Authored By: Awopeju Temiloluwa
University of Ibadan
Introduction
According to the Code of Medical Ethics in Nigeria, healthcare professionals are expected, by virtue of their profession, to always uphold high standards of professional conduct and to ensure that personal motives or profit making do not influence the independent exercise of professional judgement on behalf of patients.[1] This expectation, however, raises a critical dilemma: can healthcare providers reasonably be expected to shoulder these obligations while their own rights and working conditions remain persistently neglected?
While the government places the responsibility of safeguarding patients’ rights on healthcare professionals, it frequently fails to provide the conditions necessary for them to effectively fulfil this duty. Chronic underfunding, inadequate medical facilities, poor remuneration, and weak institutional support continue to undermine the ability of healthcare providers to deliver quality healthcare. This reality reveals a troubling contradiction within Nigeria’s health sector and explains the persistent violations of rights of both patients and healthcare providers, as well as the poot state of the health sector despite the availability of legal and institutional frameworks in Nigeria.
This article argues that the protection of both patients’ and healthcare providers rights is essential to improving healthcare delivery, and that achieving a meaningful balance between these competing rights requires addressing the underlying challenges and affirming the central role of the government across all arms. The article proceeds as follows: Section II sets out the legal framework governing patients’ and healthcare providers’ rights. Section III examines the challenges and conflicts arising from competing rights. Section IV proposes recommendations for reconciling and balancing the competing interests of patients and healthcare providers.
Legal Framework
Patients’ Rights
Right to Quality Care
The Patients’ Bill of Rights (PBoR)[2] in Nigeria recognises the right of patients to receive quality healthcare. This includes the right to access a clean, safe, and secure health environment, as well as equitable access to competent caregivers irrespective of disability. Correspondingly, healthcare providers have a duty to deliver care that minimises risk and harm to patients, adopt appropriate clinical governance standards, and ensure that the best possible care is provided while protecting patients from abuse or neglect.
Quality is expected to be guaranteed to all patients regardless of their socioeconomic status and geographical location.[3] For patients, quality care often translates to obtaining the best possible health outcomes without undue delay. It therefore encompasses the provision of safe, efficient, accessible, affordable, and patient-centred healthcare services.
Right to Emergency Care
The Constitution of the Federal Republic of Nigeria (CFRN) 1999, the supreme law of the land, indirectly guarantees the right to emergency care through Section 33, which provides that every person has a right to life and shall not be intentionally deprived of it except in the execution of a court sentence. One of the rationales underlying the right to emergency care is therefore the preservation of human life and dignity. Several legal instruments expressly recognise this right.
Notably, Section 20 of the National Health Act (NHA)[4] provides that a healthcare provider, health worker, or health establishment shall not refuse a person emergency medical treatment for any reason. The seriousness of this provision is underscored by the penalties attached to its violation.[5] Similarly, the Patients’ Bill of Rights guarantees that patients are entitled to urgent, immediate, and sufficient medical intervention in emergencies, prioritising such care over considerations such as cost, payment, or law enforcement requirements.[6] In effect, healthcare providers bear a corresponding duty to attend to patients in emergency situations irrespective of their ability to pay or any contrary legal provisions. They are also expected to promptly evaluate patients presenting with emergencies and maintain responsive and efficient twenty-four-hour emergency units within their facilities.
However, the PBoR clarifies that recognition of this right does not constitute an automatic waiver of a patient’s obligation to pay for services rendered. The provision is therefore intended to protect individuals who genuinely lack the financial means to obtain immediate medical care. The inclusion of this right is commendable, as it reflects the prioritisation of the preservation of life and professional responsibility over profit-making. Nonetheless, the provision may inadvertently enable the government to shift part of its obligations onto healthcare providers while also creating the potential for exploitation by some patients.
Other important legal frameworks that reinforce the right to emergency care and impose corresponding duties include the Compulsory Treatment and Care for Victims of Gunshot Act[7] and the Federal Road Safety Commission (Establishment) Act.[8]
Healthcare Providers’ Rights
Right to Protection from Injury to Person or Property
Section 21(2) of the National Health Act provides that a health establishment shall implement measures to minimise injury to the person or damage to the property of healthcare providers, as well as prevent disease transmission. This provision implies that healthcare providers are entitled to a safe working environment and have the right to protect themselves and their property from harm while carrying out their professional duties. It also places a corresponding obligation on health establishments to ensure adequate safety measures within healthcare facilities.
