Historical Challenges in Cardiovascular Care in Nigeria

Cardiovascular care in Nigeria has historically been hampered by limited infrastructure, high costs, and a scarcity of specialized personnel. For decades, advanced cardiac services, such as catheterisation laboratories (cath labs), were largely absent, compelling many patients to seek treatment abroad at significant expense. By the late 2000s, Nigeria, a nation exceeding 200 million people, possessed only a handful of cath labs and interventional cardiologists. As recently as 2022, Nigeria had just 12 operational percutaneous coronary intervention (PCI) facilities (11 in the private sector), averaging approximately one Cath lab per 16–17 million individuals. The country has only around 500 cardiologists in total, with only a small fraction of them trained to perform interventional procedures. This significant disparity led to widespread medical tourism, with an estimated ₦1 billion spent annually by Nigerians on overseas heart treatments.

The challenges extended beyond infrastructure to financial and human resource limitations. Over 70% of healthcare expenditures in Nigeria are out-of-pocket, rendering advanced cardiac interventions unaffordable for most citizens. The absence of a strong health insurance system and the high cost of imported cardiac stents, pacemakers, and other consumables placed life-saving procedures beyond the reach of many. Furthermore, Nigeria experienced a brain drain of specialists during the economic downturn of the 1980s and 1990s, with even early pioneers of cardiac surgery emigrating.

In the late 1970s, University College Hospital (UCH) Ibadan boasted a thriving cardiothoracic program that achieved milestones such as the first pacemaker implantation in 1976 and early open-heart surgeries. However, economic hardship led to the “dispersal of UCH doctors to various greener pastures.” Virtually the entire team of surgeons, cardiologists, and nurses emigrated, leaving local cardiac services in disarray. By 2005–2010, only a very limited number of Nigerian physicians could perform open-heart surgery or coronary interventions domestically.

Turning Points: First Local Interventions and Milestones
Despite these challenges, the last 15 years have marked a turning point, transitioning from “brain drain” to “brain gain” as Nigerian doctors trained abroad return home to establish high-calibre cardiac centres. A pivotal moment occurred in July 2009 when Dr. Adeyemi “Yemi” Johnson, an interventional cardiologist with 25 years of practice in the U.S., performed Nigeria’s first percutaneous coronary intervention (PCI) – a coronary angioplasty and stenting – at Reddington Hospital in Lagos. This landmark procedure, the first of its kind in West Africa, meant that Nigerians experiencing heart attacks or angina no longer needed to be rushed abroad for emergency angioplasty. He had left a successful practice in the U.S. specifically to found First Cardiology Consultants (FCC) in Lagos, a specialist heart hospital.

Shortly thereafter, FCC expanded its team with diaspora talent like Dr. Kofoworola “Kofo” Ogunyankin, a UK- and US-trained cardiologist who became FCC’s Chief Medical Director. Together, Dr. Johnson and Dr. Ogunyankin transformed FCC into a cardiac centre capable of catheter-based interventions and cardiothoracic surgery.

Another significant contributor to Nigeria’s cardiology resurgence is Professor Kamar Adeleke, an interventional cardiologist who trained and worked in the U.S. for over 40 years. Prof. Adeleke returned to Nigeria in 2013 with a vision to expand cardiac surgery and intervention capacity nationwide. Through his enterprise, Tristate Heart and Vascular Centre, Adeleke and his team have since partnered with several Nigerian institutions to perform high-level cardiac procedures. At UCH Ibadan, he helped activate a new catheterisation lab that had been idle for a year; in 2013, he performed the first coronary angiography in a Nigerian public hospital, demonstrating that complex diagnostics could be done locally. He went on to establish cardiac surgery programs at Babcock University Hospital and other centres. In just three years, around 2017–2019, Tristate’s team performed over 400 open-heart surgeries at Babcock University (a private teaching hospital) and dozens more at UCH Ibadan.

These included coronary artery bypass grafts and valve repairs that were previously only accessible abroad. Meanwhile, private cardiac facilities in Lagos have also been strengthened by returning specialists. Dr. Olurotimi Badero, recognised as the world’s first dual-certified interventional cardiologist and nephrologist, built his career in the United States but now serves as Director of the Interventional Cardiology Program at Lagoon Hospitals in Lagos and was very recently appointed honorary professor at the University of Lagos. Lagoon Hospitals recently opened a 27-bed cardiac centre of excellence with a brand new cath lab – a significant addition given that Lagos State previously had only five functional cath labs. One of the most remarkable recent milestones in Nigeria was achieved by Dr. Tosin Majekodunmi, a British-Nigerian interventional cardiologist who returned in 2016 to become Medical Director of Euracare Multi-Specialist Hospital in Lagos. In 2022, Dr. Majekodunmi’s team performed Nigeria’s first Transcatheter Aortic Valve Replacement (TAVR) in an 80-year-old patient with severe aortic stenosis. Similarly, in 2024, he performed the first device closure of a ruptured sinus of Valsalva aneurysm.
Diaspora Collaborations and Remote Contributions. Not all contributions necessitate a full-time return to Nigeria; many cardiovascular specialists in the diaspora are partnering remotely or through periodic visits to enhance local capacity. Nigerian cardiologists abroad often volunteer for short-term “missions” or proctor new procedures for their colleagues back home. For instance, Mr. O.C. Nwezi, a cardiac surgeon based in Belfast, Northern Ireland, serves as the lead surgeon for the Save a Heart Foundation. Over the past decade, he has led multiple medical missions to Nigeria, during which the team performed more than 400 cardiac procedures, including 320 open-heart surgeries, and provided training to local healthcare professionals.

