Blog Post 1
Trust Renewal Blog Series
Trust is the Currency of Healthcare. When It Breaks, Everything Fails
There is a point where a health system stops being a place of healing
and becomes a place of fear.
Not because there are no buildings.
Not because there are no doctors.
But because trust has collapsed.
In healthcare, trust is not a “nice-to-have.”
Trust is not a public relations slogan.
Trust is the currency that makes healthcare work.
When trust is broken, patients delay care.
They stop following instructions.
They avoid hospitals until emergencies.
They “manage it at home.”
They seek alternatives, sometimes unsafe ones.
And even when they show up, they do so with suspicion, not confidence.
A Patient’s Lived Experience: “I Was Treated Like I Didn’t Matter”
A young mother arrived at a public hospital late in the evening with her child burning in fever. She had been advised by neighbors to come early, because “if you come late, nobody will attend to you.”
She begged for help at the nurses’ station.
No response.
She waited.
Minutes became hours.
When a staff member finally appeared, the mother was scolded, not supported:
“Why did you come this time? Can’t you see we are tired?”
The child’s breathing became fast. The mother’s voice shook.
Eventually, a junior worker whispered to her:
“If you want them to act fast, you know what to do.”
That night, she did not only lose time.
She lost something deeper.
She lost confidence that the system would protect her child.
She went home with fear, anger, and a conclusion many Nigerians have reached:
“In this place, my life does not matter.”
What This Reveals: Trust Breaks When Integrity Breaks
Trust collapses when patients repeatedly experience the following:
- Unpredictability: Care depends on who is on duty, who is in the mood, or who you know.
- Unfairness: People are treated differently based on money, status, or informal payments.
- Silence and impunity: Mistakes happen, but nobody explains, apologizes, or takes responsibility.
- Disrespect: Patients are shouted at, ignored, humiliated, or abandoned.
These are not merely “service issues.”
They are integrity failures.
Integrity in healthcare means doing the right thing, even when no one is watching:
- Showing up
- Telling the truth
- Treating fairly
- Protecting the patient
- Being accountable
When integrity collapses, trust collapses.
Why Trust Matters More Than We Admit
A health system cannot succeed on infrastructure alone.
It cannot succeed on funding alone.
It cannot succeed on policies alone.
Because every reform depends on human behaviour:
- Will patients come early enough?
- Will they disclose symptoms honestly?
- Will they accept referral?
- Will they take medicines correctly?
- Will they return for follow-up?
- Will they accept immunization?
- Will they enrol in health insurance?
All these depend on one invisible force:
Trust.
Trust is what makes a patient cooperate.
Trust is what makes a mother believe.
Trust is what makes a community accept a health intervention.
Trust is what makes citizens support reforms.
Once broken, trust becomes expensive to rebuild.
What Must Change (Practical Actions)
Trust renewal is possible, but only through integrity-first reforms.
1) Leadership and Policy
- Make trust a measurable goal, not a vague aspiration.
- Fund patient safety and quality systems, not only buildings.
2) Facility Management
- Establish clear service standards and enforce them consistently.
- Reduce waiting chaos through simple triage and patient flow systems.
3) Health Workers
- Treat every patient with dignity regardless of status.
- Let professional ethics be visible in conduct, not only in certificates.
4) Regulators
- Strengthen professional discipline systems and enforcement.
- Protect patients from unsafe practice and exploitation.
5) Citizens and Communities
- Speak up, document experiences, and demand fairness.
- Support credible feedback and accountability channels.
The Integrity Call
This is the central message of Trust Renewal: The Integrity Call for Better Health for All:
Nigeria cannot achieve better health outcomes without rebuilding trust.
And trust cannot be rebuilt without integrity.
Trust renewal is not a slogan.
It is a national survival strategy.
Nigeria will build a health system where every patient matters,
not by privilege, but by principle.
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IHAT is here to listen. IHAT is here to act.
Dr. Abdullahi Jibril Mohammed
Convener/CEO, Initiative for Health Accountability and Transparency
Author, Trust Renewal: The Integrity Call for Better Health for All
