‘The puzzle of 240 million people with Doctors everywhere but no hospital at home’
There is a video in circulation this week that should make every Nigerian leader hide his face in shame. In it, a former Head of State – General Abdulsalami Abubakar, who handed over power to President Olusegun Obasanjo 27 years ago in 1999 – is seen advertising an Indian hospital where he just had a knee replacement surgery. He is smiling. He is grateful. He is advertising. He is our former Commander-in-Chief advertising foreign healthcare as if he is an influencer for Indian medical tourism. Gen. Abdulsalami is 84. We wish him long life and quick recovery. This is not an attack on him. It is an attack on the system he led, the system he handed over, and the system that has refused to build a hospital that can replace a knee for its own former leader. This video is just an addition to many reproaches. President Umaru Yar’Adua returned from a Saudi Arabia hospital in 2010 and died in Aso Villa. Former President Muhammadu Buhari actually died in a London hospital in July 2025 after spending more days in London hospitals than in Daura between 2015 and 2025.

President Bola Tinubu has been visiting France repeatedly since 2023. The State House says it is holidays. There have been persistent speculations that he goes there on health grounds. When Macron, his host in France, goes to UNGA, our President stays back in France. The optics is terrible. The list is endless: Our former leaders, ex-this, ex-that have died in hospitals in Egypt, Sudan, Saudi Arabia, UAE, US, UK, Germany, etc. We have a roll call of shame: Former Vice Presidents, Senate Presidents, Governors, Ministers – all dying abroad as if Nigeria is cursed never to have good hospitals.

Which raises the question that will not go away: When will Nigerian leaders, including physicians who became Governors and Ministers, combine resources to build and equip hospitals for Nigerians and for themselves?

When will the bicameral legislature debate the danger of non-existent all-Nigerian health insurance whereby most people won’t depend on out-of-pocket expenses on healthcare? How many leaders must die abroad before we get angry and intentional about healthcare as a fundamental objective and directive principle of state policy under Chapter 2 of our Constitution?

Lest we forget, when will citizens be active enough to demand this responsibility from government at all levels? This is the puzzle of 240 million people.

‘The irony – We have the Doctors, but no hospitals’: Nigeria has no shortage of doctors. In fact, we export doctors. According to the UK General Medical Council, over 12,000 Nigerian-trained doctors work in the UK alone. In the US, over 4,000. In Canada, Saudi Arabia, Australia – thousands more. These are our doctors. Trained with our tax money in our universities. Now they are brain gain to the West. Why did they run? They ran because there is no hospital to work in at home. We have so many universities – federal and state – offering medicine and health sciences with teaching hospitals. University of Ibadan, University of Lagos, Ahmadu Bello University, University of Nigeria Nsukka, University of Benin, University of Ilorin, University of Port Harcourt, University of Jos, Bayero University Kano. Over 40 federal and state universities offering MBBS. There are universities of medical sciences of late. What of the University of Ibadan and its University College Hospital, UCH? UCH Ibadan was once ranked the 4th best hospital in the entire Commonwealth – comprising UK, Canada, Australia, New Zealand, India, Pakistan, and all former British colonies. Yes, 4th.

It was built and equipped to the standard of the London University Teaching Hospital. In the 1960s and 1970s, even the Saudi Royalty used to visit UCH Ibadan for medical care. Saudi princes flew to Ibadan, not Ibadan flying to Saudi Arabia.

Today, UCH cannot do a simple CT scan consistently. Its theatres are in darkness. Its doctors are on strike over lack of gloves. Its roof leaks. Our leaders who graduated from UI cannot be treated there. The National Hospital in Abuja – built as the national flagship, with helipad, with oncology centre – is still ill-equipped. The University of Abuja Teaching Hospitals and others in the Territory are glorified consulting clinics. They refer everything abroad. Lagos State built Lagos State University Teaching Hospital, LASUTH. Still not fit for a Governor’s knee replacement. Delta State has two former governors who are medical doctors: Dr. Emmanuel Uduaghan and Dr. Ifeanyi Okowa. Both were commissioners for health before becoming governors. Delta should have been the medical hub of Nigeria. Is it? Ondo State had Dr. Olusegun Mimiko – a medical doctor – as governor for eight years. He tried with Mother and Child Hospitals. Where are they today? Underfunded, understaffed. Enugu state had Dr. Chimaroke Nnamani – a doctor, professor of fetal medicine – as governor. Where is the legacy hospital? So the puzzle: Doctors have ruled us as Governors, Ministers, Commissioners, but none left sustainable healthcare system, let alone good hospitals as legacies. Why?

‘The culture of medical tourism as status symbol’. Medical tourism is not just about lack of equipment. It is about status. For Nigerian elite, going abroad for treatment is a status symbol. It is like buying a private jet. “I did my knee in India” is a bragging right at Ikoyi Club. “I did my check-up in London” is a class marker.

General Abdulsalami advertising Indian hospital is not just seeking care. He is – perhaps unconsciously – telling Nigerians: If you can afford it, go to India. India is good. But India built that hospital because its leaders decided to invest in healthcare as industry. Apollo, Fortis, Medanta – these are private hospitals built by Indian doctors who stayed back. Why did Indian doctors stay back while Nigerian doctors ran? Because Indian government created environment: power, water, equipment, pay, respect.

