the ideology behind your improvement of health care in all settings is to increase funding to provide equipment in the settings and improve staff remuneration.
“But in the spirit of universal health coverage, if you privatize your hospital, it means that the hospital has to recoup the funds used to buy equipment and everything from patient care. The basic strategy that the government can adopt is to find ways to improve the financing of our federal institutions. Currently, most of the primary and secondary health care facilities of the state are not functional and lack the basic manpower that is needed.”
“So what they need to do is find ways to improve the financing of these federal teaching hospitals, and find ways to support the primary and secondary facilities. And once universal health coverage is achieved, they can now think of other ways to reduce the cost of governance,” he suggested.
Professor Tanimola Akande, former national chairman of the Association of Public Health Physicians of Nigeria, warned that privatisation could limit access to quality health care for many Nigerians.
The Public Health Professor argued that privatization could focus primarily on those who can afford expensive medical care, neglecting the broader population group in need of subsidized care.
The doctor stressed that the idea of privatizing federal teaching hospitals was not suitable for Nigeria, adding that these hospitals, which are funded and managed by the federal government, play a vital role in delivering essential health care to the local population through highly qualified health professionals.
The don pointed out that even in developed countries with better economic conditions, government-run hospitals are not privatized. He stressed that health care should be accessible to all citizens as a fundamental right.
He also stressed that privatization would hamper access to health care for poorer Nigerians at a time when they need it most.
The don said that instead of privatization, the government should explore an alternative option such as public-private partnership and expanding health insurance to address the financing problems of federal university hospitals.
He acknowledged that privatization can improve quality, but also argued that similar results could be achieved through increased government funding, greater transparency, accountability and better motivation of health care workers.
Akande was concerned about the potential job losses among healthcare workers as a result of privatisation, citing the current low efficiency levels in hospitals.
He argued that while privatization may reduce medical tourism, it could also increase financial barriers for the poor, potentially worsening Nigeria’s already dire health indicators.
The professor stressed that it is the government’s responsibility to ensure that health care is accessible to all citizens. He advocated measures that increase efficiency without compromising service delivery.
He further said: “Federal Teaching Hospitals are run and funded by the Federal Government. They provide medical care to people in their catchment areas through highly qualified health professionals. The proposal for privatization is ill-conceived for a country like Nigeria. Even well-developed countries with citizens who have better economic status still do not privatize their government-run hospitals.
“It is the right of every citizen to have access to quality health care at all levels. It is the social responsibility of the government to provide this access to health care. Privatization of federal teaching hospitals is an inappropriate option that denies poor Nigerians access to health care when the need arises.
“There are several other options to address the problem of federal teaching hospital funding. These include public-private partnerships and high-cost health insurance.
“Privatization will improve the quality of health care, but this can also be achieved by increasing government funding, ensuring transparency and accountability, and motivating health workers to deliver quality care.”
“Privatization will certainly lead to job losses among health workers, because the owners want to be more efficient in their services. At the moment, efficiency is low. But retained health workers may be more motivated.”
On how privatisation would affect attitudes towards work, the doctor said: “In addition, health workers’ attitudes towards work and patient care, as well as productivity, should be improved and properly monitored, along with effective supportive supervision.
“Public-private partnerships will significantly improve efficiency in service delivery. Improved technology and use of ICT will help improve efficiency.
“The idea of privatizing federal teaching hospitals should be discouraged. Instead, other measures should be considered to improve efficiency. If allowed, it will definitely affect financial access among the poor.
“This could further worsen the already poor health indices in Nigeria. While privatization may reduce medical tourism, only the rich will have access to the services in those facilities.
“However, the government has a social responsibility to make health care accessible to its citizens, which will contribute to achieving universal health care.”
