23 May 2025 | Africa, News and features, Nigeria, Volume 54.01 Spring 2025
This article first appeared in Volume 54, Issue 1 of our print edition of Index on Censorship, titled The forgotten patients: Lost voices in the global healthcare system, published on 11 April 2025. Read more about the issue here.
With a growing population that now exceeds 200 million, Nigeria’s demand for effective healthcare is immense – but the sector is critically underfunded. Less than 4% of the country’s GDP has been spent on health in recent years, resulting in operational inefficiencies, the deterioration of medical infrastructure, health professionals migrating to other countries, and medical tourism, where wealthier Nigerians pay for healthcare abroad instead of at home.
This year, the health sector was allocated only 5.18% of the total governmental budget, which will further impact the provision of quality services and deepen disparities in access.
Last September, the World Bank approved a $1.57 billion loan for Nigeria, including $570 million to strengthen primary healthcare provision. This is one of many international funds provided to help improve the country’s healthcare infrastructure. However, systemic failures including corruption divert essential resources away from those who need them most.
A recent report from Transparency International – a global coalition against corruption – highlights corruption as a barrier to effective healthcare delivery globally and indicates that $500 billion is lost to the problem annually. Nigeria ranks 140 out of 180 in its Corruption Perceptions Index, reflecting its pervasive nature within the country’s institutions. In healthcare, corruption manifests in many ways, including organ trafficking and unethical transplants, counterfeit drugs and the diversion of humanitarian aid.
In north-east Nigeria, the illegal trade of Ready-to-Use Therapeutic Food, which is intended for malnourished children, highlights the severe misuse of humanitarian aid, with healthcare workers implicated in diverting supplies for sale in local markets.
Systematic financial abuse has also been documented by organisations set up to help Nigerians access affordable, quality healthcare. The National Health Insurance Scheme (NHIS), for example, allegedly misappropriated more than 6.8 billion Nigerian Naira ($4.5 million) through illegal allowances between 2016 and 2017. Despite its mandate to reduce out-of-pocket healthcare spending, the NHIS has managed to cover only 5% of Nigerians since it began in 2005, with the majority of Nigerians still financing their own healthcare through out-of-pocket payments.
A report by the news agency Sahara Reporters revealed rampant corruption at the National Hospital Abuja in Nigeria’s capital, where patient-staff bribery and payments to private accounts are common. In another concerning account at a community health centre in Lagos, one anonymous healthcare worker told Index that contracted health workers who were paid to immunise young children had recorded discarded oral polio vaccinations as “administered”. This distortion not only alters public health data but also places entire communities at risk of preventable diseases. There was also alleged misuse of resources, with the source reporting that solar-powered lights intended for use in healthcare centres were installed in the homes of local politicians instead.
Challenges faced by whistleblowers
Amid these challenges, whistleblowing has emerged as a critical strategy for combating corruption. Experts identify it as an accountability tool that can promote transparency and reduce corruption in healthcare service delivery. However, it is fraught with challenges, including intimidation, a lack of legal protection and a culture of silence. Whistleblowers endure significant personal risks, including emotional distress, underscoring the need for protective measures and a supportive environment.
A major shortcoming is the law. Onyinyechi Amy Onwumere, of the Civil Society Legislative Advocacy Centre (CISLAC), provides free, confidential and professional legal advice to victims and witnesses of corruption. She noted: “Nigeria does not have a comprehensive whistleblowing law. Existing protections are fragmented and insufficient, leaving whistleblowers vulnerable to retaliation.
“Whistleblowers in Nigeria’s healthcare system often encounter retaliation, including threats, suspension or sacking, and even physical harm. These actions create a toxic atmosphere where human rights violations thrive, and potential whistleblowers are discouraged from coming forward.
“The failure to adequately protect whistleblowers leads to a deteriorating healthcare system and a loss of public trust.”
There is also a lack of awareness among potential whistleblowers regarding their rights and the protections and reporting mechanisms that do exist, she added. According to the Centre for Fiscal Transparency and Public Integrity, a Transparency and Integrity Index the organisation compiled found that only 10 ministries, departments and agencies out of 512 in Nigeria have a whistleblower policy. “This is far from best practice,” said Onwumere.
