Addressing Corruption in Nigeria’s Health Sector By Chinedu Moghalu

Early this month, the Nigerian Bureau of Statistics (NBS) and the United Nations Office on Drugs and Crime (UNODC) published the “Report on Corruption in Nigeria: Patterns and Trends,” being the third survey on corruption as experienced by the Nigerian population. This blog delves into the alarming findings of this report, with a particular focus on corruption within the health sector and its far-reaching consequences on Nigeria’s economy and society.

A Crisis of Confidence

Corruption in the health sector is not just a bureaucratic hiccup; it is a crisis that strikes at the very heart of Nigeria’s social fabric and economic stability. The NBS and UNODC report reveals that in 2023, 30% of Nigerians had contact with healthcare professionals, with 12% of these interactions involving bribery. Although this figure is lower than in other sectors, it remains a significant concern.

Health professionals, including doctors, nurses, and midwives, were shown to have demanded bribes before attending to patients. Such practices undermine the quality of care and erode public trust in the health system, discouraging individuals from seeking medical attention when needed. The impact is profound, affecting both the quality of care and the overall health outcomes for the population.

Economic Consequences of Corruption

The financial implications of corruption in the health sector are staggering. Bribes drain household resources, pushing many families further into poverty. The report highlights that an average bribe payer in rural areas pays 5.8 bribes annually, compared to 4.5 in urban areas . This disparity exacerbates the economic divide, hitting the most vulnerable hardest.

Moreover, corruption inflates the cost of healthcare delivery. Funds meant for medical supplies, infrastructure, and personnel are siphoned off, leading to shortages and dilapidated facilities. This not only hinders the government’s ability to provide adequate health services but also discourages investment in the health sector, stalling progress and innovation.

Cultural Dimensions of Health Sector Corruption

An often-overlooked aspect of corruption in the health sector is the cultural dimension, where families of patients voluntarily offer gratifications to doctors and other healthcare workers who attended to their relatives and friends. This practice, deeply rooted in social norms and expectations, can set an unsavory precedent where some medical workers begin to expect such gratuities. While these gestures are seen as tokens of appreciation, they can inadvertently perpetuate a cycle of informal payments and expectations of preferential treatment, undermining the integrity of healthcare delivery.

More Than Just Bad Apples

Reflecting on his experience, the Honorable Coordinating Minister of Health and Social Welfare, Muhammad Ali Pate, CON, described corruption as an epidemic, embedded deeply within the system. “Corruption is like an infectious disease, spreading insidiously through our institutions and eroding the very foundation of our society,” he stated. Recent incidents, such as the misappropriation of therapeutic foods meant for malnourished children, highlight the systemic nature and dire evil of corruption . It’s clear that addressing individual corrupt actors is not enough; systemic reforms are essential.

Interagency Collaboration

Corruption in the health sector has a ripple effect, fueling corruption in other sectors. The UNODC Report indicates that corruption in the health sector, though seemingly lower in prevalence, contributes significantly to broader systemic corruption. For instance, funds diverted from healthcare often flow into other areas, perpetuating a cycle of misappropriation and graft. Sister agencies and ministries, such as the Economic and Financial Crimes Commission (EFCC) and the Independent Corrupt Practices and Other Related Offences Commission (ICPC), have highlighted how corruption in one sector can undermine efforts across the board.

The Basic Health Care Provision Fund (BHCPF) is particularly vulnerable to such corruption. The BHCPF 2.0 aims to improve access to primary health care by providing financial resources directly to healthcare facilities. Ensuring the integrity of these funds is crucial. Without robust interagency collaboration, the effectiveness of the BHCPF could be compromised, leading to inefficiencies and continued poor health outcomes.

The FMOHSW’s Sector-Wide Approach (SWAp), which is embedded in the Nigeria’s Health Sector Renewal Investment Initiative (NHSRII), aims to foster coordination among stakeholders, ensuring that funds are used appropriately and transparently. By working closely with the EFCC and ICPC, the ministry can implement stringent monitoring and accountability measures, reducing opportunities for corruption. The Nigerian Medical Association (NMA), led by Prof. Bala Audu, supports these efforts by advocating for stricter enforcement of ethical standards and enhanced training for healthcare workers on the consequences of corruption. Additionally, the Medical and Dental Council of Nigeria (MDCN), under the leadership of Prof. Fatima Kyari, is working to strengthen training on ethics and the code of practice, emphasizing integrity and ethical behavior in the healthcare profession.

Strategies and Solutions for Corruption-Free Health Sector

To combat corruption effectively, the FMOHSW is working closely with the ICPC. Joint task teams comprising FMOHSW’s anti-corruption unit and ICPC representatives are set to develop a robust anti-corruption program. This includes enhanced monitoring mechanisms, hotlines, and web portals for reporting irregularities, and engaging civil society and local communities to foster transparency and accountability.

Furthermore, public awareness campaigns are crucial. Educating citizens about their rights and the detrimental impacts of bribery can empower them to resist corrupt practices. The role of a rejigged SERVICOM is critical here and needs to extend beyond public service. Nigerians need to understand that they deserve to be served better and must stand up against inefficiency and corruption across sectors. Investing in capacity building for health workers and regulatory bodies will also ensure that they uphold professional standards and resist corruption .

Several low- and middle-income countries (LMICs) have successfully implemented anti-corruption measures that Nigeria can learn from. For example, Rwanda has made significant strides in reducing corruption through strict enforcement of anti-corruption laws and robust public sector reforms. Similarly, Ghana’s introduction of digital health records has minimized opportunities for corrupt practices by increasing transparency and accountability in the health sector.

Conclusion: Business Unusual

Corruption in Nigeria’s health sector is more than a moral failing; it is a national crisis that demands immediate and comprehensive action. By addressing systemic corruption and fostering a culture of accountability and transparency, Nigeria can rebuild trust in its health institutions and ensure that all citizens have access to quality healthcare by adopting a “business unusual” attitude. The Honorable Coordinating Minister of Health and Social Welfare emphasized, “Our fight against corruption is akin to fighting an epidemic. We must treat the system, not just the symptoms, to achieve lasting change.”

Barrister Chinedu Moghalu

Senior Special Adviser

Hon CMHSW.