Corruption and the emergence of a healthcare 'marketplace' in Nigeria's primary health centres

Reframing Drivers and Solutions

Dados Bibliográficos

ID4589922
AutoresAloysius Odii (0000-0002-2222-0835, University of Nigeria), Eleanor Hutchinson (0000-0002-9718-2407, Hutchinson (United Kingdom)), Obinna Onwujekwe (0000-0002-1214-4285, University of Nigeria), Prince Agwu (0000-0001-9224-7622, University of Dundee), Tochukwu C Orjiakor, Charles T Orjiakor (0000-0001-5379-8915, University of Nigeria), Pamela Ogbozor (0000-0003-1343-1822, Enugu State University of Science and Technology), Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine), Dina Balabanova (0000-0001-7163-3428, London School of Hygiene & Tropical Medicine)
Ano2025
Volume383
Páginas118356
Data de publicação2025-10-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoSocial Science & Medicine (JOURNAL)
Identificadores do periódicoISSN: 0277-9536 • E-ISSN: 1873-5347
EditoraElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2025.118356
PMID40680478
OpenAlexW4411919696
IdiomaEN
Referências citadas32

Corruption in the health systems of low- and middle-income countries (LMICs) is fuelled by many factors, including health system failures, practical norms, informal rules, and social networks. Researchers have historically scrutinized these factors in isolation, often failing to grasp the intricate interconnections and the combined manner in which they manifest. In this ethnographic study, we present evidence from Nigeria's healthcare system, where these factors converge, fundamentally reshaping the structure and operation of the healthcare system away from those set out in policy. Our study entailed three months of simultaneous participant observation at six Primary Health Centres in Enugu, Nigeria by four researchers. Following this, we conducted in-depth interviews with healthcare workers and their managers, and focus group discussions with service users. Our findings show that informal payments and rent-seeking, are widespread. Failures to provide basic infrastructure, staff and commodities means that healthcare providers have to use informal means to raise money in order to address these deficiencies. These practices are deeply embedded in reciprocal obligations among staff members, coordinated by groups who collaborate and engage in sustained interactions. Over time, their shared norms and networks are underpinned by informal agreements when and how to charge patients and allocating collected resources. Under this situation, healthcare facilities metamorphose from the ideal of primary health facilities as a setting in which care is provided according to need, into a 'marketplace,' where access to care and health commodities is profoundly shaped by economic imperatives and intricate social processes. The findings of this study suggest that any single "silver bullet" approach, such as solely focusing on norms, and health system failures, is likely to have minimal impact. Instead, policy makers should seek innovative ways through which more equitable access to care can be achieved in the current context

Cognitive reframing · Economic growth · Economics · Health care · Language change · Political science · Primary health care · Public health · Sociology · Healthcare Systems and Reforms · Medicine · Nursing · Psychology · Social Psychology