The Chairman of the National Health Facilities Regulatory Agency (NHFRA) Establishment Committee, Dr. Richardson Ajayi, has defended the proposed National Health Facilities Regulatory Agency Bill, arguing that Nigeria’s healthcare system remains dangerously under-regulated because health facilities are not subject to a unified national safety framework.
Ajayi’s defence comes in response to a petition by the Association of Community Pharmacists of Nigeria (ACPN), signed by its National Chairman, Pharm. Ambrose Ezeh, urging the National Assembly to suspend consideration of the bill over concerns that it would duplicate the functions of existing regulatory agencies and worsen inter-professional tensions.
Reacting to the objections on Monday, Ajayi said the concerns overlook what he described as the biggest challenge confronting Nigeria’s healthcare system—unsafe health facilities operating under weak and inconsistent oversight.
“The reality is simple: Nigeria licenses the people and the products, but not the places,” Ajayi said.
“That missing part of the system is where unsafe theatres, contaminated instruments, broken oxygen systems and fraudulent clinics cause damage. This is not duplication; it is a gap that must be closed.”
According to him, regulatory agencies such as the Pharmacy Council of Nigeria (PCN), the National Agency for Food and Drug Administration and Control (NAFDAC), the Medical and Dental Council of Nigeria (MDCN), and the Nursing and Midwifery Council of Nigeria (NMCN) regulate professionals and medical products but are not empowered to inspect and license healthcare facilities as institutions.
“A licensed pharmacist in an unsafe clinic is still working in an unsafe clinic. A NAFDAC-approved drug administered in an unregulated facility can still become dangerous if the system itself is unsafe,” he said.
Ajayi also dismissed claims that the National Health Act 2014 already provides adequate legal backing for facility regulation, explaining that while the Act outlines Nigeria’s health system, it does not establish a national licensing and inspection framework for healthcare facilities.
He noted that Nigeria currently lacks a central register of health facilities, routine inspection cycles, public quality ratings and a national authority empowered to suspend or shut down unsafe facilities.
“The repeated anti-quackery raids across the country show that we are often responding after harm has already occurred,” he said.
Ajayi further argued that the establishment of the National Tertiary Health Institutions Standards Committee (NTHISC) in 2023 demonstrates that the Federal Government already recognises the need to regulate health facilities as institutions.
However, he said the committee’s mandate is limited to teaching hospitals and Federal Medical Centres, leaving private, secondary and primary healthcare facilities—which provide the bulk of healthcare services—without a unified national regulatory framework.
He observed that private healthcare providers account for about 60 per cent of healthcare delivery in Nigeria, while nearly 70 per cent of healthcare spending comes directly from patients through out-of-pocket payments.
“That is where the real danger lies—maternity homes, diagnostic centres and neighbourhood clinics where most Nigerians receive treatment every day,” he said.
Ajayi cited incidents in Kano State where authorities uncovered more than 100 illegal hospitals and pharmacies, including a case involving the use of infected blood for transfusion, as evidence of existing regulatory gaps.
Addressing concerns over possible federal encroachment on state responsibilities, Ajayi maintained that the proposed NHFRA would work in partnership with state governments rather than take over their powers.
“This is not about taking powers from states. It is about establishing a national minimum safety standard while states continue to inspect and supervise facilities within their jurisdictions,” he explained.
He pointed to the National Primary Health Care Development Agency (NPHCDA) as an example of successful collaboration between the Federal Government and states, and cited the Health Facility Monitoring and Accreditation Agency (HEFAMAA) in Lagos State as a model of effective facility regulation.
“The NHFRA will coordinate, not usurp. It will strengthen states by providing a unified framework and a national register,” he added.
Ajayi, however, acknowledged concerns over a provision in the draft bill that reserves the office of the Director-General exclusively for medical doctors, describing the clause as one that should be amended.
“That clause should be changed. This agency must be neutral and multidisciplinary. Leadership should be based on competence, not profession,” he said.
He also proposed statutory representation for pharmacists, nurses, laboratory scientists, radiographers and other healthcare professionals on the agency’s governing board to promote inclusiveness and build confidence among stakeholders.
Ajayi warned against allowing professional disagreements to derail reforms aimed at protecting patients.
“Patient safety must come first. The proper response is to strengthen the bill and pass it—not kill it,” he said.
If passed into law, the NHFRA would establish minimum national safety standards for hospitals, clinics, laboratories and diagnostic centres, creating what proponents describe as Nigeria’s first coordinated national framework for licensing, inspecting and monitoring healthcare facilities.
“For me, this goes beyond policy,” Ajayi said. “Every Nigerian deserves to walk into a health facility with confidence that it has met the minimum safety standards required to protect lives.”
