“The real issue is not whether a public officer travels abroad for treatment. The real issue is whether the law travelled with him. Nigeria’s health system needs investment.”
Imagine this.
It is 2:00 a.m. in a general hospital somewhere in Lagos. A mother sits on a plastic chair, cradling her feverish child. The fan is broken. The nurse is doing her best with one functioning thermometer and a torchlight. The doctor on call has not slept in 36 hours.
And yet, this mother is here.
She has nowhere else to go. She trusts—because she must—that the system will not fail her child tonight.
Now imagine this.
The same morning, a public official boards a flight. He is not fleeing danger. He is travelling abroad for medical care, with the cost borne by public funds.
The mother in the general hospital will probably never meet this official. But they are connected by a question that goes to the heart of Nigeria’s health system:
Position of the law when public officers travel abroad for treatment
What does the law say when public money is used to send public officers abroad for medical treatment?
The answer can be found in a little-known provision of the National Health Act 2014: Section 46.
What The Law Actually Says
Section 46 addresses medical treatment abroad.
It begins by preserving the right of every Nigerian to seek medical check-up, investigation or treatment anywhere within or outside Nigeria. But it then places a specific restriction on publicly-funded overseas treatment for public officers.
The section provides that no public officer of the Government of the Federation or any part thereof shall be sponsored for medical check-up, investigation or treatment abroad at public expense except in exceptional cases, following recommendation and referral by the medical board, with that recommendation and referral duly approved by the Minister or Commissioner, as the case may be.
The distinction is important.
The law does not prohibit Nigerians from seeking treatment abroad. It regulates when public funds may be used to sponsor such treatment for public officers.
That means Section 46 is not an attack on the right of a public officer to seek the best medical care available. Nor does it say that every illness must be treated in Nigeria.
It establishes something more basic:
Where the taxpayer is paying, the law must govern the decision.
There must be an exceptional case. There must be a medical board recommendation and referral. There must be the required approval.
The public purse cannot simply become an open-ended medical travel account.
The Enforcement Question
This raises an uncomfortable question.
Section 46 has been part of Nigerian Law since the NHA came into force in 2014. Yet how much do Nigerians actually know about its operation?
How many publicly-funded overseas medical trips take place each year?
How many are made pursuant to the medical-board process contemplated by the Act?
How many recommendations and referrals are made? How many approvals are issued?
How much public money is spent? And how many of these decisions are subjected to independent audit?
These are not questions about the private medical histories of public officers. Medical information is private.
They are questions about public expenditure and compliance with public law.
Nigerians are entitled to expect that when public money is spent, there is a lawful process behind the expenditure.
Silence does not necessarily prove illegality. But persistent opacity makes accountability difficult and weakens public trust.
This Is Really A Question Of Trust
The debate about medical treatment abroad is often presented as a question of money.
It is certainly a question of money.
But it is also a question of trust.
When citizens see public hospitals struggling with equipment, staffing, drugs and infrastructure while public officials are able to access treatment abroad at public expense, they may reasonably ask whether the health system belongs equally to everyone.
The citizen in the general hospital is not asking for perfection.
She is asking for fairness.
She is asking whether the people who make decisions about healthcare financing, hospital infrastructure and health policy have a meaningful stake in the system that ordinary Nigerians depend upon.
That does not mean that every public officer must use a public hospital, regardless of medical circumstances.
Nor does it mean that treatment abroad is automatically wrong.
It means something simpler.
Those entrusted with public resources should be subject to the law governing those resources.
Section 46 Is About More Than Medical Travel
There is a deeper principle here.
A health system cannot command public confidence if citizens believe that the system is good enough for them, but not good enough for those who govern it.
This is not an argument for forcing public officials into unsafe or inadequate healthcare.
Quite the opposite.
It is an argument for building a healthcare system that is good enough for everyone—including those who make the decisions that determine how the system is funded and managed.
When those who make decisions about health financing and infrastructure also have a personal stake in the public system, the political incentives for improving that system may become stronger.