Cultural and systemic barriers
Cultural and societal norms create a challenging environment for whistleblowers. Informal corruption networks thrive where they are tolerated, particularly when they benefit the community. Tosin Osasona, a programme manager at the NISER/MacArthur Foundation Research Grant Project on Corruption Control in Nigeria, explained: “In a society where loyalty is highly valued, speaking out against one’s institution can be perceived as a betrayal.”
This attitude discourages people from stepping forward.
Osasona highlighted the professional risks that whistleblowers face. “They often encounter blacklisting by seniors, reduced future job prospects and ostracisation. The reality is that potential whistleblowers are intimidated, isolated and discouraged.”
He stressed the need for a dedicated whistleblower reporting system tailored to the healthcare sector. “A reporting mechanism that guarantees confidentiality, independence, and impartiality is essential to breaking the cycle of corruption,” he said.
One community health officer told Index that patients who were already burdened by the cost of treatment could find themselves extorted for basic medical services. They explained how a patient recently reported a staff member for selling injections that were meant to be free and for inflating the cost of other items.
“Instead of facing disciplinary action, the individual was merely transferred to another clinic in the subdivision.”
And when staff members are the whistleblowers, they ultimately get transferred, “perpetuating a cycle of corruption and silence with no real change”, the source added.
This climate of suppression extends to the media, where censorship continues to stifle investigative journalism – particularly on financial embezzlement. Despite amendments, authorities continue to misuse the broad powers of the 2015 Cybercrimes Act to detain and prosecute journalists uncovering corruption.
The path forward
There are severe consequences of widespread corruption in healthcare, including loss of life, increased healthcare costs and a deterioration of the health sector, disproportionately affecting vulnerable people.
Yusuff Adebayo Adebisi, a pharmacist and director of research and thought leadership at the international organisation Global Health Focus, said: “Corruption in healthcare resource allocation damages patient care. It deprives people who need treatment of crucial supplies and funding. This problem leads to drug shortages, outdated equipment and neglected facilities – all of which put patients at risk. Some people turn to expensive private clinics or skip treatment entirely because vital resources have been syphoned away.”
A recent review from five English-speaking West African countries, including Nigeria, suggests that poor working conditions and low wages push some healthcare workers to engage in unethical behaviour. Adebisi emphasised that “a real solution calls for a detailed understanding of how corruption operates in each place so that decision-makers can craft effective strategies that address these problems at their core”.
Empowering healthcare professionals to safely report corruption and mismanagement requires a combination of legal protection, secure reporting channels and a supportive workplace culture. Adebisi said that whistleblower protection laws are “essential” and should be communicated clearly to staff “so they know they will be shielded from retaliation”. Secure, anonymous platforms – such as confidential hotlines or encrypted digital tools – can also help professionals speak up without fear of losing their jobs or facing harassment.
Training and awareness programmes on ethics and accountability can boost staff confidence. Adebisi suggested that “working with professional associations, non-governmental organisations and community groups adds an extra layer of support and helps create a culture where reporting is seen as a collective responsibility rather than an individual risk”.
International models provide useful insights into how Nigeria can strengthen its whistleblowing framework. For instance, in the UK, National Health Service organisations rely on “Freedom to Speak Up guardians” who serve as neutral, trusted people who staff can approach with sensitive concerns. In some Latin American countries, partnerships between government agencies and civil society groups have led to digital whistleblowing platforms that maintain user anonymity. These ideas could be tailored to Nigeria, said Adebisi, taking into account the “unique challenges” of different regions.
Artificial intelligence can also enhance these efforts. He explained that “tools powered by machine-learning can track procurement data, pinpoint suspicious patterns in drug prescriptions and flag irregularities that might indicate theft or bribery”. While technology alone won’t solve the issue, he believes that integrating AI with “robust legal frameworks” and education programmes could help to “significantly strengthen oversight”.
“There’s no single solution that works for every institution, so it’s important to combine strategies that promote accountability, protect staff and foster a culture of transparency.”
A lack of accountability can have real-world consequences. One nurse in a teaching hospital told Index how corruption in resource management exacerbated existing disparities.
“Some wards are fully equipped with state-of-the-art machines, have a constant power supply and are staffed with highly efficient medical personnel,” she explained. “Meanwhile, other units struggle with outdated equipment, erratic electricity and severe staff shortages.”
