It is news to most Nigerians that since October 2014, Nigeria has had a federal law that fundamentally changes how healthcare should work in this country. The National Health Act of 2014 is not a policy document, not a guideline, and not a political promise. It is binding law. It gives Nigerians enforceable rights to emergency healthcare and basic medical services, regardless of income, status, or location. Yet, more than ten years after it was signed into law by President Goodluck Jonathan, millions of Nigerians have never heard of it. Hospitals routinely violate it. Governments fail to enforce it. Funds meant to make it work disappear. And the result is a quiet national disaster unfolding in wards, maternity rooms, and emergency units across the country.
The National Health Act was designed to address a brutal reality: that Nigerians were dying from preventable causes because healthcare had been turned into a cash-and-carry business. Lawmakers understood that in emergencies, time matters more than money. They understood that a woman in labour cannot wait for her husband to borrow transport money. They understood that a road traffic accident victim cannot negotiate fees while bleeding. They understood that a child convulsing with malaria cannot be told to come back tomorrow. That understanding is written clearly into the law.
Under Sections 20, 27, and 29 of the Act, no health facility in Nigeria has the right to refuse emergency treatment to anyone. Not government hospitals. Not private hospitals. Not clinics. Not mission hospitals. Not teaching hospitals. Not primary health centres. Not community health extension workers. All are bound by this law. In an emergency, treatment must come first. Money comes later. Documentation comes later. Police reports come later. Anything that delays life-saving care is illegal.
Yet, step into many Nigerian hospitals today and you will see the opposite of that crucial law being imposed on hapless Nigerians with impunity. An accident victim is rushed in by good Samaritans. The nurses look at him, assess the severity, and then ask, “Who is going to pay?” When no one answers immediately, the patient is left on a bench or on the floor. Minutes pass. Blood pools. The victim groans and then goes quiet. By the time someone produces money or a relative arrives, it is too late. This is not an exaggeration. This is a recurring reality.
Pregnant women in labour are another tragic example. A woman arrives at a hospital at midnight, screaming in pain. She is told to buy a card, open a file, pay a deposit, and purchase gloves, cotton wool, disinfectant, and syringes before she can be attended to. She pleads that she has no cash. The nurses shrug. Hours pass. Complications set in. Sometimes the baby dies. Sometimes the mother dies. Sometimes both. Later, the hospital records it as “late presentation.” In truth, it was delayed care caused by illegal demands.
Gunshot victims face an even more cruel fate. Despite clear legal provisions that hospitals must treat gunshot victims without insisting on police reports, many facilities still refuse them outright. Victims are told to go to the police first, even when they are bleeding heavily. Some die in transit between police stations and hospitals. Others are rejected by multiple hospitals in one night. The law is clear. The practice is deadly.
Children are not spared. A child under five is brought to a primary health centre with severe fever and convulsions. The parents are told to buy drugs from outside because “there are no drugs.” They are told to pay consultation fees. They are told the nurse on duty is not available. By the time the child reaches another facility, the convulsions have caused brain damage or death. This is happening in a country where the law guarantees free care for children under five at the primary level.
The National Health Act goes beyond emergency care. It establishes a Basic Minimum Package of Health Services that every Nigerian is entitled to receive. This includes free immunization, free antenatal care, free childbirth services, free family planning, treatment for common illnesses at primary health centres, free Medicare for children under five, and emergency stabilization nationwide. These are not campaign slogans. They are legal entitlements.
To make this possible, the Act created the Basic Health Care Provision Fund. This fund is not optional. The law mandates that at least one percent of Nigeria’s Consolidated Revenue Fund must be set aside every year for basic healthcare. That money is meant to support primary health centres, supply essential drugs, fund maternal and child healthcare, strengthen emergency medical systems, and provide health insurance for the poor. It is supposed to reach all 774 local government areas in Nigeria.
On paper, this is revolutionary. In practice, it is largely invisible. Many primary health centres remain abandoned buildings with no drugs, no equipment, and skeletal staffs. Communities are told there is “no money,” even though the law says the money must exist. Pregnant women are charged fees in facilities that are supposed to provide free antenatal and delivery services. Emergency care is still monetized. The poor are still excluded. The system still favours those who can pay quickly.
