“Coming together is a beginning; keeping together is progress; working together is success.” – Henry Ford
The Nigerian healthcare system is sick and under siege. The illness is not solely due to disease, underfunding, or brain drain; it stems from within. A corrosive, and often loud, intra-professional conflict among healthcare workers has been eating away at the soul of the sector. The rivalry between doctors, pharmacists, nurses, medical laboratory scientists, and other allied professionals has grown so toxic that patients are no longer the central focus—power struggles, ego trips, and supremacy battles now dominate the stage.
We must salvage our healthcare system before it is too late. But to do that, we must first heal the healers themselves.
The deplorable state of Nigeria’s healthcare delivery system is well documented. Our health indices remain among the worst globally:
Maternal mortality rate: One of the highest in the world, with 993 women dying per 100,000 live births.
Infant mortality rate: Over 70 per 1,000 live births.
Life expectancy: A low 55 years.
Healthcare financing: Less than 5 per cent of the national budget—far below the 15 per cent benchmark set by the 2001 Abuja Declaration.
Nigerian health professionals are highly skilled, yet poor service delivery, fragmented care, and low patient satisfaction persist. The sector is routinely paralysed by strikes, leadership crises, and professional turf wars.
How did we arrive at this sorry state? What are the root causes of the inter-professional wars? The answers are as varied as the people asked, but several common factors stand out:
Historical dominance and colonial legacy: The British colonial health system entrenched a hierarchy with doctors at the apex and other professionals relegated to subordinate roles. This outdated structure has never been reformed, despite progress in medical education and practice.
Policy and legal ambiguities: The National Health Act and various schemes of service lack clear, enforceable definitions of professional roles, leading to overlaps and disputes. For example, the law allows doctors to keep medicines for immediate use, a loophole that has been exploited to bypass pharmacists.
Lack of inter-professional education: Health professionals are trained in silos. With no early exposure to teamwork, graduates emerge with a mindset of competition rather than collaboration.
Leadership crisis: Appointments in public health institutions are often based on professional seniority rather than competence, vision, or leadership ability.
Union fragmentation: With multiple unions—PSN, NMA, JOHESU, and others—pushing divergent agendas, the sector resembles a battlefield. Unity remains elusive.
Discriminatory compensation structures: Unequal salaries and incentives across professional lines have entrenched division and made meaningful reconciliation a distant hope.
Have we truly considered the cost of this disunity?
An African proverb reminds us: “If you want to go fast, go alone. If you want to go far, go together.” The consequences of disunity in the health sector are staggering:
Patients experience delayed, duplicated, or incomplete care.
Healthcare teams work in silos, reducing innovation and efficiency.
Strikes disrupt services and erode public trust.
Brain drain intensifies as professionals seek dignity and respect abroad.
Rather than collaborating to solve Nigeria’s health crisis, professionals bicker over titles, roles, and entitlements. Meanwhile, other countries provide examples of what works:
In Canada, inter-professional education and integrated primary care teams are the norm. Collaboration is taught from day one.
In Rwanda, despite limited resources, the health system thrives on mutual respect, task-shifting, and accountable leadership.
In the United Kingdom (NHS), leadership is based on competence, not cadre. Nurses and pharmacists often occupy top roles, and clinical decisions are shared.
In the United States, Accountable Care Organisations (ACOs) incentivise team-based care and reward outcomes driven by collaboration.
These models prove that when teamwork replaces territorialism, patient outcomes improve and systems flourish.
We must begin to reimagine a new future for Nigeria, where:
Doctors and pharmacists co-design treatment plans.
Nurses and lab scientists collaborate to monitor recovery.
Health information managers digitise and streamline patient records.
Leadership appointments are open to all qualified professionals, based on merit, not cadre.
This vision is not only possible; it is necessary.
Roadmap to unity and excellence
Policy reform: Review and amend the National Health Act to define roles clearly and foster collaborative practice.
Inter-professional education: Integrate joint courses, simulations, and projects into the curricula of health schools.
Merit-based leadership: Appoint leaders based on strategic competence, not professional cadre or union affiliation.
National health harmony forum: Create an inclusive institutional platform for dialogue, policy co-creation, and conflict resolution among all professional bodies.
Reward collaboration: Offer grants, awards, and bonuses to institutions and teams that model interdisciplinary excellence.
Attitudinal shift: Health workers must see one another as partners, not competitors. Mutual respect is the cornerstone of system reform.
As Mattie Stepanek, the late advocate for peace and collaboration, once said: “Unity is strength… when there is teamwork and collaboration, wonderful things can be achieved.”
Healing Nigeria’s healthcare system begins with healing the people who run it. The journey toward effective, efficient, and equitable healthcare will be built not on bricks and budgets alone, but on trust, respect, and collaboration.
Let us bury the hatchet. Let us dethrone ego and enthrone empathy.
Let us remember that behind every rivalry lies a patient waiting to be healed.
Let us rise together and build the healthcare system Nigeria truly deserves.
Let us heal the system by healing ourselves. The patient is waiting.
Dr Lolu Ojo BPharm, MBA, PharmD, FPCPharm, FPSN, FNAPharm, is an industrial pharmacist, policy advocate, and healthcare reformer.
