Before Creating Another Health Agency, Nigeria Should Finish the One It Already Built

There is a pattern in Nigerian governance that many of us have come to recognize almost instinctively. A real problem emerges. Government responds by passing a law. The law is never fully implemented or adequately funded. Years later, instead of fixing what already exists, we create another law, establish another agency and expand the bureaucracy. It is a cycle Nigerians have watched play out repeatedly. Now, we appear poised to repeat it in healthcare. The proposed National Health Facility Regulatory Agency (NHFRA) is built on a worthy objective. Every Nigerian deserves healthcare delivered in facilities that are safe, accountable and held to consistent national standards. No reasonable person should argue against stronger regulation of hospitals, clinics, laboratories and pharmacies. But before we create another federal regulator, we should ask a simple question. Have we fully implemented the one our laws already provide? That question has received surprisingly little attention in the public debate. Nigeria's National Health Act of 2014 already established much of the framework the proposed Bill seeks to create. Section 13 requires every health facility to obtain a Certificate of Standards, with penalties for non-compliance. Sections 9 and 10 establish a national facility standards committee empowered to develop minimum standards, inspect facilities and accredit institutions. Section 19 places a statutory obligation on health facilities to maintain quality of care under the oversight of the National Council on Health. The architecture has existed in Nigerian law for more than a decade. The problem was never the absence of law. The problem was the absence of implementation. That distinction matters because creating another agency does not automatically solve the failures of the existing system. If anything, it risks repeating them. Every new regulatory institution comes with its own bureaucracy, licensing processes, accreditation requirements and compliance obligations. Those costs do not disappear. They are borne by healthcare providers and ultimately passed on to the Nigerians who pay for care. In a health system where many providers are privately owned and operate on limited resources, additional regulatory costs can discourage expansion, increase the cost of healthcare and even force smaller facilities out of operation. That outcome would undermine, rather than advance, Nigeria's pursuit of Universal Health Coverage. More bureaucracy is not the same as better regulation. The impact extends beyond healthcare providers. Investors do not fear regulation. They fear uncertainty. Ask any hospital administrator or health-tech entrepreneur what slows the establishment or expansion of healthcare facilities in Nigeria, and regulatory overlap is likely to feature prominently. Multiple approvals, overlapping inspections and competing authorities create delays, increase operating costs and discourage investment. Duplicating a regulatory function rarely produces double the safety. More often, it produces more paperwork, longer approval timelines and greater opportunities for administrative inefficiency. There is also an important due process concern. Under the proposed Bill, appeals against decisions of the Agency would be determined by the Honourable Minister of Health—the same Ministry responsible for establishing and supervising the Agency. That arrangement raises legitimate questions about regulatory independence. Nigeria's existing professional regulatory councils provide clearer avenues for independent disciplinary review and judicial oversight. Any new regulatory framework should strengthen those safeguards, not weaken them. The governance structure proposed in the Bill also deserves careful scrutiny. Good regulation depends not only on technical competence but also on public confidence. Those being regulated must believe that the regulator is fair, balanced and independent. It is against that standard that the governance provisions of the Bill should be assessed. The Bill reserves both the positions of Board Chair and Director-General for medical practitioners. It also grants medicine two seats on the governing Board—one representing its regulatory council and another representing its professional association—while other health professions, including pharmacy, nursing and medical laboratory science, are represented only through their regulatory councils, without corresponding representation for their professional associations. This is not merely a pharmacy concern. It is a governance concern. One profession would effectively exercise disproportionate influence over the regulation of healthcare facilities involving multiple disciplines, including pharmacies and diagnostic laboratories—facilities that are governed by distinct professional standards and statutory responsibilities. An agency responsible for regulating Nigeria's diverse healthcare institutions should reflect the multidisciplinary nature of modern healthcare, not concentrate authority within a single profession. Interestingly, Nigeria's own National Health Act already provides a more balanced model. It requires only that the Chair of the facility standards committee be "a person in the health profession", while ensuring representation for the various health professional regulatory councils. We do not need to invent a fairer model. We already have one. The National Health Act should be strengthened, adequately funded and fully implemented. If genuine regulatory gaps remain—particularly at the primary and secondary healthcare levels—they can be addressed through carefully considered amendments rather than by creating a parallel bureaucracy to perform functions the law already envisages. Patient safety deserves serious regulation. Healthcare quality deserves effective oversight. But neither objective requires abandoning an existing legal framework before it has been given a genuine opportunity to succeed. Good governance is not measured by the number of agencies a nation creates. It is measured by how effectively it uses the institutions it already has. Nigeria does not need another unfinished health agency. It needs to finish the one it already built.