By Prof. Chiwuike Uba, PhD
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There are public projects whose significance goes far beyond the physical structures being constructed. The Enugu International Hospital could become one of them. Properly equipped, staffed, financed and managed, it could expand Enugu’s capacity to provide advanced medical care, reduce dependence on healthcare services outside the state and help create a broader healthcare economy.
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For this reason, the decision by the administration of Governor Peter Mbah to invest in advanced specialist healthcare deserves genuine commendation. At a time when Nigeria continues to lose substantial human and financial resources through medical tourism, investing in high-level domestic healthcare capacity is both a health policy intervention and an economic strategy. The project is particularly significant because it seeks to address a gap at the top of the healthcare pyramid while the state is simultaneously investing in primary healthcare infrastructure. But commendation should not become complacency.
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The more important question is not whether Enugu is building an impressive hospital. It is whether the investment can become part of a functioning health system capable of delivering quality, affordable and accessible healthcare while attracting specialists, retaining healthcare expenditure and creating new economic opportunities.
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The Enugu International Hospital is reported as a 300-bed specialist facility with advanced infrastructure, including MRI machines, cancer-treatment equipment, mammography and modern surgical theatres. The planned services include emergency medicine, surgery, obstetrics and gynaecology, intensive care, cardiology, oncology, neurology, radiology, laboratory services, pharmacy and rehabilitation. The state has also presented the facility as having roles in research and training. This is important because Nigeria does not simply need more hospital buildings. It needs functioning health systems.
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Nigeria has highly competent doctors, nurses, pharmacists, laboratory scientists and other health professionals, many of whom practise successfully in some of the world’s most advanced healthcare systems. Yet inadequate infrastructure, technology, financing, institutional capacity and professional opportunities have limited the ability to deploy comparable capacity at home. The result is medical tourism.
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Nigerians who can afford it travel to India, the United Kingdom, the United States, South Africa, Turkey, the United Arab Emirates and other countries for specialised treatment. Others travel within Nigeria, particularly to Lagos and Abuja, because specialist services are unavailable or perceived to be more reliable there.
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The economic consequences are considerable. When Nigerians travel abroad for complex treatment, expenditure that could support Nigerian hospitals, doctors, pharmaceutical companies, hotels, transportation providers and other businesses leaves the country. Nigeria loses not only medical expenditure but also jobs, professional opportunities, investment and institutional learning. The system becomes trapped in a cycle in which inadequate capacity encourages medical tourism, medical tourism drains resources and that leakage makes it harder to build domestic capacity.
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The Enugu International Hospital offers an opportunity to begin breaking that cycle. The economic case is therefore as important as the medical case. If Enugu can provide complex procedures locally, patients who would otherwise travel to Lagos, Abuja or abroad could increasingly seek care within the state. Money that currently leaves the region could circulate through hospitals, laboratories, pharmacies, hotels, transport services, insurance companies and other businesses. This is why the hospital could become more than a health facility. It could become an anchor for a healthcare economy. But there is an important qualification. Reversing medical tourism should not mean creating a facility where Nigerians can obtain world-class healthcare only if they can afford world-class prices.
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International-standard healthcare must also be accessible healthcare. This makes health insurance central to the success of the project. A sophisticated hospital without an effective financing mechanism risks becoming an institution primarily for wealthy Nigerians, expatriates and medical tourists while ordinary citizens continue to depend on poorly financed services or incur catastrophic out-of-pocket expenditure.
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The broader health-system investments of the Mbah administration therefore matter enormously. The state has reported interventions across 260 Type-2 primary healthcare centres, alongside investments in equipment, digital transformation, solarisation, electronic health records and real-time health data systems. The World Health Organization has also recognised the administration’s broader health-system investments. This combination is strategically sound.
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The International Hospital can provide the apex. Primary healthcare can provide the foundation. Secondary hospitals should provide the critical middle. Digital systems can connect the different levels. The real opportunity is to build a continuum of care in which a patient can move from community-level prevention and primary treatment to secondary care and, where necessary, to advanced specialist services. The International Hospital should therefore be the apex of an integrated referral architecture, not an isolated mega-project. But this is precisely where an uncomfortable reality must be confronted.
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A world-class hospital cannot compensate for a weak primary and secondary healthcare system.
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The latest Human Resources for Health assessment presents a stark picture of Enugu’s primary healthcare workforce. Across 566 PHC facilities in the state’s 17 LGAs, the system requires 8,274 clinical and frontline personnel but currently has only 1,810, leaving a gap of 6,464 personnel or 78.1 percent. That is not a minor staffing problem. It is a structural constraint.