When whistleblowers have the support of the media and the public, their reports can lead to meaningful reform. Onwumere highlighted the Ministry of Niger Delta Affairs scandal, where a whistleblower’s revelations of looting at the ministry prompted policy changes. Similar pressure in the healthcare sector could drive accountability and bring change.
Ensuring that those who expose wrongdoing in healthcare can speak out freely is not merely a matter of individual rights – it is a critical step towards a functional and equitable healthcare system for the tens of millions of Nigerians who depend on it.
21 May 2025 | Belarus, Europe and Central Asia, News and features
The International Day of Solidarity with Political Prisoners in Belarus is marked on 21 May. There are currently more than 1,180 political prisoners in the country, and more than 6,940 people have been sentenced in politically-motivated criminal cases.
Behind bars, people who have shown resistance to Alyaksandr Lukashenka’s regime face inhumane conditions designed to break their spirit and ruin their health. Some are denied or cannot receive necessary medical care. Others are deliberately left to deteriorate. Just yesterday, rights campaigners found out that political prisoner Valentin Shtermer has died behind bars in unclear circumstances.
The date to show solidarity is dedicated to political prisoner and activist Vitold Ashurak, who died in prison in 2021 under unclear circumstances. His body was reportedly returned to his family with his head bandaged, raising serious suspicions about the cause of death.
Another tragic case occurred in July 2023, when political prisoner, famous Belarusian artist Ales Pushkin, died in intensive care after being transferred there directly from prison. According to Belarusian independent media, Pushkin had an ulcer that was not treated in time and developed sepsis, leading to multiple organ failure.
According to the Viasna Human Rights Center, political prisoners Mikalai Klimovich, Aliaksandr Kulinich, Ihar Lednik, Vadzim Khrasko and Dzmitry Shlethauer also died in detention. Recently, Hanna Kandratsenka and Tamara Karavai died soon after their release from unjust sentences – their health deteriorated in prison.
Clearly, lack of proper medical care is a tool to pressure political prisoners. One disturbing example is the case of Maryia Kalesnikava, one of the leaders of the democratic movement, who was sentenced to 11 years in prison. After spending several days in a punishment cell, she was eventually hospitalised with a perforated ulcer and peritonitis. She underwent surgery and lost a lot of weight, but was later returned to forced labour and denied proper aftercare.
The way Lukashenka’s regime holds people hostage and allows the system to operate with such lawlessness and inhumanity is chilling – especially when it comes to people who have been kept completely incommunicado for more than two years. The politician considered by many as the president-elect of Belarus, Sviatlana Tsikhanouskaya, often says that she doesn’t even know if her husband Siarhei (an opposition politician who was arrested) is alive.
According to Viasna, at least 206 political prisoners are at increased risk, with 77 of those having physical health issues and others facing disabilities, mental illnesses or advanced age. These numbers show just how widespread the issue is – and how urgently healthcare is needed.
Leanid Sudalenka, a Belarusian human rights defender and chairman of the Gomel branch of Viasna, was himself a political prisoner and was released in 2023 after serving his sentence (he’s now been sentenced to a further five years in absentia). In his mind, this failure or inadequate provision of medical care is a form of cruel, inhumane and degrading treatment.
“First of all, courts in Belarus do not consider the health conditions of those convicted under so-called extremist or terrorist articles of the criminal code,” he said.
He went on to describe how he suffers from diabetes. “The person in judicial robes did not ‘find’ even a single day of leniency for my illness, although they had every legal right to consider it a mitigating factor. As a result, I served the full term without ever being able to measure my blood sugar levels,” he said.
Inside prison, he witnessed a terrible situation for people in critical conditions: “Even when cancer is diagnosed there, prisoners are not released from their sentences – they die right there in their prison beds.”
Kseniya Lutskina, a journalist and released political prisoner, has a brain tumour. The regime took her pro-democratic activism very personally – Lutskina was a state TV journalist who joined the media workers’ strike in 2020 after the fraudulent election. She was sentenced to eight years, but in August 2024, she was “pardoned”. While in pre-trial detention under criminal charges and already suffering from her condition, she was told directly: “You will die in prison.”
Lutskina shared her experience with Index, describing how access to medical care in pre-trial detention is extremely limited, and that no proper diagnostics can be carried out at this point.
“The doctors there – often just general practitioners – simply don’t have the tools, resources, or authority to provide proper treatment. Their role is mostly limited to emergency care,” she said.
