…As patients choose between long wait times and high healthcare costs
For millions of Nigerians, seeking medical care has become a test of endurance and financial survival.
In overcrowded public hospitals, patients wait hours for subsidised treatment, while private clinics offer faster care at costs that can wipe out a lifetime of savings.
As underfunding, staff shortages and failing infrastructure weaken the public system, a growing number of people are being pushed into seeking private care, where the price of survival is often painfully out of reach.
For Divine Osariemen, the crisis hit on March 24th while he was driving from Port Harcourt to Benin. A sudden darkness clouded his left eye, a terrifying realisation that grew into a frantic search for help. To confirm, he covered his right eye, only to realise he still could not see.
He drove straight to a hospital, where, after several tests, he was told that one eye was already blind and that only four hospitals in Nigeria could perform the required surgery.
He chose to visit a public hospital in Abuja (name withheld). Arriving at 5:00 a.m. on the day of his consultation, he was met by a large crowd.
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“When I got to the hospital, I discovered that I was the 60th person in the queue for the day’s consultation,” he shared with BusinessDay.
“After a very long wait, I was later attended to and told that I needed nine million naira for the surgery. However, I couldn’t wait due to delays, so I visited a private facility in Kaduna State to perform the surgery at a much higher cost,” he added.
In Lagos, Vivian Salefu faced a similar hurdle for something as routine as a hepatitis vaccine. When the public clinic told her they were out of stock, she was forced to pay N21,000 for the three doses, N7,000 each at a private facility—a significant sum for a preventive measure that should have been accessible.
Nigeria’s healthcare delivery is a tale of two worlds. The public sector, built on a three-tier structure of primary, secondary, and tertiary care, boasts experienced professionals and subsidised rates. However, these halls are haunted by chronic underfunding, a “brain drain” of talent moving abroad, and infrastructure that often fails at the moment of greatest need.
In the vacuum left by the state, private providers have flourished, now handling an estimated 60 to 70 percent of outpatient care. They offer shorter wait times and modern record-keeping, but these come at a price many cannot pay. With over 60 percent of the population living below the poverty line, the “private option” is often a mirage.
“Only the citizens are left to bear the brunt,” Tuyi Mabewondu, a medical doctor, noted.
As a result, many Nigerians are compelled to make healthcare decisions based not only on the severity of their condition but also on their financial capacity and tolerance for risk.
With over 60 percent of Nigerians living below the poverty line, and as much as 75 percent in rural communities per World data, experts warn that a significant share of the population remains highly vulnerable to the consequences of this widening divide.
Emmanuel Oziuwa-John, chief executive of Salvus Emergency, described the disparity as a structural challenge within the health system, noting that bureaucratic inefficiencies continue to slow service delivery while providers grapple with rising operational costs and limited funding.
“There’s no synergy between the public and private sectors, and this is slowing down operations, shutting out communities in underserved areas while creating high operational costs for private facilities,” he said.
Taiwo Obindo, president of the Association of Psychiatrists in Nigeria, warned that the divide is also fuelling unsafe practices.
“Many private healthcare facilities are now breeding grounds for quack practices, as they have taken advantage of the gap this divide has created,” he stated.
Observed annually on April 7, World Health Day underscores the urgency of addressing these systemic gaps. This year’s theme, “Together for health: Stand with science,” highlights the need for stronger collaboration across healthcare systems, researchers, and both public and private stakeholders, experts say.
This year’s observance launches a year-long campaign celebrating the power of collaboration among researchers, private and public stakeholders to protect the health of the people,” the World Health Organisation (WHO) said in a press statement.
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Public vs private healthcare structure
According to reports by Capsuletech on African Health, Nigeria’s healthcare delivery system operates through a dual structure where public and private providers serve overlapping populations but function in markedly different ways.
“The public sector is organised across three tiers. Primary healthcare is managed by local governments, secondary care is overseen by state governments, and tertiary institutions run by the federal government. In total, the system includes about 30,000 primary health centres, 4,000 secondary facilities, and around 60 tertiary institutions,” the report stated.
“While this network is extensive on paper, many facilities, particularly in rural areas, face chronic shortages of staff, equipment, and medicines. A significant proportion of primary health centres are either non-functional or only partially operational, especially in underserved regions,” the report stated.
“The private healthcare facilities have grown rapidly to fill these gaps with thousands of hospitals, clinics, and diagnostic centres, providing care to an estimated 60 to 70 percent of outpatient care, often offering more reliable services, shorter wait times, and better record-keeping systems,” the report stated.
However, coordination between the two sectors remains weak. Referral systems are inconsistent, and patient data rarely moves seamlessly across providers. This fragmentation affects continuity of care and limits the effectiveness of health data systems. While digital health initiatives are emerging to address these gaps, integration across the system is still in its early stages.
In addition, about 50 percent of private healthcare facilities have either shut down, downsized or charge exorbitant fees just to stay afloat due to high operational costs, which many citizens in rural or underserved communities cannot afford.
This has created a huge gap in access, particularly for many living below the poverty line.
Government Efforts
Nigeria’s healthcare system is being reshaped through a mix of policy reforms, increased funding, and system-wide investments aimed at improving access and quality of care. The Federal Ministry of Health continues to lead national coordination, working through key agencies such as the National Primary Health Care Development Agency (NPHCDA), NAFDAC, and the National Health Insurance Authority (NHIA).
A central pillar of recent reform is the Nigeria Health Sector Renewal Investment Initiative (NHSRII), introduced in 2023. The programme has mobilised over $3 billion in external funding, supported the revitalisation of more than 1,000 primary health centres, and expanded workforce capacity by retraining tens of thousands of frontline health workers. This aligns with broader efforts to strengthen primary healthcare as the foundation of the system.
Legislative action has also played a role. The NHIA Act 2022 made health insurance mandatory, pushing enrolment to nearly 20 million people by the end of 2024. At the same time, federal health spending has increased significantly, rising from N1.17 trillion in 2023 to N2.71 trillion in 2025.
Despite these gains, structural challenges persist. Government health spending remains below the Maputo Declaration target of 15 percent of the national budget and per capita expenditure is still low compared to regional peers. As a result, out-of-pocket payments continue to dominate, leaving most Nigerians effectively self-insured and financially vulnerable when seeking care.
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Way forward
Experts have outlined several measures to bridge this gap, including increased health funding, proper utilisation of funds, stronger synergy between private and public health facilities through streamlined operations, and improved regulatory actions to curb quackery.
“The Nigerian health system is too bogus in terms of operational efficiency; it needs to be streamlined to improve synergy,” Oziuwa-John noted.
Neto Ikpeme, a health economic analyst, also highlighted the need for more efficient use of available funds, while allowing public hospitals greater autonomy in managing their resources to enhance efficiency and accountability.
“If hospitals are allowed to manage resources independently from the government, it will improve efficiency and healthcare service delivery outcomes, as facilities will compete with each other, further improving their performance,” he noted.
