A United States-based Nigerian physician, Dr. John Mabayoje, has renewed his call for a fundamental overhaul of Nigeria’s healthcare delivery system, proposing the establishment of a nationally coordinated 911 emergency medical system as a safety net for citizens requiring urgent medical attention.
Mabayoje, who was responding to concerns raised by some of his friends and former classmates following his earlier advocacy for a Nigerian 911 emergency framework published on Veracity Desk (veracitydesk.com), said the central question should no longer be whether such a system is possible, but how it can be designed and implemented sustainably.
According to him, the proposed system should guarantee access to basic emergency care when it is needed, irrespective of a patient’s immediate ability to pay.
“How do we implement a 911 system to create a self-sustainable emergency medical system as a safety net for our population? That is where I would suggest we start,” he said.
Mabayoje stressed that his intervention was intended as a policy suggestion to government and not a demand, adding that policymakers would ultimately decide whether to consider and implement the proposals.
Beyond Emergency Calls
The physician argued that Nigeria’s healthcare challenges extend beyond the availability of doctors and hospitals, insisting that the country must also develop the industrial and infrastructural capacity required to support healthcare delivery.
He cited the need for increased domestic production of cotton and other essential materials used in healthcare, including cotton wool, gauze, dressings, uniforms, cleaning materials, antiseptics, ethanol and isopropyl alcohol.
He also pointed to products such as sanitary pads and feminine hygiene supplies as examples of essential commodities that could benefit from stronger local production capacity.
For Mabayoje, the broader challenge is the absence of integrated planning across sectors, including healthcare, agriculture, electricity, water supply, transportation, education, security and industrial development.
He therefore advocated stronger regional planning and restructuring of governance around Nigeria’s six geopolitical zones, arguing that such an approach could help address basic infrastructure and service-delivery needs more effectively.
How the 911 Model Could Work
Mabayoje explained that his conception of a Nigerian 911 system goes beyond establishing an emergency telephone number.
Rather, he envisages an integrated emergency-care framework linking telecommunications, hospitals, emergency physicians, nurses, laboratories, diagnostic centres, pharmacies, insurance providers and other relevant professionals.
Under his proposal, patients arriving at designated emergency facilities would have access to basic stabilising treatment, including initial diagnostic imaging, laboratory investigations, essential medicines and life-saving equipment, without emergency treatment being denied because they could not immediately pay.
“The ‘911’ system is about access to needed emergency care when it is needed,” he stated.
He argued that the financial architecture of the system should distribute the cost of emergency infrastructure and services over time rather than place the entire financial burden on patients at the point of care.
Lessons From the United States
Drawing from his experience working in emergency medicine in rural America, Mabayoje referenced the historical development of emergency medical services in the United States, particularly the pioneering Freedom House emergency medical programme in Pittsburgh.
He said the experience demonstrated how trained community-based emergency personnel, physicians, philanthropists and healthcare institutions could collaborate to bring emergency care closer to underserved populations.
According to him, a similar framework could be adapted to Nigeria’s circumstances, with appropriate modifications to reflect the country’s population, economy, healthcare structure and regional realities.
Predictable Funding and Equipment Leasing
One of the central components of Mabayoje’s proposal is predictable funding.
He suggested that a modest, structured surcharge attached to telecommunications services could potentially provide a steady revenue stream for emergency medical services, subject to appropriate legislation, transparency and accountability.
He also proposed the use of financing mechanisms such as leasing and hire-purchase arrangements to reduce the pressure associated with large, one-off capital expenditures.
Recalling his experience as a County Emergency Director in the United States, Mabayoje said he once leased a modern 124-slice General Electric CT scanner for an emergency and radiology service rather than making an immediate outright purchase.
He argued that such financing arrangements could enable Nigerian hospitals to acquire critical diagnostic equipment while spreading expenditure over months or years.
Building a Self-Sustaining Healthcare Ecosystem
Mabayoje believes the proposed emergency system could eventually serve as a foundation for a broader healthcare financing framework.
He envisaged a system in which telecommunications and insurance mechanisms could gradually expand coverage from emergency stabilisation to appropriate follow-up and inpatient care, with different categories of patients contributing according to their ability and coverage.
He described the concept as potentially creating a form of social cross-subsidisation, allowing higher-income patients and insured populations to contribute to a system that could also provide continuity of care for lower-income Nigerians.
The physician further argued that the implementation of a national emergency system could generate substantial employment opportunities for young graduates across Nigeria’s geopolitical zones, including opportunities in emergency medicine, nursing, pharmacy, laboratory science, accounting, engineering, architecture, telecommunications, insurance, actuarial services and health administration.
Experts Needed Around the Table
Mabayoje stressed that such a complex reform should not be designed by government officials alone.
He called for a multidisciplinary process involving emergency physicians, critical-care specialists, cardiologists, surgeons, nurses, pharmacists, accountants, architects, engineers, insurance and actuarial professionals, telecommunications experts and health administrators.
According to him, these professionals should meet in structured policy retreats to examine the financial, medical, technological, infrastructural and administrative implications of the proposal.
He said discussions should also identify what could be standardised across Nigeria’s six geopolitical zones and what should be adapted to local circumstances.
‘The Goal Is to End No Money, Let Him Die’
Mabayoje said his advocacy is rooted in a question he has contemplated throughout his decades of experience in medicine: what would constitute an ideal healthcare system for Nigeria and Africa?
He said his experience in emergency medicine in rural America convinced him that Nigeria could develop a system that prevents patients from being abandoned simply because they cannot produce money at the point of emergency.
“The way out of ‘He got no money, let him die’,” he said, should be through a system that prioritises immediate emergency stabilisation while developing sustainable mechanisms for financing care.
He acknowledged that implementing such a framework would be a major undertaking, but maintained that the discussion should begin because healthcare emergencies eventually affect virtually every family.
“This is a national concern,” Mabayoje said, urging stakeholders to engage the proposal seriously and explore practical pathways toward building a more accessible, sustainable and accountable emergency healthcare system for Nigerians.
