A Square Peg in a Square Hole: Leadership in Nigeria’s Health System
By Abdulkadir S. Abdulkadir, PhD Candidate
Fiscal Space Analyst and Social Justice Advocate
BAUCHI, NIGERIA — The long-running debate over whether leaders are born or made has shaped leadership thinking for more than a century. The nineteenth-century Great Man theory, followed by trait-based approaches, suggests that some individuals possess inherent qualities that give them an advantage in decision-making, influence and the ability to attract followership.
Contemporary leadership thinking, however, increasingly recognises leadership as a set of competencies that can be developed: communication, strategic thinking, emotional intelligence, people management, ethical judgement and the ability to navigate complexity.
Both perspectives contain elements of truth. Some individuals may indeed begin with advantageous traits. Yet what often separates ordinary managers from exceptional leaders is deliberate personal development—the continuous process of refining judgement, deepening emotional intelligence, expanding capacity and learning from experience.
Nowhere is this more consequential than in healthcare.
In clinics, hospitals, public-health institutions and ministries of health, the quality of leadership can influence patient outcomes, staff performance, resource utilisation and the resilience of entire health systems. Leaders who rise to these challenges are rarely those who simply “have the gift.” They are often those who treat leadership itself as a discipline that must continually be developed.
Beyond Credentials: The Leadership Question
Nigeria has struggled with this distinction, particularly in the appointment of ministers overseeing health and education.
Too often, we have equated impressive academic credentials or professional accomplishment with leadership capacity. The two can certainly coexist, but one does not automatically guarantee the other.
An accomplished professor of surgery, neurology, physics or another discipline may possess exceptional technical expertise while lacking some of the competencies required to lead a complex public institution. In scrutinising academic records and professional achievements, therefore, we must not overlook one of the most important questions surrounding such appointments: Can the individual lead?
The appointment of Professor Muhammad Ali Pate offers an interesting case study.
Beyond his academic credentials, Pate brought extensive experience in global health, development and health-system leadership. For a President who understood what Pate represented, entrusting him with the responsibility of Coordinating Minister was a significant decision and a first for Nigeria’s health sector.
I have followed Pate’s record since his earlier service as Minister of State for Health, when he championed the Saving One Million Lives initiative. Yet it was during his 2023 ministerial screening that one aspect of his presentation particularly caught my attention.
He offered a fundamentally different way of looking at Nigeria’s health sector and its place within the national economy: unlocking the health value chain.
Health as More Than a Social Service
The concept moves beyond the four walls of hospitals and the conventional public-health space. It encompasses the wider value chain involved in producing, transporting, storing, financing and distributing health commodities and services.
That represents an important conceptual shift.
Health is not only a social service or an expenditure item. It is also an economic sector capable of supporting local production, investment, employment, innovation and national health security.
The idea of unlocking the health value chain has also moved beyond rhetoric. The Federal Ministry of Health and Social Welfare has established a dedicated implementation vehicle to advance the initiative, strengthen local manufacturing capacity, coordinate stakeholders and mobilise investment and financing across the health value chain.
From Programmes to Systems
A second distinctive feature is the systems-thinking approach underpinning the Nigeria Health Sector Renewal Investment Initiative (NHSRII).
Leadership, in this context, does not mean that one minister personally produces every outcome. Effective leadership is about coordinating institutions, people and resources towards a common objective.
Under Pate’s coordinating leadership, federal and state governments, the FCT, development partners, civil society, the private sector and other stakeholders have been brought into a common reform architecture.
The Health Sector Renewal Compact, signed by all 36 state governors and the FCT, provides an important political and institutional basis for this alignment.
The NHSRII is operationalised through the Sector-Wide Approach (SWAp). Instead of allowing primary, secondary and tertiary healthcare, government institutions, development partners and implementing organisations to operate as disconnected components, the approach seeks to treat the health sector as a system and align its component parts around a common direction.
That philosophy is captured in the expression: “One vision, one conversation, one budget, one report.”
This is leadership expressed through coordination—creating the conditions for multiple institutions, each with distinct mandates, to work towards shared priorities while respecting Nigeria’s federal structure.
For a health system historically characterised by multiple programmes, funding streams, implementing partners and, at times, overlapping interventions, a systems approach has the potential to improve coordination, strengthen accountability, reduce duplication and direct available resources towards agreed national and subnational priorities.
