When care becomes a choice between time and survival

When patients must choose between long waiting hours and unbearable medical bills, it is a clear sign that a healthcare system is failing the very people it was designed to protect. Across Nigeria today, this painful dilemma has become routine, a quiet crisis unfolding in hospital corridors, private clinics, and family homes.

For millions, seeking healthcare is no longer just about healing; it is about endurance, sacrifice, and, too often, despair.

In overcrowded public hospitals, patients arrive before dawn, hoping to secure a place in long queues that stretch endlessly. The promise is affordability, but the cost is time, sometimes dangerously long delays that can worsen conditions or even cost lives. On the other hand, private hospitals offer speed and efficiency, but at prices that can wipe out savings, plunge families into debt, or force them to abandon care altogether.

This is not how healthcare should work.

In an ideal Nigeria, healthcare would not be a gamble. A mother would not have to decide between feeding her children and paying for a vaccine. A young professional would not lose his sight because of delays or unaffordable treatment. Care would be timely, affordable, and accessible, regardless of income or location.

“Fixing Nigeria’s healthcare system does not require reinventing the wheel. It requires doing the basics, consistently and well.”

Public hospitals would function as the backbone of the system (well-funded, properly staffed) and be equipped with modern facilities. Waiting times would be reasonable because there would be enough doctors, nurses, and diagnostic equipment to meet demand. Essential drugs and vaccines would always be in stock.

Private healthcare providers, rather than serving as an expensive alternative, would complement the public system. Through strong partnerships, they would expand access, share expertise, and operate within regulated pricing structures that protect patients from exploitation.

Most importantly, no Nigerian would have to pay out-of-pocket for life-saving treatment. A robust health insurance system would ensure that the cost of care is shared fairly, removing the financial fear that currently shadows every illness.

This is not an unrealistic dream but a standard already achieved in many nations with fewer resources than Nigeria. The difference lies in commitment, coordination, and accountability.

Today’s reality tells a different story. Patients like Divine Osariemen are forced into impossible decisions, waiting in crowded public facilities where time is not on their side or turning to private hospitals where survival comes at a premium. Preventive care, such as vaccines, has become a financial burden for many, undermining efforts to build a healthier population.

Behind these individual stories lies a systemic failure (underfunded public facilities, overstretched health workers, poor infrastructure, and weak coordination between public and private providers). The result is a fragmented system where efficiency and affordability rarely coexist.

For a nation where a significant portion of the population lives below the poverty line, this divide is not just inconvenient; it is dangerous.

Fixing Nigeria’s healthcare system does not require reinventing the wheel. It requires doing the basics consistently and well.

The foundation of any effective health system is strong primary care. Nigeria must go beyond revitalising a handful of centres and ensure that all primary health facilities are fully functional, especially in rural and underserved areas. These centres should be the first point of care, reducing the burden on secondary and tertiary hospitals.

The National Health Insurance Authority framework is a step in the right direction, but coverage must move from millions to the majority of Nigerians. Informal sector workers, who make up a large portion of the population, must be fully integrated through flexible and subsidised plans. Healthcare should not depend on one’s ability to pay at the point of service.

Rather than operating in silos, public and private healthcare providers must work as a unified system. Standardised referral pathways, shared data systems, and regulated pricing can ensure continuity of care while preventing excessive costs. The government can also partner with private facilities to deliver services at controlled rates, especially in areas where public infrastructure is weak.

No system can function without its people. Nigeria must address the ongoing brain drain by improving salaries, working conditions, and career development opportunities for healthcare professionals. Retaining talent is not just a health issue; it is a national priority.

The rise of unregulated private facilities is a direct consequence of gaps in the system. Stronger oversight is needed to ensure that all providers meet minimum standards. Patients should not have to worry about whether the care they receive is safe.

While recent increases in health spending are commendable, they remain insufficient. More importantly, funds must be efficiently utilised. Granting hospitals greater financial autonomy (paired with strict accountability) can improve service delivery and encourage innovation.

Integrated digital records can bridge the gap between public and private providers, ensuring that patient information flows seamlessly across facilities. This reduces delays, improves diagnosis, and enhances overall efficiency.