Right to Refuse Patients’ Treatment
Section 21(3) of the National Health Act permits a healthcare provider, except in the case of psychiatric patients, to refuse treatment to a patient who is physically or verbally abusive or who engages in sexual harassment. The provision also entitles the healthcare provider to report such incidents to the appropriate authority.
Similarly, Section 45 of the Code of Medical Ethics in Nigeria allows a healthcare provider to withdraw treatment for good cause. The Code outlines circumstances where such withdrawal may be justified, including where it is necessary to protect the doctor’s honour and self-respect, where a patient insists on an unjust or immoral course of treatment, where the patient deliberately disregards agreed obligations such as fees or expenses, or where the healthcare provider acts in the exercise of rights recognised under Nigerian labour laws.
These provisions suggest that while healthcare providers generally have a duty to attend to patients, the law recognises certain circumstances where refusal or withdrawal of treatment may be justified. However, such refusal must still be carried out in a professional and dignified manner, typically through adequate notice and appropriate referral to another healthcare provider. Notably, the recognition of labour law rights within the Code of Medical Ethics reflects an important acknowledgement that healthcare providers are also entitled to the protection of their professional and employment rights.
Right to Fair Working Conditions
The Labour Act[9] primarily governs employment conditions in Nigeria, including those applicable to healthcare workers. Sections 13 to 20 of the Act provide for various terms and conditions of employment, including provisions relating to contracts of employment, remuneration, and workplace protections. These provisions underscore the entitlement of healthcare providers to fair labour conditions and adequate workplace protections while carrying out their professional responsibilities.
Despite these legal protections, tensions frequently arise where healthcare providers are required to fulfil extensive professional obligations while operating within inadequate institutional conditions. These tensions form part of the broader challenges examined in the next section.
Challenges and Conflicts of Competing Rights
- Legal and Institutional Factors
- Weak Enforcement of Socio-Economic Rights
Socio-economic rights, including the rights to health and fair working conditions, are recognised in several domestic and international legal frameworks. Section 17(3)(c) and (d) of the Constitution of the Federal Republic of Nigeria 1999 obliges the state to ensure that the health, safety, and welfare of all employees are protected and that adequate medical and health facilities are provided for all persons. However, the non-justiciability of Chapter II, where this section is contained has historically limited the direct enforcement of these rights.
Although alternative avenues have emerged to promote enforceability, particularly through rights contained in Chapter IV of the Constitution and the African Charter on Human and Peoples’ Rights (Ratification and Enforcement) Act,[10] practical enforcement remains weak. Factors such as limited public resources, corruption, and inadequate accountability mechanisms continue to undermine the effective realisation of these rights. Consequently, both patients and healthcare providers often struggle to enjoy the protections theoretically guaranteed under the law.
Institutional Accountability Deficits
Another challenge lies in the limited level of institutional accountability within the healthcare system. In many instances, when adverse medical outcomes occur, the law and society are quick to assign blame to healthcare professionals without sufficiently interrogating the systemic deficiencies that contribute to such outcomes.
This tendency masks the broader structural issues within the healthcare sector, including underfunding, inadequate infrastructure, and poor institutional oversight. Responsibility for failures within the healthcare system rarely lies solely with individual practitioners. Rather, it often reflects deeper governance and policy shortcomings attributable to the government.[11]
Economic and Social Factors
Structural Underfunding and Inadequate Healthcare Facilities
A major structural challenge confronting Nigeria’s healthcare system is the persistent inadequacy of healthcare infrastructure. Many healthcare facilities remain poorly equipped to provide adequate medical care. Essential infrastructure such as functional ambulances, hospital beds, and modern diagnostic equipment including CT scans and MRI machines are often unavailable or insufficient.
In some cases, patients are required to purchase basic medical supplies such as syringes, gloves, cotton wool, and prescribed drugs before treatment can be administered. Such conditions not only undermine patients’ access to quality healthcare but also place healthcare providers in difficult professional situations where they are expected to deliver optimal care despite severe resource constraints.
Brain Drain and Poor Remuneration
Poor remuneration and unfavourable working conditions have contributed significantly to the emigration of healthcare professionals. As many skilled healthcare workers seek better employment opportunities abroad, Nigeria continues to experience shortages of trained medical personnel.
