Annals of African Medicine
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Year : 2023  |  Volume : 22  |  Issue : 2  |  Page : 229-230  

Navigating through Nigeria's struggling health system: The staggering experience of a struggling family

Department of Paediatrics, Alliance Hospital, Abuja, Nigeria; Faculty of Paediatrics, National Postgraduate Medical College of Nigeria; Department of Maternal and Child Health, School of Public Health, James Lind Institute, Geneva, Switzerland

Date of Submission29-Jan-2022
Date of Decision23-Oct-2022
Date of Acceptance17-Nov-2022
Date of Web Publication4-Apr-2023

Correspondence Address:
Qadri Adebayo Adeleye
Department of Paediatrics, Alliance Hospital, Abuja

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aam.aam_26_22

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She was born at 28 weeks of gestation and weighed 800g. Following delivery, her mother suffered wound dehiscence and was re-admitted for a prolonged period. For the care of the little baby, the father had preferred a public health facility where the cost is less prohibitive. Incidentally, Nigerian resident doctors were 23 days into a nationwide industrial action at the time; health workers were on strike during the two previous births. With no one available to help out with household chores, the father alone combined the care of two children and the logistics of two hospitals. Having to pay hospital bills out of pocket, the financial burden became unbearable, and the baby's siblings soon dropped out of school. Though the prolonged stay in the hospitals eventually ended on a happy note, it came at a huge social and economic cost that may linger for some time.

   Abstract in French 

Elle est née à 28 semaines de gestation et pesait 800g. Après l'accouchement, sa mère a subi une déhiscence de la plaie et a été réadmise pour une période prolongée. Pour la garde du petit bébé, le père avait préféré un établissement de santé public où le coût est moins prohibitif. Incidemment, les médecins résidents nigérians étaient à 23 jours dans une action revendicative nationale à l'époque; les agents de santé étaient en grève lors des deux accouchements précédents. Sans personne disponible pour aider aux tâches ménagères, le père combinait à lui seul la garde de deux enfants et la logistique de deux hôpitaux. Devant payer de leur poche les factures d'hôpital, la charge financière est devenue insupportable et les frères et sœurs du bébé ont rapidement abandonné l'école. Bien que le séjour prolongé dans les hôpitaux se soit finalement terminé sur une note heureuse, il a entraîné un coût social et économique énorme qui peut persister pendant un certain temps.
Mots-clés: Système de santé, grande prématurité, coût socio-économique, famille en difficulté, Nigeria

Keywords: Health system, severe prematurity, socioeconomic cost, struggling family, Nigeria

How to cite this article:
Adeleye QA. Navigating through Nigeria's struggling health system: The staggering experience of a struggling family. Ann Afr Med 2023;22:229-30

How to cite this URL:
Adeleye QA. Navigating through Nigeria's struggling health system: The staggering experience of a struggling family. Ann Afr Med [serial online] 2023 [cited 2023 Jun 6];22:229-30. Available from:

Nigeria, a west African country with an estimated population of over 225 million people, ranks 1st in Africa and 7th in the world.[1],[2] It is one of the largest economies on the continent; yet it continues to witness a health system characterized by infrastructural and workforce deficits.[3],[4] By 2021 estimate, the supply of doctors, nurses, and midwives in Nigeria was a paltry 16 per 10,000 population – a far cry from the recommended minimum of 44.5 per 10,000.[3],[4] Amid this crisis, health practitioners emigrate in their numbers mostly in search of better living conditions, justifiably so, arguably. At home, pressure groups in the health sector continue to exchange baton in their unending race of industrial actions.

This article is about a Nigerian family of four: a 38-year-old man with secondary level of education who hails from Umueze village in Ngor Okpala Local Government Area of Imo state, south-eastern Nigeria, his wife and their two children – a 6-year-old boy and a 3-year-old girl. They all live in a 2-room apartment on the outskirts of Nigeria's Federal Capital Territory, Abuja, about 25 km from the city centre. The family runs a menial firm that earns them a net income of N500,000 (about $1,125) per annum.

After two spontaneous mid-trimester pregnancy losses, the couple were excited to find out in February 2021 that another pregnancy was already five weeks gone. Two months after, bleeding per vaginam started yet again. The incident did not only withhold the family's joy; it was the beginning of a long journey for which they were not prepared. On multiple occasions, she visited a nearby health facility for treatments and bed rest. At 28 weeks, the fetal umbilical cord prolapsed, and she delivered (through emergency surgery) a tiny female baby, weighing 800g.