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The cadre-specific figures are even more revealing. Medical Officers face an 81.8 percent gap; Pharmacists, 96.7 percent; Medical Laboratory Scientists, 90.0 percent; Nurses and Midwives, 90.9 percent; Medical Laboratory Technicians, 92.0 percent; Pharmacy Technicians, 96.1 percent; and Medical Records personnel, 99.4 percent. Community Health Extension Workers have a deficit of 1,116 personnel, representing 49.3 percent of the requirement, while Junior CHEWs face a 61.5 percent gap.
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The 2024 audit also captured non-clinical personnel, including Environmental Health Officers, who have since been repositioned to the Water, Sanitation and Hygiene unit under ENRUWASA. This required a recalibration of the clinical workforce baseline. These figures fundamentally change how the International Hospital should be understood.
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The question is not whether Enugu should build advanced specialist capacity. It should. The question is whether the state can build the human and institutional infrastructure beneath that capacity quickly enough to make the entire system work. There has already been encouraging progress. Following approval for 2,200 PHC workforce positions, the Enugu State Primary Health Care Development Agency launched an online recruitment exercise that attracted 6,000 applicants, of whom 4,000 completed the Computer-Based Test. Phase One has successfully onboarded 450 candidates.
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This deserves recognition. It demonstrates that the administration understands that buildings and equipment must be matched by people. But the scale of the remaining challenge is enormous. The 450 recruits represent only about 7 percent of the identified workforce gap. With approval secured for aggregated two-phase recruitment, the Agency projects onboarding 1,350 personnel by the end of 2026. Even if that target is achieved, approximately 5,114 positions would remain to be filled by the end of 2027.
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The implication is clear: workforce development must become a sustained, multi-year strategy rather than a series of recruitment exercises. The most urgent gaps should receive priority, particularly Medical Officers, Pharmacists and Medical Laboratory Scientists. At the same time, Enugu should expand the capacity of its schools of health to train additional CHEWs. The shortage of 1,116 CHEWs is particularly important because they provide one of the most direct links between communities and formal healthcare. Recruitment, however, is only half the problem. Retention matters just as much.
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Health professionals do not leave only because of salaries. They also leave because they cannot practise effectively, equipment is unavailable, workloads are excessive, professional development is limited and career progression is uncertain. Enugu therefore needs a deliberate retention strategy covering career development, continuing professional education, supportive supervision, performance incentives and improved working conditions. This is especially important for the International Hospital. A specialist hospital will require specialists who can work with advanced technology, undertake complex procedures, train younger professionals and participate in research.
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Nigeria’s medical diaspora should be part of this strategy. Enugu does not necessarily have to persuade every Nigerian specialist abroad to return permanently. It can develop structured opportunities for visiting specialists, specialist procedures, telemedicine, mentorship, training, research collaboration and technology transfer.
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The International Hospital could become a bridge between Enugu and Nigerian medical expertise around the world. It should also become a centre of learning, not merely treatment. Specialist training, advanced nursing education, clinical research, biomedical engineering and international partnerships should form part of its long-term development. This would enable Enugu gradually to move from being primarily a consumer of medical services to becoming a producer of medical knowledge and specialist expertise.
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There is, however, another question that cannot be avoided: opportunity cost. Government operates within a finite fiscal envelope. Every major investment involves choices about how public resources are allocated. The question is therefore not whether the International Hospital is desirable. It clearly is. The question is whether investment in advanced specialist healthcare is being appropriately balanced with the enormous requirements of primary and secondary healthcare.
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Enugu does not have to choose between the two. It needs the International Hospital and functional PHCs. It needs advanced specialist care and strong secondary hospitals. It needs sophisticated equipment and the people capable of using it. The danger would be creating an impressive apex while the foundation and middle remain too weak to support it.
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This is why the 260 PHCs are so important. Their success should not be measured merely by how many have been constructed or renovated. The real test is whether they are functional when citizens need them, whether qualified personnel are available, whether medicines and consumables are present, whether electricity and water are reliable, whether equipment works and whether referrals function. Infrastructure is necessary. Functionality is decisive.
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The same principle applies to secondary healthcare. Secondary hospitals should absorb cases that exceed PHC capacity without unnecessarily sending every patient to the International Hospital. A strong secondary-care network would reduce pressure on the specialist facility, lower costs for patients and improve referral efficiency.
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Digital health can strengthen this architecture. The reported deployment of electronic health records and digital systems across PHCs and secondary facilities could improve referrals, reduce duplication of investigations, strengthen continuity of care and enable clinicians at different levels to share relevant patient information. Real-time dashboards could improve resource allocation, surveillance and performance management.
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But technology should not become another collection of impressive statistics. The question should always be simple: Does it help a patient receive better, faster and more affordable care?
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The same outcome-based approach should apply to the International Hospital itself. Nigeria has seen public facilities deteriorate after commissioning because construction received more attention than long-term maintenance. The Enugu International Hospital must avoid that trap.