Healthcare providers within the country are often subjected to excessive workloads, high levels of occupational stress, and exposure to health risks that are not commensurate with their compensation. These occupational stress-related factors inevitably affect morale, efficiency, and the overall quality of healthcare.
Inequality in Distribution of Healthcare Resources
Issues relating to distributive justice also significantly affect the realisation of healthcare rights. Healthcare personnel and medical facilities are disproportionately concentrated in urban centres, leaving rural communities with limited access to essential healthcare services.[12]
This uneven distribution contributes to disparities in healthcare access, quality of care, and health outcomes across different regions. As a result, both patients and healthcare providers in underserved areas face heightened challenges in accessing and delivering adequate healthcare services.
Inefficiencies in the National Health Insurance System (NHIS)
The limited coverage of the National Health Insurance Scheme further complicates the relationship between patients’ rights and healthcare providers’ obligations. A significant proportion of Nigerians remain outside any form of health insurance coverage, leaving many patients unable to afford healthcare services, particularly in emergency situations.
This situation creates financial risk uncertainty for healthcare institutions and may discourage healthcare providers from responding promptly to emergencies due to concerns regarding patients’ ability to pay for services rendered.
Policy and Legal Recommendations for Reconciling Competing Rights
International Enforcement of Socioeconomic Rights
The protection of socio-economic rights is fundamental to effective healthcare in Nigeria. As a state party to several international instruments, Nigeria bears obligations to meet the socio-economic needs of its citizens. Article 16 of the African Charter on Human and Peoples’ Rights (Ratification and Enforcement) Act[13] guarantees every person the right to enjoy the highest attainable standard of physical and mental health and obliges state parties to take the necessary measures to protect citizens’ health and ensure access to medical attention. Similarly, Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR)[14] affirms the right to health.
Irrespective of funding challenges, the state remains duty-bound to uphold these rights. Nigeria’s membership of ECOWAS, through its Protocol on Democracy and Good Governance, reinforces this obligation by guaranteeing rights set out in the ACHPR and other international instruments. Individuals and organisations can seek redress in both national courts and, where available, courts of special jurisdiction. In the absence of such courts, supplementary protocols empower common or civil law judicial bodies to enforce these rights.[15]
Amendment to the National Health Act to Include Labour Protections
Pursuant to Rule 45 of the Code of Medical Ethics in Nigeria, healthcare providers may, in certain circumstances, withdraw or refuse treatment, including where patients fail to fulfil agreed obligations such as payment or where the provider is exercising rights recognised under Nigerian labour laws. Incorporating these exceptions into the National Health Act would extend its applicability and strengthen judicial enforceability, ensuring that healthcare professionals can safeguard their labour rights, work under safe conditions, and deliver quality care without being unfairly exposed to systemic risks.
Apportionment of Liability
Patients retain the right to seek redress whenever their legally guaranteed rights are violated. However, where harm results partly or wholly from factors beyond the healthcare provider’s control, such as non-functional equipment, unsafe facilities, or administrative failures, liability should extend to the government. This ensures practical accountability on the part of the government while safeguarding the rights of both patients and healthcare providers.
Duty of Good Faith
Healthcare providers must always act in good faith and exercise their professional duties with diligence. While they may withdraw or refuse treatment in justified circumstances, this right cannot be used as an excuse for negligence. Providers are expected to uphold professional standards, protect patient welfare, and ensure that any refusal or withdrawal of care is ethical, proportionate, and properly documented. This principle safeguards public trust and reinforces the balance between patients’ rights and healthcare providers’ rights.
Conclusion
This article has examined the competing rights of patients and healthcare providers in Nigeria, highlighting the legal frameworks, the systemic challenges, and proposed measures to balance these rights.
The analysis demonstrates that meaningful protection of patients’ rights cannot be fully realised in isolation. Patients’ rights are best safeguarded when healthcare providers’ rights are recognised, respected, and adequately protected, particularly through the active fulfilment of the government’s obligations. These obligations include the provision of safe and well-equipped facilities, adequate remuneration, sufficient staffing, and functional healthcare systems that support the professional duties of providers. Without such support, the tension between these rights persists, creating a structural conflict of interest that undermines both patient care and provider welfare.
