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Kazeem Awojoodu
A consultant neurologist, Dr Temitope Farombi, has warned that Nigeria’s fragmented healthcare system, weak regulatory enforcement and widespread quackery are putting patients at risk, calling for far-reaching reforms to strengthen coordination, accountability and quality of care across the country.
Farombi, founder of the Brain Centre for Neurocritical and Rehabilitation Services, Ibadan said the challenges confronting Nigeria’s healthcare system went beyond inadequate facilities and personnel, stressing that poor coordination among primary, secondary and tertiary healthcare facilities was compromising the continuity and effectiveness of treatment.
Speaking with journalists on Thursday at the Brain Centre, Dr Farombi described the country’s healthcare system as “highly fragmented”, lamenting that critical information about patients was often not properly transferred as they moved from one level of care to another.
“The healthcare system in Nigeria is highly fragmented. What happens in the primary care centre is not known to what happened in the secondary care, as well as what happened in the tertiary care.“
“And also, there is not so much policy monitoring. When you give out guidelines, there is not enough monitoring of those guidelines,“ Farombi said.
She said the situation had created gaps in the healthcare chain, making it difficult to ensure that patients received coordinated treatment from the point of first contact through specialist care.
Farombi said, “We need to look at the healthcare system as a whole. It is not enough to have policies and guidelines on paper. There must be effective monitoring to ensure that those policies are actually implemented.”
She maintained that stronger coordination between the different levels of healthcare was essential to preventing patients from falling through the cracks of the system.
According to her, “If a patient is moving from primary care to secondary care and then to tertiary care, there should be continuity. The information about that patient should follow the patient.”
Farombi also identified weak enforcement of healthcare regulations as a major factor allowing unprofessional practices to persist.
She said the problem was not necessarily the absence of regulations but the failure to consistently monitor compliance and impose appropriate sanctions where necessary.
“We have regulations, but the issue is enforcement. When people know that there is no monitoring and there are no consequences for violating the rules, they are more likely to operate outside the standards.”
The neurologist described quackery as another major threat to patient safety, particularly when healthcare workers attempted to treat conditions beyond their training and professional competence.
“There are situations where people manage patients beyond their competence instead of referring them to the appropriate specialist. That is dangerous because the patient may not get the right treatment at the right time.”
Farombi added that healthcare workers should recognise their limitations and refer patients whenever a condition required specialist intervention.
“Referral is part of good healthcare practice. You do not have to know everything. If something is beyond your area of competence, the right thing is to refer the patient,” she said.
She also raised concerns over the indiscriminate sale and use of medicines, particularly antibiotics, warning that the practice was contributing to antimicrobial resistance.
Farombi said people without adequate medical knowledge sometimes dispense medicines based solely on symptoms reported by patients.
“I have seen people who are not adequately trained dispensing drugs simply because somebody tells them, ‘I have a headache’ or ‘I have a fever’, and they give them medication without proper assessment,” she said.
She warned that such practices could result in misdiagnosis, treatment failure, drug resistance and other complications.
“Antibiotics are not harmless drugs that should be taken whenever somebody feels sick. Their indiscriminate use is one of the things driving antimicrobial resistance,” Farombi said.
She urged Nigerians to stop the practice of self-diagnosis and self-medication, particularly the tendency to attribute virtually every fever, headache or other symptom to malaria or typhoid.
“You cannot assume that every headache is malaria or every fever is typhoid. Symptoms can have different causes, and proper investigation is important,” she said.
Farombi urged healthcare professionals to investigate patients thoroughly before prescribing treatment, noting that apparently ordinary symptoms could sometimes be signs of serious illnesses.
“Sometimes, what appears to be a simple complaint may actually be pointing to something much more serious. That is why proper assessment matters,” she said.
On the migration of Nigerian medical professionals, Farombi attributed the persistent brain drain largely to the search for better opportunities, improved working conditions and access to modern healthcare facilities.
“People naturally want to work in an environment where they can grow professionally, where they have the tools to do their jobs and where their efforts are properly rewarded.”
She, however, maintained that the exodus could be reversed if governments addressed the conditions encouraging professionals to leave the country.
“If we want our doctors and other healthcare professionals to stay, we must create an environment in which they can practise effectively,” Farombi said.
She called for improved working conditions, increased healthcare funding and the provision of modern equipment and facilities in Nigerian hospitals.
“Doctors cannot perform miracles when they do not have the equipment, facilities and support systems required to provide modern healthcare,” she said.
Farombi urged the government to study countries that had successfully attracted professionals trained abroad by creating conditions that made returning home attractive.
“We should learn from countries that have been able to bring their professionals back. They created an environment where those people could return and thrive,” she said.
She also advocated greater use of digital healthcare as a short-term strategy for harnessing the expertise of Nigerian medical professionals in the diaspora.
Farombi said a government-backed digital health platform could enable specialists abroad to provide virtual consultations and support to patients and healthcare workers in Nigeria.
“We have Nigerians who are specialists all over the world. We should find a structured way of connecting them with the healthcare system here through technology,” she said.
Farombi said telemedicine could particularly help bridge the specialist-care gap between rural communities and major urban centres.
“If somebody is in a remote community and needs to speak to a neurologist, that person should not necessarily have to travel several hours to a major city before getting specialist advice,” she said.
“Technology can connect that patient or the healthcare worker managing the patient to a specialist who may be somewhere else.”
The neurologist also called for greater investment in brain health, describing it as an important component of Nigeria’s human capital development and economic productivity.
“Brain health is not just a medical issue. It is a human capital issue,” Farombi said.
“If we have a population whose brains are healthy and functioning optimally, we have a population that can learn, work, innovate and contribute more effectively to the economy.”
She urged the federal, state and local governments to integrate brain health into their policies and development programmes.
“Brain health should be part of our national development conversation. We need policies that recognise the importance of protecting the brain from childhood through old age,” she said.
Farombi also advocated reforms in the education sector, urging schools to place greater emphasis on analytical, logical, quantitative and verbal reasoning to strengthen cognitive development among young Nigerians.
“Education should not only be about memorising information. We need to train young people to think, analyse problems, reason logically and communicate effectively.”
She further identified good nutrition, access to green spaces, recreational facilities and healthy social interaction as important factors in maintaining brain health.
“Brain health starts from childhood. What a child eats, how the child learns, plays and interacts with other people all contribute to brain development,” she said.
Farombi stressed that protecting brain health should be viewed as a lifelong responsibility, adding, “We should not wait until somebody develops a neurological problem before we start talking about brain health. Prevention and healthy brain development must begin early and continue throughout life.“