Since vaginal bleeding began, the gentleman had needed a helping hand for household chores and hospital logistics. Employing a housekeeper was not affordable, and all efforts to bring in a relative were unsuccessful at the time. He had to care for the entire family all by himself until his sister-in-law volunteered to help out; she was recalled back to the hometown a month after. Added to this, he had to pay hospital bills out-of-pocket since his family's health was not insured. In Nigeria, only 3% of people between 15 and 49 years old have health insurance, and most are not fully insured.[5],[6] The recent signing of the National Health Insurance Authority (NHIA) Act will hopefully change the current narrative.[7]

The newborn infant was referred to the city center due to lack of neonatal intensive care facility at the birth hospital. The father preferred a public healthcare facility where the cost of such care is less prohibitive. Incidentally, resident doctors in public hospitals were 23 days into a nationwide industrial action. For the couple, this was only reminiscent of their previous experience when the older kids were born.

Resolved to give his daughter a chance to live, the father arrived the city with his baby in an ambulance. After presenting at three private health facilities, he settled for his fourth and least expensive option; this was at the baby's 28th hour of life.

Less than a week after delivery, the mother's surgical wound broke down and she was re-hospitalized. The gentleman relied on public means of transportation (a harrowing experience for Nigerian masses) to handle the daily logistics between the home and the two hospitals.

Supervision of his humble enterprise continued to suffer, and the family income continued to dwindle; still, hospital bills continued to mount.

The little baby survived a bumpy period of respiratory distress syndrome, severe neonatal jaundice, methicillin-resistant Staphylococcus aureus bacteremia, recurrent anemia and thrombocytopenia, repeated hypoglycemia and apnea, feeding difficulties, and 37.5% loss in weight, among others. Her response to treatment gave the father the impetus to seek loans and donations from friends and associates. He later sold off his ancestral land back in hometown. After exhausting all available funds, he could no longer finance his children's education; he had to watch them drop out of school.

The baby was considered fit for home care on the 45th day of life; but again, no one was available to care for her in her mother's stead. Hence, she remained in hospital until her mother was discharged. They both went home on the 73rd day of life, and the entire family could reunite once again.

For this family, their prolonged contact with the hospital may have ended favorably, but the social, economic, educational, and emotional impact may not fade in a hurry.

Resident doctors returned to work after 65 days of downing tools. Meanwhile, allied health workers were preparing to collect the baton two days earlier. The planned action was later reconsidered, and the baton exchange was aborted. That brought an uninteresting relay to an end, and Nigerian masses could heave a sigh once again, at least for a moment.

Informed consent and approval

The father gave informed consent to publish the case. The hospital approved submission of the article for publication.

Declaration of patient consent

The author hereby certifies that appropriate consent form has been obtained from the father. He gave informed consent for social and clinical information to be reported in the journal. He understands that names or initials of the patient or any other member of his family will not be published, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

CIA. The World Factbook: Nigeria. November 2022. Available from: [Last accessed on 2022 Dec 02].  Back to cited text no. 1
Worldometer. Nigeria Population; January 2022. Available from: [Last accessed on 2022 Dec 02].  Back to cited text no. 2
Adebayo O, Labiran A, Emenini F, Omoruyi L. Health workforce for 2016 2030: Will Nigeria have enough? Int J Innov Healthc Res 2016;4:9-16.  Back to cited text no. 3
WHO. Health workforce requirements for universal health coverage and the sustainable development goals. 2016 Available from: 10665/250330/9789241511407-eng.pdf. [Last accessed on 2022 Dec 02].  Back to cited text no. 4
Ekwochi U, Osuorah DC, Ndu IK, Ezenwosu OU, Amadi OF, Nwokoye IC, et al. Out of pocket cost of managing sick newborns in Enugu, Southeast Nigeria. Clinicoecon Outcomes Res 2014;6:29-35.  Back to cited text no. 5
National Population Commission. Nigeria Demographic and Health Survey; 2018. Available from: 123456789/3145/1/NDHS%202018.pdf. [Last accessed on 2022 Dec 02].  Back to cited text no. 6
NHIA. National Health Insurance Authority (NHIA)-News Release. May 2022. Available from: [Last accessed on 2022 Dec 02].  Back to cited text no. 7


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