“In some cases, if medical documents can be provided from outside, the detainee may be allowed to receive specific medications. But this requires confirmed diagnoses; otherwise, even getting basic treatment becomes a bureaucratic impossibility.”
She said that for detainees with serious health conditions, it can be nearly impossible to get what they need.
“When political prisoners begin to deteriorate – and many inevitably develop health problems – they are often only treated for symptoms, to the extent possible,” she explained. “It’s not entirely accurate to say there is no medical care, but it is extremely limited and deeply inadequate for serious conditions”.
Lutskina told Index about the harsh environment of prison labour, especially for women. With her formal diagnosis, rather than being exempted from work, she was reassigned to a different type of labour where she didn’t operate heavy machinery.
“But if I fail to meet the daily quota, I’ll be sent back there, to the machines. So, regardless of how you feel – sick or well – you’re still expected to work,” she said.
Even with a medical exemption against carrying heavy weight, this was never guaranteed.
In colonies, prisoners are forced to work, and that labour is physical and often very hard. Health issues are not acknowledged until they become critical. Sudalenka described how the prison administration only pays attention to a prisoner’s health once they faint.
“In that case, they’re wrapped in a blanket and carried to the medical unit. This is especially true for political prisoners, who are not excused from work even with a fever,” he said.
He told Index about the attitude of medical staff towards inmates.
“When I was thrown into a cold punishment cell, where it was impossible to sleep at night due to the cold, I voiced my complaints during a medical personnel round. ‘If you get sick, we’ll treat you,’ they replied – and walked away.”
He said he witnessed a middle-aged man fall ill at the workshop and ask to go to the medical unit. He was told that visits to the doctor are only allowed outside working hours. The prisoner collapsed, and it turned out to be a stroke.
“One of the gravest problems in the Belarusian penitentiary system is the lack of proper diagnostics. This results in frequent – very frequent – deaths,” he said. “And while cancer deaths are somewhat explainable, how do you explain what happened in our colony when a 35-year-old man went to bed after lights out and never woke up? By morning, his body was already cold.”
Healthcare is a basic human right. But in Lukashenka’s Belarus – where the crackdown on pro-democracy resistance has led to a massive increase in human rights violations since 2020 – it has become another means of punishment against dissent.
To find out more about how health is weaponised against political prisoners, explore our Spring 2025 magazine: The forgotten patients: Lost voices in the global healthcare system.
15 May 2025 | Europe and Central Asia, News and features, United Kingdom, Volume 54.01 Spring 2025
An investigation into maternity care in the UK originally appeared in Volume 54, Issue 1 of our print edition of Index on Censorship, titled The forgotten patients: Lost voices in the global healthcare system, published on 11 April 2025. Read more about the issue here.
Donna Ockenden is a senior midwife who chaired the independent review into maternity services at Shrewsbury and Telford Hospital NHS Trust. Published in March 2022, it found that catastrophic failures at the trust may have led to the deaths of more than 200 babies and nine mothers. Ockenden concluded the trust “failed to investigate, failed to learn and failed to improve, and therefore often failed to safeguard mothers and their babies at one of the most important times in their lives”.
In May 2022, it was announced that Ockenden would chair a review of maternity services at Nottingham University Hospitals NHS Trust. It will report in 2026. She spoke to Index on Censorship for its special print edition on silenced voices in healthcare. Below is a full version of her powerful interview, and you can read Index’s investigation into whistleblowing in NHS maternity services here.
Index: Certain NHS trusts seem to be really struggling. This may be to do with all sorts of factors, including poverty and geography. Is this something you’ve also recognised?
Donna Ockenden: Absolutely. We know that if we take deprivation, where you live, where you receive your healthcare, the state of the public health provision around you, this will have a huge impact on all kinds of health outcomes. We know that women living in deprivation have much worse maternity outcomes, and often minority ethnic women are more likely to live in those areas of deprivation. So those are definitely linked.
The other thing – and it pains and upsets me to have to say it – is that I think a lot of kindness, compassion and civility has been lost from some areas of healthcare. The vast majority of people who work in the NHS every day go in to give their very all, to give us their very best. There’s no doubt about that.
But I’ve heard firsthand from mothers who have been shouted at, or mocked. When women talk about getting into the maternity room, they describe it as a brick wall. They have to ring [the hospital] multiple times when they know they are in labour. And there are examples of families who had an obstructed labour over days and days at home with tragic outcomes.
