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| Pharm. Anweh Basil Ter, B.Pharm, FPCPharm, M.Sc. HEMP |
Persistent drug shortages in public hospitals are not inevitable—they are the result of leadership failures, weak accountability, and systemic mismanagement.
Walk into many Teaching Hospitals, Federal Medical Centres, or State-owned hospitals across Nigeria and you will hear the same tired refrain: “OUT OF STOCK (O/S).” Patients are sent out to private pharmacies. Relatives roam the streets searching for medicines that should be stocked in public facilities. Meanwhile, government officials continue to announce billions in health sector investments. So we must ask the uncomfortable question: what and where exactly is the problem?
The truth is that the persistent drug crisis in Nigeria’s public hospitals is no longer about lack of funds or policy gaps. It is about failed leadership, weak accountability, and deliberate tolerance of dysfunction within hospital management structures.
Teaching hospitals and Federal Medical Centres are not small clinics. They receive federal allocations, NHIA reimbursements, donor-supported commodities, and internally generated revenue (IGR). State hospitals, despite funding constraints, still operate revolving drug funds and central medical stores. Yet across all these levels, drug management systems remain shockingly primitive—if they exist at all.
In many hospitals, there is no reliable inventory system. Consumption is not forecast. Stock levels are unknown until shelves are empty. Expired drugs coexist with emergency stock-outs. Procurement is reactive, opaque, and sometimes driven by personal interests rather than patient needs. These are not system failures—they are management failures.
At the centre of this dysfunction is the Medical Director or Chief Medical Director, who doubles as the hospital’s chief executive and accounting authority. These individuals wield enormous power over procurement, approvals, and internal governance. Yet when drug revolving funds collapse, when essential medicines disappear, or when patients are pushed into private pharmacies operating within hospital premises (PPP), no one is held responsible.
This culture of impunity is most visible in Teaching Hospitals and FMCs. Pharmacy departments—the very units trained to manage medicines—are often reduced to passive dispensaries, excluded from strategic procurement and planning. Pharmacists who insist on standard operating procedures, transparent audits, or evidence-based forecasting are branded as “troublesome.” Meanwhile, drugs leak out of the system, and patients pay the price.
State hospitals mirror the same pattern. Even where funds are limited, mismanagement multiplies scarcity. Revolving drug funds are treated as emergency slush accounts rather than protected patient resources. Political interference replaces professional oversight. Leadership changes, but the chaos remains.
Government after government continues to invest in hospital buildings, equipment, staffing, insurance schemes, and special interventions. But money cannot fix a system where leadership failure has no consequences. Until drug availability becomes a performance metric for hospital managers, nothing will change. Until Medical Directors are questioned, sanctioned, or removed for persistent stock-outs, the system will continue to punish patients.
Let us be clear: drug shortages in public hospitals are not inevitable. They are the result of choices—choices to ignore systems, to sideline professionals, to tolerate opacity, and to protect managers from accountability.
A health system where patients must leave a Teaching Hospital to buy basic antibiotics is not underfunded—it is poorly governed. A Federal Medical Centre where essential medicines are “out of stock” year-round is not unlucky—it is mismanaged. A State hospital where drug funds vanish without audit is not struggling—it is failing its people.
Until Nigeria confronts this truth and demands accountability from those entrusted to manage public hospitals, the drug crisis will persist—not because solutions are unavailable, but because responsibility is absent. And in healthcare, absence of responsibility is absence of care.
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