“Coming together is a beginning; keeping together is progress; working together is success.”– Henry Ford
Sir: The Nigerian healthcare system is ‘sick’ and under siege. The ‘sickness’ is not solely from disease, underfunding, or brain drain, but from within. There has been a silent (often loud), corrosive and destructive war among healthcare professionals that is gradually destroying the soul of the sector. The rivalry between doctors, pharmacists, nurses, medical laboratory scientists, and other allied health workers has reached a point where patients are no longer the central focus: power, ego, and supremacy battle have taken the centre stage.
We must salvage our healthcare system before it is too late and to do this, we must first heal the healers themselves.The deplorable state of healthcare delivery system in Nigeria is well documented. Our various health indices remain among the worst in the world:Maternal mortality rate: One of the highest globally (993 women die per 100,000 live births)
Infant mortality rate: Over 70 per 1,000 live births.
Life expectancy: Low at 55 years. Healthcare financing: Less than 5% of the national budget—far below the 15% target of the 2001 Abuja Declaration. Nigerian health professionals are very good at their jobs but despite their noble efforts, poor service delivery, fragmented care, and low patient satisfaction persist. The health sector is held hostage by recurring strikes, leadership disputes, and professional turf wars.
Some factors are responsible. They include: Historical Dominance and Colonial Legacy, Ambiguities in Policy and Law: Lack of Inter-Professional Education; Leadership Crisis: Union Fragmentation: Compensation mechanism: Have we ever pondered on the price or cost of the division in the health sector?
According to an African proverb, “If you want to go fast, go alone. If you want to go far, go together.”The fallout from the disunity in the sector is staggering:
Patients suffer delayed, incomplete, or duplicated care. Healthcare teams operate in silos, reducing efficiency and innovation.Strikes disrupt service delivery and trust in the system. Brain drain accelerates as professionals seek more respectful environments abroad. Rather than collaborate to solve Nigeria’s health crisis, our professionals fight over titles, job descriptions, and leadership privileges. In other climes, we have evidence of collaboration that can be adopted as the global best practices andlessons in harmony and unity. In Canada, there is a promotion of inter-professional education and integrated primary care teams.
Pharmacists, nurses, and physicians are trained to collaborate from day one. In Rwanda, despite resource constraints, the country has built a resilient system through task-shifting, mutual respect, and strong public health leadership. In the United Kingdom (NHS), where many of our senior doctors were trained, leadership is competence-based. Clinical and administrative roles are often held by non-doctors, including nurses and pharmacists. In United States, Accountable Care Organizations (ACOs) incentivize team-based care, linking compensation to outcomes and collaboration.These examples show that patient-centered systems flourish when collaboration, not competition, is the norm.
It is time for us to reimagine a future in Nigeria where:
Doctors and pharmacists will co-design patient treatment plans. Nurses and medical lab scientists coordinate to track recovery. Health information managers streamline digital health records for efficient care.
Leadership appointments are open to all qualified professionals, based on merit, not cadre. This vision is not only possible, but also necessary through Policy Reforms: Review, Inter-Professional Education; Merit-based Leadership Appointments: Open leadership roles to all professionals, National Health Harmony Forum. Reward of Collaboration through grants, recognitions, and performance bonuses for institutions; Attitudinal change by all the players in the sector; and it should begin first, by seeing the other person as a partner rather than a competitor.
The journey toward effective, efficient, and equitable healthcare in Nigeria begins with trust, respect, and collaboration among all professionals.The health sector must practice what it preaches: healing. Healing of rifts, of mistrust, of rivalry. Until we achieve this, no amount of funding, buildings, or policies will yield a truly effective healthcare system.
• Dr. Lolu Ojo is an Industrial Pharmacist, Policy Advocate, and Healthcare Reformer
