…Calls for Urgent, Globally-Informed Reforms
By Bianca Iboma-Emefu
The Association of Community Pharmacists of Nigeria (ACPN) has issued a strong statement condemning the detrimental impact of physician dominance on Nigeria’s healthcare system, urging the Federal Government to implement comprehensive reforms aligned with international best practices.
In a statement signed by Ambrose Ezeh, MAW, DCPHARM, the ACPN expressed appreciation for the intellectual debate sparked by the recent response from the Nigerian Association of Resident Doctors (NARD), while clarifying key issues and perspectives.
Ezeh argued that the Nigerian healthcare system has been severely compromised by the monopolization of leadership roles by physicians. He highlighted that their high-handedness has fostered unprecedented corruption, with top positions such as CMD/CEO, C-MAC, and D-C-MACs being exclusively reserved for doctors. This reckless concentration of power has contributed to over $30 billion in debts owed to pharmaceutical companies.
He emphasized that optimal patient outcomes are typically achieved when hospitals are managed by qualified and experienced administrators— a practice common in other countries. Historically, Nigeria adhered to this standard until 1985 when the late Dr. Olikoye Kuti, in collaboration with then-military President Ibrahim Babangida, enacted Decree 10 of 1985, forcing physicians to lead Federal Healthcare Institutions (FHIs).
During Nigeria’s earlier decades, hospital systems operated with decorum and efficiency, partly because health professionals adhered to their areas of expertise. Institutions like the University College Hospital (UCH) Ibadan were ranked among the top five in the Commonwealth, attracting international patients.
Ezeh outlined how physician dominance has eroded the healthcare system, the high-handedness of physicians has dismantled civil service norms, leading to institutionalized corruption. In FHIs, key positions related to procurement, catering, and energy are often occupied by physicians, who also control the acquisition of medical equipment and drugs. The Independent Corrupt Practices Commission (ICPC) recently branded the health sector as the most corrupt in Nigeria.
Multiple physician ministers and CEOs have been disgraced over corruption allegations, including the recent removal of a physician-CEO at the National Health Insurance Authority (NHIA). The mismanagement has led to the collapse of critical schemes like the Drug Revolving Fund (DRF), resulting in over $30 billion in debts to pharmaceutical companies.
Many physician leaders lack the requisite competence in leadership, communication, and business management, causing underutilization of advanced equipment and poor healthcare delivery.
The national health indices have worsened, with Nigeria ranking 187th out of 191 countries. High maternal and infant mortality, fake medicines, weak immunization programs, and poor procurement trace back to a shift from preventive to curative care driven by pecuniary motives among physician-led management.
Ezeh pointed out that physicians resist broadening their roles, often opposing appointments of non-physicians to key health leadership positions. The tendency to set the terms for salaries and benefits has entrenched a culture of exclusivity, hindering reforms. Notably, attempts to include pharmacists and other health professionals in leadership have faced stiff resistance, exemplified by threats from medical associations in the past.
The ACPN urges Nigeria to abandon the cycle of ineffective reforms and embrace a comprehensive overhaul grounded in global best practices. This includes diversifying leadership, improving governance, and aligning policies to foster transparency, efficiency, and quality healthcare delivery across the nation.