Beyond the Bills: Rethinking Health Governance in Nigeria -By Patrick Iwelunmor

In Nigeria, health reform often announces itself through legislation. Bills are transmitted, constitutional provisions cited, committees assigned. The language is orderly, procedural, reassuring. Yet beyond these formalities lies a pressing question: can a health system weighed down by decades of mismanagement be fixed by law alone? President Bola Tinubu’s transmission of 24 health sector bills to the Senate is a test not merely of legislative diligence, but of Nigeria’s willingness to confront the deep-seated failures that have long crippled the sector. The truth is uncomfortable but unavoidable: Nigeria’s health crisis is as much a problem of governance, accountability, and political will as it is of statutes or institutions.

The President has explained that the bills follow a comprehensive review of existing laws, conducted by the Attorney-General of the Federation in collaboration with the Minister of Health and Social Welfare and approved by the Federal Executive Council. That is reassuring in itself. But it also acknowledges a hard reality: Nigeria’s health sector has been over-administered yet under-performing. Boards proliferated, regulatory agencies multiplied, and authority became visible everywhere, yet care remained inconsistent. Past reforms, from the National Health Act of 2014 to attempts at hospital autonomy, repeatedly show that simply changing the law cannot overcome inefficiency, politicisation, or weak oversight. The structures exist, but the culture that should give them life, habits, incentives, accountability, remains stubbornly unchanged.

For decades, reform has been about boards, councils, and layers of administration, while little attention was paid to how these institutions actually behave. Hospitals carry the weight of heavy bureaucracy, yet their frontline service remains fragile. The National Hospital for Women and Children, for example, may now report to a leaner board, yet nurses often work without essential supplies, patients wait for hours for treatment, and administrators juggle overlapping lines of authority. Federal Medical Centres and clinics across the country are no different. Improving structure is essential, but without a shift in institutional culture, authority alone does not translate into results.

Streamlining boards is necessary, but far from sufficient. Smaller boards may clarify responsibility and speed decision-making, but only if appointments are transparent, performance metrics enforceable, and statutory protections shield regulatory independence. Otherwise, reform risks being cosmetic, simply rearranging power without holding anyone accountable. History in Nigeria shows this pattern again and again, where reorganising hierarchies created the illusion of progress while systemic weaknesses remained untouched. Real health governance depends on structure, culture, and accountability working together.

The breadth of the proposed amendments, from teaching and specialty hospitals to professional councils and regulatory agencies such as NAFDAC, the Medical Laboratory Science Council, and the National Blood Service Agency, signals ambition. But ambition alone cannot guarantee impact. Regulatory agencies need independence, enforcement capacity, and resilience against political and commercial pressure. Teaching hospitals require management autonomy, ethical leadership, and adequate funding if they are to fulfil their purpose. Without these elements, even the most well-intentioned legislative reforms may fail. A concrete measure, such as linking board and executive performance to clear service delivery benchmarks and periodic audits, could help align incentives with outcomes in a practical way.

Some proposals point toward a more modern understanding of health governance. The Records Officers Registration and Digital Health Bill 2025 recognises that reliable data, continuity of care, and institutional memory are essential foundations for functional healthcare. Poor record-keeping has long undermined patient care, research, and policy planning. Meanwhile, the Federal College of Complementary and Alternative Medicine Bill 2025 addresses a sector that has operated largely outside formal regulation for decades. Bringing alternative medical practices under some level of governance can improve safety and accountability, but only if guided by evidence and public interest rather than political expediency.

The Senate now carries a heavy responsibility. Oversight in the health sector has often been sporadic, deferential, or procedural rather than substantive. Committees may review proposals without questioning implementation, funding, or institutional capacity. If these bills are treated as routine submissions rather than tools for national wellbeing, structural adjustments alone will not protect patients or improve care. Lawmakers must demand measurable benchmarks, monitor progress, and hold institutions accountable. History tells us that weak legislative engagement prolongs inefficiency and denies citizens access to quality healthcare.

In the end, these reforms will be judged in hospitals and communities, not in plenary chambers. In overcrowded wards, a mother waits hours for treatment for her newborn. Clinics struggle to maintain regular immunisation schedules. Essential drugs are often unavailable, equipment fails, and preventable illnesses continue to claim lives, especially in rural areas. If governance becomes leaner but service delivery remains broken, the reform will have failed its simplest and most urgent test. True health governance requires legislation, yes, but also political will, ethical leadership, sustained funding, and a shift in culture. Beyond the bills lies the harder work of building institutions that prioritise patients over patronage, outcomes over optics, and public trust over procedural comfort. Nigeria cannot reform its health sector with laws alone. It must change the culture those laws are meant to guide, and it must act decisively. Lives depend on it.