The question, then, is not whether Nigeria has good healthcare laws. It clearly does. The real question is why the law is not being implemented, and why it is especially important that the current APC-led government enforces it fully and transparently.
The APC government inherited the National Health Act. It did not create it, but it is bound by it. Governance is not about choosing which laws to obey based on political convenience. The Act is federal law, and the federal government has the primary responsibility to ensure its implementation. This includes releasing the required funds, monitoring their use, sanctioning non-compliant hospitals, and educating Nigerians about their rights.
Failure to implement the Act has consequences that go beyond individual deaths. It erodes trust in the healthcare system. It normalizes cruelty. It tells healthcare workers that there are no consequences for illegal behaviour. It tells hospitals that profit matters more than life. It tells politicians that health budgets can be looted without accountability. And it tells ordinary Nigerians that survival depends on luck, not rights. The human cost of this failure is staggering. Nigeria continues to rank among the countries with the highest maternal mortality rates in the world. Many of these deaths occur in hospitals, not at home. They occur because women are delayed, denied, or neglected. Children die from malaria, diarrhea, and pneumonia—conditions that are easily treatable at the primary level. Accident victims die not from the severity of their injuries, but from the refusal of hospitals to act without payment. These deaths are not inevitable. They are not acts of God. They are the result of deliberate choices to ignore the law. Implementing the National Health Act is not just a legal obligation for the APC government; it is a moral one. A government that cannot protect its citizens at their most vulnerable moments has failed at the most basic level. Emergency healthcare is not a luxury. It is a fundamental function of the state. When a government allows hospitals to turn away dying patients, it is complicit in those deaths.
Full implementation of the Act would change lives immediately. Hospitals would know they cannot legally demand money before stabilizing patients. Health workers would understand that refusal of emergency care carries consequences. Primary health centres would be better funded and better equipped. Poor families would have access to essential services without being pushed into debt. Nigerians would begin to see healthcare as a right, not a favour.
Awareness is equally critical. A right that people do not know exists is easy to violate. Nigerians must be educated about their healthcare rights in simple language, through radio, television, social media, community meetings, and schools. When people know the law, they are more likely to demand compliance. When hospitals know that patients know their rights, behaviour begins to change.
Enforcement must follow. Laws without enforcement are invitations to abuse. Hospitals that violate the National Health Act should face real penalties, including fines, license suspension, and prosecution where appropriate. Health officials who divert or embezzle funds meant for basic healthcare should be held accountable. Transparency in the management of the Basic Health Care Provision Fund is essential. Nigerians deserve to know how much is allocated, where it goes, and what it is used for. Nigeria does not need new healthcare laws to stop people from dying unnecessarily. It needs the courage to enforce the one it already has. The National Health Act represents a social contract between the state and the people. It says that in moments of crisis, life comes first. Every day that this law is ignored, that contract is broken.
The tragedy is not that Nigerians lack rights. The tragedy is that those rights are buried under ignorance, corruption, and indifference. Until that changes, hospitals will continue to break the law, and people will continue to die quietly, needlessly, and illegally.
Most people believe that Nigeria is not a country without laws. We can perhaps say that it is a country where laws exist but people do not obey the laws and government does not feel concerned. The few examples mentioned earlier capture this tragedy painfully but that is what is happening daily in Nigerian hospitals. Every day, men, women, and children are turned away from hospital gates, corridors, and emergency rooms because they cannot produce the money for their treatment immediately or on the spot. Every day, lives that could have been saved are lost, not because medicine failed, but because the law was ignored and the people did not know their rights.
A nation that allows this cannot claim to value human life. Implementing the National Health Act fully is not optional. It is urgent. It is necessary. And for countless Nigerians whose lives hang in the balance, it is the difference between life and death. And so, every Nigerian must be made to know and appreciate his or her medical rights by the APC-led government.
Chief Sir Asinugo is a Veteran Journalist