Index: It’s not a pretty picture. Is there a problem with listening to women? Is there a misogyny issue here?
DO: I think there’s definitely an issue with listening to women, a lack of hearing their voices, and then a lack of acting upon what they are telling you. There was an extra addition to this in Shrewsbury [and Telford], which is highlighted in the report. In some cases, when women died, they were blamed for their own deaths. The first time that one bereaved husband knew that it wasn’t his wife’s fault was when my team and I sat down and told him that, and he brought his teenage son along to hear it from us, because the boy had blamed himself as well. It’s horrible. So yes, in some trusts there is a problem; there is a belief that they always know best, and women are not listened to.
Index: Some parents have called for a wider national inquiry into maternity care. Do you think there is a good argument for a wider investigation?
DO: I have mixed views on that. I know many of the parents who are calling for a wider inquiry, and I appreciate where they’re coming from, and I’ve had many discussions with them on this. I suppose my concern is that public inquiries usually take a very long time to set up, and in the meantime, I think we know that what we need to do is to begin fixing perinatal care.
I say perinatal care, which means “around birth care”, because that includes not just maternity care, but also neonatal care and all the allied professionals. It would include health visiting, which is so, so important. We’ve completely lost our way with that – it’s a skeleton service. One health visitor said to me: “Our service has been vaporised.”
I think there is so much more that we could do in the here and now. I believe that what we are spending in a year on maternity claims more or less equals what we spend on maternity care provision. I’m not saying that a family shouldn’t be compensated – I would never say that. But we’re paying out so much for the cost of harm. And even with that compensation, we still leave behind harmed families whose lives can never be put back together again.
Index: Some people can no doubt be difficult, but surely, the first instinct should always be to listen, and assume that people aren’t problematic or lying. It seems that poorly run trusts assume the worst of people. Do you agree?
DO: I think you’re absolutely right, that is true. So, with our review, we offer all families the opportunity for a conversation. We don’t use the words “family stories” by the way. We say family accounts, because stories sound to me like Cinderella or Snow White, fairytales. But we start from the premise of believing families. [A traumatic event] might have happened a year ago, two years ago, five years ago, or eight years ago. Frequently, families will say this is the first time they have been heard, believed, or able to share what happened to them.
Index: You have spoken about your frustration that some of your “immediate and essential actions” (IEAs) from the Shrewsbury and Telford review have still not been implemented. Now we have another review into Nottingham. How optimistic are you that your findings will be taken up this time?
DO: I will keep pushing for the immediate and essential actions to be fully implemented. I think on a positive note, my sense is that the government is listening about health-related issues, of which maternity is one of many. But time will tell, and I will certainly keep campaigning and speaking out for the right thing to be done.
Index: You don’t want people to be frightened of going to their local hospital, but there does seem to be a postcode lottery. Do you have thoughts on this?
DO: I do a lot of work in Nottingham, specifically with minority ethnic women. So Black women, women of South Asian origin, and women living in deprivation. Often, the reason women and families won’t come forward for all kinds of healthcare (not just maternity care) is that they’ve completely lost trust in their local systems. They will describe to me how they haven’t been listened to or how they’ve been “othered”. They’ve been disregarded for so long. We saw that anyway during Covid, where the way to reach families was often through local community leaders. I think sometimes the NHS has a tendency to say: “Oh those women, they’re just hard to reach.” I think that, actually, if we go out and take time to build trust with communities, women and their families will come [to healthcare services] without a doubt. I think it’s really easy to talk about “hard-to-reach” populations: no, you’re just not trying hard enough, you’re not building trust and you’re not taking time.
Index: What needs to be done to address this crisis?
DO: It’s got to be investment into perinatal services. There’s a [financial] shortfall in maternity services, [whilst] more than £1 billion is paid out in claims [every year]. So, I think investment is the first thing and secondly, there has got to be an absolute commitment to listening to women, hearing women and acting on what they tell you. It’s fair to say that for many staff in the NHS, not just maternity services, they do not currently have the time to care. But there are occasions where there would be time, and still, women aren’t listened to. I always try to look at all aspects of an issue, rather than just say, “It’s definitely all funding,” and that’s the end of it. Funding is a massive issue, but civility, compassion, and lack of listening are huge issues as well.