Similarly, expatriate Nigerian cardiologists like Dr. Ogundu Ungwu (an electrophysiologist in the U.S.) contribute by co-organising training workshops and live-case demonstrations via webinars and conference visits. These interactions expose Nigerian clinicians to the latest techniques and guidelines. The diaspora is also assisting in sourcing equipment, where local options are limited, hospitals leverage diaspora networks to procure essential devices and consumables at a lower cost. Nigerians living abroad are increasingly contributing their skills and resources back home. This engagement is slowly turning what was once a loss of talent (“brain drain”) into a valuable asset (“brain bank”) that can benefit Nigeria’s healthcare system.
Policy Recommendations for Sustaining the ‘Brain Gain’
The resurgence of cardiovascular care in Nigeria, driven by returning and collaborating experts, is a promising trend. To sustain and expand this “brain gain,” concerted efforts in policy and funding are essential:

Strengthen Infrastructure and Funding: The government should increase investments in cardiac care infrastructure, from cath labs to cardiac surgery theatres, particularly in public tertiary hospitals. As experts have noted, improved facilities and equipment are crucial to attract talented specialists back. Public-private partnerships, such as the collaborations between Tristate and institutions like University College Hospital, Babcock University, and Reddington Hospital, can be leveraged to share costs and expertise. Additionally, sustainable financing models (e.g., expanded national health insurance coverage for cardiac procedures) are needed to ensure patients can afford high-tech care. When life-saving procedures are covered or subsidised, the volume of local cases will increase, attracting even more specialists to stay or return.

Invest in Human Capital and Training: Nigeria must deliberately train a new generation of cardiologists, surgeons, and technologists while incentivising its diaspora professionals to contribute. This includes expanding local postgraduate training in cardiology and cardiothoracic surgery, as well as creating short-term exchange programs where cardiology fellows can train under seasoned cardiologists. Government scholarships or partnerships could support subspecialty fellowships for Nigerian doctors in high-volume international centres. Likewise, diaspora experts should be engaged as adjunct faculty in Nigerian teaching hospitals, whether in-person or through tele-education. These steps address the skilled personnel shortage by building local expertise and aligning with global standards.

Enhance Diaspora Engagement Mechanisms: There is a need for structured avenues to integrate diaspora contributions beyond ad hoc missions. NIDCOM’s Diaspora Healthcare Initiative is a positive start. This platform could be expanded to create a database of willing Nigerian clinicians abroad and match them with local needs, for example, recruiting teams to help establish new cardiac units in underserved regions or to remotely participate in weekly grand rounds. Formal twinning of Nigerian hospitals with foreign institutions (facilitated by diaspora intermediaries) can also help bridge gaps in care. Furthermore, easing regulatory and logistical hurdles for diaspora professionals, such as fast-tracking medical licensure when they come for short stints or providing incentives like tax breaks for those who return to set up practices, would make Nigeria a more attractive place to work.

Improve Public Awareness and Preventive Care: Finally, a longer-term strategy is to reduce the burden of advanced cardiac disease through prevention and early management. Public health campaigns should educate citizens about heart disease risk factors and encourage timely care-seeking, so that fewer patients present with end-stage conditions requiring complex intervention. Strengthening primary care and emergency medical services (e.g., for rapid management of heart attacks) will improve outcomes for cardiovascular patients and reinforce confidence in local healthcare, further stemming the outflow of patients and specialists.
In conclusion, Nigeria’s journey from a period of cardiac “brain drain” to one of “brain gain” is well underway, as visionary Nigerian cardiologists reclaim leadership in addressing the country’s cardiovascular disease burden. The first PCI in 2009 and the first TAVI in 2022 on Nigerian soil are emblematic milestones, turning points made possible by diaspora returnees.

Their stories demonstrate how reversing the talent exodus can directly revitalise the healthcare sector. Patients who once had no option but to fly abroad can now find cutting-edge cardiovascular care at home, delivered by Nigerian experts of global repute. To nurture this progress, policymakers must build an enabling environment that retains local talent and welcomes back diaspora skills. By investing in infrastructure, training, partnerships, and affordable care, Nigeria can solidify the gains of today and inspire the next generation of heart specialists to continue this virtuous cycle, ultimately transforming its “brain drain” into a lasting “brain gain” for the health of its people.