That is not a guarantee of instant reform.
But it is a reasonable starting point for thinking about public accountability.
What Section 46 Should Mean In Practice
If Section 46 is to be more than words in a statute book, its operation should be transparent.
First, there should be clear administrative guidance.
The relevant health authorities should clarify how the medical-board process operates, what documentation is required, who makes the referral, who grants approval and what records must be maintained.
Second, publicly-funded overseas medical treatment should be subject to appropriate financial transparency.
The public does not need access to a public officer’s confidential medical records. But Nigerians should be able to know, in aggregate, how much public money is being spent on overseas medical treatment and how many cases are being approved.
Third, the statutory process should leave an auditable trail.
Where public funds are used, the relevant recommendation, referral and approval should be properly documented and available to authorised auditors and oversight institutions.
Fourth, responsibility for monitoring compliance should be clear.
A statutory requirement is weakened when no institution is clearly responsible for checking whether it is being followed.
Fifth, the National Assembly should consider whether the enforcement architecture is adequate.
Section 46 establishes a restriction and an approval process. But the Act does not appear to provide a specific sanction within Section 46 for breach of that provision. This deserves legislative attention.
Indeed, a Bill seeking to introduce sanctions for public officers who violate Section 46 was previously considered by the House of Representatives.
A 2022 report on that Bill stated that it proposed a fine of up to ₦500 million or imprisonment for up to seven years. That proposal should not, however, be confused with the law currently in force.
The distinction matters.
A proposed penalty is not a statutory penalty.
And What About Our Hospitals?
There is another side to this debate.
Regulating overseas treatment will not, by itself, make Nigerian hospitals better.
The underlying challenge is to build domestic capacity so that fewer Nigerians—including public officials—need to seek treatment abroad.
That means sustained investment in hospital infrastructure, diagnostic equipment, specialist services, health technology, reliable electricity, skilled personnel and effective clinical governance.
The NHA itself establishes a framework for standards in healthcare delivery. For example, Section 19 requires health establishments to comply with quality requirements and standards prescribed by the National Council on Health, covering matters including human resources, equipment, hygiene, delivery of health services, safety and the manner in which users are accommodated and treated.
That is important.
The answer to medical tourism cannot simply be: “Stop going abroad.”
The better answer is:
“Let us build a system that Nigerians can trust.”
A Civic Proposal
There is also a civic dimension to this debate.
Political office holders could voluntarily commit to using Nigerian public health facilities for non-emergency care where medically appropriate, while complying fully with Section 46 whenever public funds are sought for overseas treatment.
Such a commitment would not replace the law.
It would reinforce it.
It would send a simple message:
“I am not merely an administrator of this health system. I am also a stakeholder in it”.
That kind of shared stake can strengthen public confidence.
The Law And Public Trust
Section 46 does not demand that public officials never receive medical treatment abroad.
It demands something more modest—and more important.
Where public money is used to sponsor a public officer’s medical treatment abroad, the statutory conditions must be respected.
The medical board process must be real.
The required approval must be obtained.
The expenditure must be properly documented.
And public institutions must be capable of demonstrating that the law has been followed.
There is nothing unreasonable about that.
The citizen who pays taxes should not have to wonder whether the rules governing public expenditure apply differently when the patient is powerful.
The real issue is not whether a public officer travels abroad for treatment.
The real issue is whether the law travelled with him.
Nigeria’s health system needs investment. It needs better infrastructure. It needs stronger clinical governance. It needs accountability.
But it also needs something less tangible and equally important: trust.
Trust begins when citizens believe that the institutions governing their lives are governed by the same rules that govern everyone else.
Section 46 gives Nigeria one small but significant opportunity to demonstrate that principle.
The law gives us the doorway.
What we need now is the courage to walk through it—and to let the light in.
Until next week, stay dignified.
•Sanu is a Nigerian lawyer, researcher and health law scholar. This column examines contemporary health policy and legal issues through the lens of accountability, justice and human dignity.