While this article does not seek to assess the practical feasibility of implementing the proposed policy and legal recommendations in Nigeria, it emphasises that government intervention is indispensable. The proposed measures would not only strengthen the healthcare system but also foster an environment in which both patients and providers can exercise their rights effectively, thereby promoting trust, professionalism, and improved health outcomes.
Ultimately, the protection of healthcare rights in Nigeria is interdependent: the realisation of patients’ rights depends on the recognition and enforcement of healthcare providers’ rights, and vice versa. Without the government performing its responsibilities, conflicts of interest are inevitable, and the promise of equitable, high-quality healthcare remains unfulfilled.
Reference(S):
Legislation
Constitution of the Federal Republic of Nigeria 1999
National Health Act 2014
Labour Act, Cap L1, Laws of the Federation of Nigeria 2004
Patients’ Bill of Rights 2018
Compulsory Treatment and Care for Victims of Gunshots Act 2017
Federal Road Safety Commission (Establishment) Act 2007
Code of Medical Ethics 2008
International Instruments
African Charter on Human and Peoples’ Rights (Ratification and Enforcement) Act, Cap A9, Laws of the Federation of Nigeria 2004
International Covenant on Economic, Social and Cultural Rights 1966 (ICESCR)
ECOWAS Protocol on Democracy and Good Governance 2001
Secondary Sources
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Gloria C Nwafor and Anthony O Nwafor, ‘The Healthcare Providers‑Patients Relationship and State Obligations in Times of Public Health Emergency’ (2016) 9(4) African Journal of Legal Studies 268 https://brill.com/view/journals/ajls/9/4/article-p268_3.xml accessed 14 March 2026
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[1] Section 8(A) of the Code of Medical Ethics in Nigeria, 2008.
[2] Patients’ Bill of Rights, 2018.
[3] Olaitan O Olusegun and Babafemi Odunsi, ‘Advancing the Rights of Patients in Nigeria: Analysing the Patients Bill of Rights’ (2021) 7 DELSU Law Review https://delsulawreview.com/13043/advancing-the-rights-of-patients-in-nigeria-analyzing-the-patients-bill-of-rights/vol-7/ accessed 15 March 2026
[4] National Health Act, 2014.
[5]Section 20(2) of the National Health Act provides that any person who contravenes this section commits an offence and is liable on conviction to a fine of N100,000 or to imprisonment for a period not exceeding six months, or to both.
[6] Section 7, Patients’ Bill of Rights, 2018.
[7] Compulsory Treatment and Care for Victims of Gunshot Act, 2017. This Act provides a comprehensive regulation as regarding emergency treatment of victims of gunshot in Nigeria.
[8] See section 10(4)(z) of the Federal Road Safety Commission (Establishment) Act, 2007.
[9] Labour Act, Cap L1, Laws of the Federation of Nigeria 2004.
[10] African Charter on Human and Peoples’ Rights (Ratification and Enforcement) Act, Cap A9, Laws of the Federation of Nigeria, 2004.
[11] Dele A Olatinwo, ‘Beyond the Doctor’s Mistake: Investigating the Chain of Legal Responsibility in Cases of Medical Negligence Involving Multiple Parties’ (OAL Law, 19 January 2026) https://oal.law/beyond-the-doctors-mistake-investigating-the-chain-of-legal-responsibility-in-cases-of-medical-negligence-involving-multiple-parties/#:~:text=Liability%20of%20medical%20institutions%20with,transmission%20of%20infections%2C%20among%20others accessed 15 March 2026
[12] Akpuogwu Michael Obidimma, ‘The Ethics of Providing Quality Healthcare System in Nigeria’ (2025) 9(2) International Journal of Research and Innovation in Social Science 1570 https://ideas.repec.org/a/bcp/journl/v9y2025i2p1570-1579.html accessed 14 March 2026
[13] African Charter on Human and Peoples’ Rights (Ratification and Enforcement) Act, Cap A9, Laws of the Federation of Nigeria, 2004.
[14] International Covenant on Economic, Social and Cultural Rights, Dec. 16, 1966, 993 U.N.T.S. 3.
[15] Article 1(h) of the Protocol on Democracy and Good Governance Supplementary to the Protocol relating to the Mechanism For Conflict Prevention, Management, Resolution, Peacekeeping and Security, 2001.