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Sophisticated equipment requires preventive maintenance, biomedical engineering capacity, reliable power and water, spare-parts arrangements and equipment-replacement plans. The true test of an MRI machine is not whether it is installed. It is whether it remains operational five, ten and fifteen years later.
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The hospital also needs strong institutional governance. It should have professional autonomy, rigorous clinical governance, transparent procurement, measurable performance standards and clear accountability for clinical outcomes, patient safety, financial performance, equipment uptime, staff performance and patient experience. Government ownership does not require government micromanagement.
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Most importantly, the institution must be designed to survive beyond the administration that created it. That may ultimately be the most important test of Governor Mbah’s healthcare legacy.
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The hospital should become an anchor for a wider healthcare ecosystem involving universities, specialist training, research institutions, medical technology companies, pharmaceutical and diagnostic businesses, insurance providers, rehabilitation services and other private-sector participants. Such an ecosystem could generate employment, attract investment and retain healthcare expenditure within Enugu and the South-East.
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Healthcare is therefore not merely a social service. It is economic infrastructure. A healthier population is more productive. Healthy children learn better. Healthy workers lose fewer working days to illness. Families are less exposed to catastrophic medical expenditure. Businesses benefit from a healthier workforce.
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The connection is straightforward: Healthy people create productive people; productive people create a productive economy. This broader perspective is one reason the Mbah administration deserves credit for pursuing a project of this scale while also investing in primary healthcare. The strategy, if properly executed, could position Enugu not merely as a consumer of advanced medical services but as a regional centre for specialist healthcare, medical education, research and investment.
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But the greatest test will come after the construction is complete. Five years after commissioning, Enugu should be able to answer some very basic questions: How many complex procedures are being performed locally? Has outbound medical travel declined? How many specialists have been attracted and retained? How many professionals are being trained? What is the equipment uptime? What are the clinical outcomes and patient-satisfaction levels? How much private investment has the healthcare ecosystem attracted? How much medical expenditure that previously left the region is now retained within it?
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The same discipline should apply to primary healthcare. How quickly is the 6,464-person workforce gap being reduced? Are health workers equitably distributed across the 17 LGAs? How many PHCs are actually functional? Are medicines available? Are referrals improving? Are maternal, child and other health outcomes improving? These are the indicators that will determine whether the investment has produced value for money.
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The Enugu International Hospital is therefore worthy of both commendation and scrutiny.
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It is commendable because Enugu needs advanced specialist healthcare capacity. It is commendable because medical tourism represents both a health-system weakness and an economic leakage. It is commendable because the project creates opportunities to attract expertise, stimulate investment, strengthen medical education and position Enugu as a regional healthcare centre. But precisely because the investment is important, it must also be subjected to rigorous scrutiny.
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A sophisticated hospital cannot compensate for an inadequately staffed primary healthcare system. Capital investment without recurrent financing and maintenance can lose value. Medical excellence without affordability can deepen inequality. And government must ultimately demonstrate that scarce public resources are producing measurable results. The appropriate position is therefore neither unconditional praise nor blanket criticism. It is constructive confidence.
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Enugu has made a bold and potentially transformative investment. Governor Peter Mbah deserves recognition for the ambition and direction of that investment. But the state must now match the physical infrastructure with equally ambitious investments in people, institutions, financing, maintenance, referral systems and accountability. The opportunity before Enugu is much bigger than a 300-bed hospital.
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The 260 PHCs can provide the foundation. A strengthened secondary-care network can provide the middle. The International Hospital can provide the specialist apex. Digital systems can connect the different levels. Health insurance can finance access. A comprehensive HRH strategy can provide the people. Universities and research institutions can provide knowledge. Professional governance can sustain the institutions. If these elements are successfully integrated, the International Hospital could become one of the most consequential health-sector investments in Enugu’s recent history. It could help retain healthcare expenditure within the state, attract specialists and investment, create employment, strengthen medical education, support research, reduce outbound medical travel and, most importantly, save lives.
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But the International Hospital is an opportunity, not yet an outcome. Its ultimate value will not be determined by the grandeur of the facility but by the quality of the health system built around it. The real legacy of the investment will therefore be measured not in concrete, steel, machines or beds, but in patients treated, lives saved, professionals trained, specialists retained, families protected from catastrophic healthcare costs, healthcare expenditure retained and communities given reliable access to quality care. If Enugu can achieve that, the International Hospital will have become much more than a landmark building. It will have become the apex of a stronger health system and a catalyst for a new healthcare economy in Enugu and the South-East.
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Professor Chiwuike Uba is a Nigerian development economist, public financial management expert, and governance reform specialist. He serves as the Chairman of the Board for the ACUF Initiative for Policy and Governance and frequently provides public policy critiques on Nigeria’s economy, national security spending, and fiscal policies.