Nigerian elite did the opposite: They killed environment at home and use their looted money to pay Indian hospitals. The economics is staggering:

Central Bank of Nigeria estimates Nigeria spends “over $1.5 billion annually on medical tourism”. The African Development Bank says Africa spends $6 billion, with Nigeria taking 25%. That $1.5 billion can build 10 world-class hospitals every year. In 10 years, 100 hospitals. That money can equip UCH, LUTH, ABUTH, UNTH, National Hospital to world class.

But we prefer to give it to India, UK, Egypt, UAE. And the shame: most of these foreign hospitals are run by Nigerian doctors who ran abroad! You fly to the UK to see Dr. Okonkwo who left UCH because UCH had no electricity.

You fly to India where the orthopedic surgeon is Dr. Naresh Trehan, but his assistant is Dr. Adeyemi from Ibadan who left because he was paid N250, 000 per month. It is a comedy of shame.

But our National Assembly has never debated healthcare as an emergency. What do they debate? New cars for senators, new jets for president, new state creation, tax bills that tax poor more. When did the Senate last have a 3-day emergency session on why Nigerians spend out-of-pocket for health? According to WHO, over “75% of health spending in Nigeria is out-of-pocket” – the highest in the world. Meaning you pay cash before you are treated. No insurance. No cover.

NHIS – National Health Insurance Scheme – covers less than 5% of Nigerians, mostly federal civil servants. The rest – 230 million – pay cash. If you have no cash, you die. How many times has the House Committee on Health summoned the Minister of Health to explain why National Hospital Abuja has no PET scan? How many times has Senate asked why UCH Ibadan’s radiotherapy machine has been broken for two years? They don’t because they themselves will go abroad. So why fix it? This is the danger of a legislature that does not use the hospitals it appropriates money for.

‘The Doctor-Governors who failed us’: This is the most painful part. We expected doctor-governors to be different. Dr. Olusegun Mimiko in Ondo state (2009-2017) is a medical doctor. He founded Nigeria’s first University of Medical Sciences. He built Mother and Child Hospitals in Akure and Ondo that reduced maternal mortality by 50%. It was celebrated globally. But after he left, funding stopped, doctors left, equipment collapsed. Today, those hospitals are shadows. He did not build a system, he built projects. Systems survive governors. Projects die with them.

Dr. Emmanuel Uduaghan in Delta (2007-2015) is a medical doctor, who had a vision of Delta as medical tourism destination. But Delta State University Teaching Hospital, Oghara, remains under-equipped. His successor, Dr. Ifeanyi Okowa, another medical doctor, also continued. Yet Delta’s biggest export is still medical patients to India.

Dr. Chimaroke Nnamani in Enugu (1999-2007) is a U.S-trained professor of medicine. He built ESUT Teaching Hospital Parklane. But today, Enugu residents still go to private hospitals or abroad. Why did they fail? 1. They built hospitals as buildings, not as ecosystems. A hospital is not cement and paint. It is power (24-hour electricity), water, equipment maintenance, supply chain for drugs, retaining doctors with good pay, training nurses, health insurance to pay bills. Nigerian governors build edifice and commission it with fanfare. No budget for diesel to power generator. No budget for spare parts for MRI.

2. They fell into the federal trap: “Federal Government will do healthcare.” No. Healthcare is on concurrent list. States can build world-class hospitals. Lagos can build hospitals better than India if it wants. But Governors prefer flyovers that can be seen from helicopter.

3. Corruption. Hospital equipment procurement remains the most corrupt in Nigeria. A $100,000 MRI machine is invoiced at $1 million. The balance is shared. So machines bought are fake or refurbished. They break in six months. No warranty. The doctor-governors were inside that system and could not break it.

What will make Nigerian leaders serious about domestic healthcare?
1. Law: Make it illegal for public officers to seek treatment abroad with pubic funds: Rwanda did it. President Paul Kagame does not go abroad for treatment. If you are a minister, you must use King Faisal Hospital in Kigali. Nigeria must pass a law: No public funds for medical tourism for President, Vice President, Governors, Ministers, National Assembly members. If you want to go abroad, pay from your pocket, not from estacode. If that law is passed, National Hospital will be fixed in six months.

2. Mandatory health insurance: NHIS must cover all 240 million. 1% of GDP must go to health insurance. Make it mandatory for employers to pay. Make it work like in Ghana where NHIS covers 60%. If people have insurance, hospitals will have money to retain doctors.

3. Fix power for hospitals first: You cannot run a hospital without regular power supply. Declare all teaching hospitals as strategic power zones. Give them dedicated gas turbines, solar grids. UCH, LUTH, ABUTH, UBTH, UNTH, National Hospital, Abuja must have 24-hour electricity before Aso Presidential Villa energy system.

4. Citizen activism: When will citizens too be active enough to demand responsibility? When will Nigerians stop saying “God will provide” and start saying “Government must provide”? Healthcare is not a privilege. It is a right. Citizens must vote on health. Must protest when hospitals have no drugs. Must sue government for violating Section 17. We have the doctors abroad, waiting to come home if home is ready. We have the money. $1.5 billion medical tourism money every year is enough. We have the land. UCH land alone is bigger than many Indian hospitals. What we lack is intentional anger. A nation that is not angry when its former leader advertises Indian hospital has lost its majesty. A nation that watches its President holiday in France while its teaching hospitals have no electricity has lost its shame.