A GUIDE FOR SMARTER HEALTH POLICY

Adaobi Amelia Ozigbo, a clinician, offers fresh perspective for a stronger health system, writes PAT ONUKWULI

Nigeria’s healthcare system now teeters on the brink, caught between rising demand and an overstretched reality. It is where urgency meets uncertainty, positioned between what it must become and what it can no longer afford to remain. On one side is a growing population with increasingly complex medical needs. On the other hand, public health infrastructure is stretched by chronic underfunding, fragmented implementation, and long-standing gaps in accountability.

The consequences are evident in the nation’s sobering health indicators. Maternal mortality remains among the highest globally at about 512 deaths per 100,000 live births. Only around 43 per cent of primary healthcare centres are fully operational, and national health expenditure has remained around 3.7 per cent of the budget, significantly below the 15 per cent commitment made in the 2001 Abuja Declaration. These realities highlight a national dilemma that has endured despite decades of discussions on financing and reforms. As a familiar Nigerian expression suggests, the remedy is often already in the room, waiting only for the courage and clarity to recognise it.

Amid this challenge, there is a valuable example in the work and training of Dr. Adaobi Amelia Ozigbo, a clinician educated in Nigeria who now advances public health practice and analysis in the United States. Her journey, from long clinical days at the Federal Medical Centre in Jabi, Abuja, to specialised work in health systems, children’s behavioural health policy, and Medicaid oversight in New York and New Jersey, provides a varied perspective from which Nigeria might reconsider its approach to health policy.

Her grounding was entirely Nigerian and shaped by realities familiar to clinicians nationwide. She trained at Chukwuemeka Odumegwu Ojukwu University and completed rotations in surgery, paediatrics, obstetrics and gynaecology, internal medicine, and emergency care, with each experience reinforcing the practical truth that Nigerian medical interns need to develop both breadth and adaptability. As she progressed through these postings, she encountered the usual pressures and improvisations that characterise clinical practice in resource-limited environments, observing how each stage of training demands more ingenuity than infrastructure.

At the Federal Medical Centre in Jabi, she experienced firsthand the ongoing impact of systemic shortcomings. Clinics faced resource shortages, staff handled overwhelming caseloads, and patients arrived late, not out of apathy but because the health system provided little assurance that early engagement would result in timely, affordable, or sufficient care. These conditions sharpened clinicians’ problem-solving skills while also exposing the limits of resilience as a national health strategy. Such environments were not acceptable norms; instead, they were a clear sign that comprehensive reform was long overdue.

Dr. Ozigbo’s subsequent training in the United States introduced her to the structural discipline that underpins more functional health systems. At the University at Albany, where she pursued a Master of Public Health with a specialisation in Health Policy and Management, she encountered a policy environment organised around clarity, measurement, and enforceability. Her fellowship at the New York State Office of Mental Health placed her within the oversight architecture of Medicaid Managed Care. This system demands rigorous compliance with standards governing children’s behavioural health. In this environment, the strength of a policy is determined not by its eloquence but by its enforceability. Evaluation, reporting, and monitoring are routine, not optional. Data is the foundation upon which decisions are made, rather than a late addition to justify predetermined choices.

Her analytical work sharpened her convictions, and it is from this body of experience that she offers a set of clear recommendations for Nigeria’s reform agenda. Through literature reviews, quality improvement projects, epidemiological analyses, and studies on disparities in maternal and child health, behavioural health, climate-related illnesses, and HIV care, she reached a key conclusion: effective health systems do not speculate. They measure, interpret, and adjust in real time. Nigeria’s challenges with low immunisation coverage, increasing non-communicable diseases, high maternal mortality, and poor child health outcomes cannot be addressed without reliable, routine data systems. One in five children remains under-immunised, thousands of health workers leave each year, and fewer than 300 psychiatrists serve more than 200 million people. These realities, she argues, highlight the need for structural reform rather than piecemeal solutions.

It is this blending of Nigerian frontline experience and American systems thinking that shapes what Dr Ozigbo herself increasingly describes as a blueprint for smarter health policy in Nigeria. She does not advocate copying the American model but instead urges adopting principles that reliably strengthen health systems across diverse contexts. In her view, policies must be regarded as firm commitments rather than rhetorical aspirations. Decisions must be grounded in dependable data.

According to Dr. Ozigbo, community-based primary care should be reinstated as the cornerstone of national service delivery. Workforce retention should be treated as a strategic priority, requiring improved professional pathways, better working conditions, and predictable career development. Mental health, particularly for children and adolescents, must be incorporated into routine medical care and financing models, reflecting both the rising burden of behavioural health needs and the scarcity of specialists available to address them.

In Greek mythology, Sisyphus was condemned to push a boulder uphill only for it to roll back down each time he neared the summit. Dr. Ozigbo often draws on this allegory to emphasise that Nigeria’s health sector must avoid reforms that mirror such futile labour, where progress repeatedly collapses because the foundations beneath it remain unchanged. Real reform, she argues, must secure the boulder firmly in place. It must ensure that gains already achieved are preserved and that each subsequent effort builds on the last with greater stability and purpose.

She insists that these ideas are neither abstract nor imported wholesale; they represent the reasoned insights of a clinician who has practised in Abuja’s outpatient departments, contributed to behavioural health oversight in New York, and participated in dialysis care in New Jersey. Therefore, they reflect her understanding that successful health policy is defined less by ambition and more by discipline, execution, and continuity.

Ultimately, as Dr. Ozigbo contends, Nigeria’s path to a stronger health system will not be defined by declarations alone, nor by the usual cycles of panel discussions and policy documents that rarely outlast their launch events. It will depend on a willingness to utilise the full range of expertise available within the country, including those whose careers have bridged the challenging realities of Nigerian clinical practice with the structured approaches of more established health systems. Voices like hers matter not because they offer simple answers, but because they bring grounded, evidence-informed perspectives shaped by what has succeeded elsewhere and what has faltered at home.

The challenge for Nigeria is to recognise the value of such insight and to channel it into practical, inclusive, and sustainable reforms. If the country is willing to listen and move deliberately rather than in haste, it can develop a health system that aligns with both its aspirations and its commitments to the millions who rely on it. The opportunity exists. What remains is the resolve to embrace it.

Dr. Onukwuli, is a legal scholar and public affairs analyst. patonukwuli2003@yahoo.co.uk