When Policy Becomes Service
Several implementation results are beginning to give substance to these reforms.
Recent Federal Ministry of Health and Social Welfare reporting indicates that more than 48,000 women have received free emergency obstetric care, while more than 4,000 free caesarean sections have been performed in NHIA-empanelled facilities.
In September 2026, the Ministry also reported that more than 32,000 women and 1,700 newborns had benefited from emergency obstetric and neonatal care through facilities implementing the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII).
These figures matter because they represent the point at which policy commitments begin to translate into services received by women and newborns.
The National Emergency Medical Service and Ambulance System (NEMSAS) provides another example.
By mid-September 2026, NEMSAS had transported nearly 79,000 beneficiaries to appropriate care, with about 60 per cent reportedly being pregnant women.
The Federal Government has also acquired tricycle ambulances, boat ambulances, Basic Life Support ambulances and Advanced Life Support ambulances as part of efforts to strengthen the national emergency medical services system.
Put simply, the ambition is moving beyond the idea of merely providing ambulances towards developing a more organised emergency referral and transportation system.
From One-Size-Fits-All to Data-Driven Intervention
Perhaps one of the more important shifts is the movement away from a one-size-fits-all approach towards interventions informed by burden and need.
For years, government interventions could sometimes appear to be designed around uniform distribution rather than the unequal distribution of health needs across communities.
MAMII represents a different approach.
Under the initiative, 172 high-burden local government areas across 33 states were identified for intensified intervention. These LGAs represent roughly 20 per cent of Nigeria’s LGAs but account for about 55 per cent of maternal deaths, according to government reporting.
Rather than spreading limited resources uniformly, the approach seeks to use data to identify where the burden is greatest and concentrate interventions accordingly.
Early results reported by the Federal health authorities are noteworthy. Government reporting indicates a 17 per cent reduction in maternal deaths and a 12 per cent reduction in newborn deaths across the 172 high-burden LGAs. Skilled birth attendance has also increased, while emergency obstetric services are being expanded within the priority areas.
These figures remain subject to continued measurement, independent scrutiny and validation. Nevertheless, they illustrate the potential value of using data to direct scarce resources towards populations and locations where the potential health gains are greatest.
Beyond Treatment: Dignity, Rehabilitation and Economic Empowerment
The Fistula Free Programme is another component of the broader reform agenda, addressing obstetric fistula among vulnerable women while extending intervention beyond corrective treatment to rehabilitation and economic empowerment.
Health-facility revitalisation is also central to the reforms, alongside efforts to strengthen primary healthcare, expand financial protection, improve health infrastructure, develop the health workforce, strengthen domestic pharmaceutical and medical-product manufacturing, and attract greater investment into the health sector.
None of these reforms can reasonably be attributed to one individual alone.
They involve federal and state institutions, local governments, health workers, development partners, civil society organisations, private-sector actors, communities and numerous implementing agencies.
But recognising this does not diminish the importance of leadership.
Indeed, it defines it.
Effective leadership is not necessarily about personally producing every result. It is about establishing direction, securing commitment, aligning resources, coordinating actors, demanding accountability and keeping complex institutions focused on measurable outcomes.
The Real Test Lies Ahead
What Nigeria is witnessing therefore provides a real-world opportunity to examine a long-standing proposition: that leadership skills, deliberately cultivated and purposefully applied, can influence the trajectory of a complex health system.
There are encouraging signs.
But the ultimate test will not be the number of announcements made, programmes launched or resources mobilised.
The real test will be whether these reforms produce measurable and sustained improvements in access to healthcare, quality of care, financial protection, maternal and child survival, health security and the everyday experience of Nigerians seeking medical attention.
That is why researchers, practitioners, policymakers and citizens have an important role to play.
The task should not simply be to celebrate progress or dismiss it.
It is to interrogate it.
Measure it.
Identify what works.
Expose what does not.
And extract lessons capable of strengthening health-system leadership in Nigeria and across Africa.
Ultimately, leadership should be judged not merely by academic credentials, eloquence or the number of initiatives launched, but by the institutions strengthened, systems transformed, people developed and outcomes that endure long after the leader has left office.
That, perhaps, is the real meaning of putting the right person in the right place: a square peg in a square hole.