Pay to Live: The Reality of Healthcare in Nigeria

Whenever I go back home to Nigeria, one of the most jarring things I notice is how normalized bribery is in everyday life. As a child, if I was allowed to go to the market with my aunties, I wasn’t allowed to speak—my American accent would instantly raise prices. At the airport, if your luggage went missing or you were suddenly selected for a “random” security check, as soon as your wallet came out, all was forgotten.

These experiences prompted me to wonder how healthcare systems function in a culture in which extortion is so normalized. Unfortunately, its exactly how one would expect it to. Those with money to bribe nurses to move you or your loved one up on the list to be seen are prioritized, while those without lie on cots outside, hoping to be seen before it’s too late.

Nigeria’s healthcare system struggles not because of a lack of resources or potential, but because of how resources are managed. Despite being one of Africa’s most resource-rich nations, access to healthcare remains deeply unequal. Government inefficiency and mismanagement have led to large gaps in infrastructure—nationwide, there are only about 0.4 ambulances per 100,000 people. Public health insurance is underutilized, which forces many people to pay out of pocket. As a result, healthcare becomes a privilege rather than a right. Those who can afford private hospitals or out-of-country care survive; those who cannot are left navigating an overstretched and underfunded system.

Another major issue is the mass migration of healthcare professionals. Nigerian doctors are among the lowest paid globally, earning less than $4,000 a year at most in many cases. Unsurprisingly, many leave for better opportunities abroad.

This creates a dangerous cycle that continues to weaken the system from within; fewer doctors mean heavier workloads for those who remain, which leads to burnout and even more departures. Furthermore, my Aunt believes that there isn't a single hospital in Nigeria that is appropriately stocked with supplies.

So if all these problems are widely known and Nigeria has the funds and resources to fix them, why don't leaders take any action? A major factor is the disconnect between government leadership and lived reality. Government officials, as well as those who are well off, seek medical care and education abroad, insulating themselves from the consequences of domestic system failures. Without personal stakes in the system, they have no urgency to fix it and would rather pocket funds that could be used to help.

Recent developments have added another layer of concern. Nigeria entered a $5.1 billion healthcare-related deal with the Trump administration, contributing $3 billion itself. This came shortly after U.S. healthcare aid was cut, raising questions about leverage and timing.

Under this agreement:

● Nigeria must share pathogen data and biological samples with the U.S.

● U.S. regulatory approval will influence how Nigeria distributes medicine

● The data may be used to develop drugs that many Nigerians cannot afford

This arrangement clearly echoes historical patterns where African populations were used in experiments that primarily benefited Western institutions. It can be argued that President Tinubu was forced to sign this deal or lose all U.S. aid. However, several less financially stable African nations have rejected similar proposals, citing strong ethical reservations. The controversy stems from the perception among Nigerians that this legislation forces Nigeria to essentially co-finance experiments on its own citizens for the benefit of the U.S. pharmaceutical industry.

At the same time, internal policy disputes continue. Radiography students in Nigeria are currently pushing back against a proposed bill that would place their profession under a board of largely untrained individuals, while also requiring that 70% of practicing fees go to the Nigerian Medical Association. For many, this represents yet another example of mismanagement and exploitation within the system.

Nigeria's healthcare crisis is fundamentally a matter of accountability, equity, and regaining public trust, not merely a problem of funding or infrastructure. The normalization of corruption infiltrates and compromises life-and-death systems. Healthcare should operate as a space where urgency is dictated solely by medical need. However, for many in Nigeria, survival tragically depends on what they can pay, not on the care they desperately require. Genuine reform requires a profound cultural and structural transformation that prioritizes human well-being over financial gain.

1Paul. (2025, June 5). Top 10 ambulance services in Nigeria. Emergency Response Africa. https://emergencyresponseafrica.com/top-ambulance-services-in-nigeria/