KEY POINTS

• Grange praises the intention behind LG autonomy but argues that local governments lack the capacity to deliver effective primary care.
• She argues Nigeria’s health crisis requires constitutional reform, not just funding transfers.
• The former minister has launched her memoir, In Pursuit of Excellence, Truth and Justice.

Professor Adenike Grange spent five decades in medicine and a stint as Health Minister watching Nigeria’s primary healthcare system underperform for the same structural reasons, and at 80-plus, she says fiscal autonomy for local governments, while necessary, will not solve the problem on its own.

Grange, a professor of pediatrics and Nigeria’s former Minister of Health under the Yar’Adua administration, made the remarks in a wide-ranging interview tied to the launch of her memoir, In Pursuit of Excellence, Truth and Justice. On the Grange primary healthcare Nigeria diagnosis, she is blunt: the constitutional framework that divides health responsibilities across federal, state, and local government tiers was always flawed, and Tinubu’s push to give local governments direct funding did not address the deeper incapacity underneath.

Autonomy without capacity is incomplete

“He meant well but unfortunately, it’s too late because they don’t have capacity to spend that money wisely and deliver the goals of efficient, effective primary care,” she said.

Beyond funding, moreover, she pointed to the absence of trained human resources, administrative expertise, and accountability structures at the local government level as the real barriers to progress.

Consequently, she argued that primary healthcare cannot improve until the constitution is tackled directly, because the current framework allows federal and state actors to dominate local governance in ways that undermine community-level health delivery.

A career built on firsts and confrontation

The Grange primary healthcare Nigeria argument draws on lived experience at every level of the system. When she served as minister, she convened local government leaders to conduct a situation analysis of primary care, only to find that chairmen sent secretaries instead of attending themselves.

Furthermore, she described how, as she pushed for solutions, bureaucratic opposition inside the ministry intensified, with officials more focused on contracts and furniture replacements than on fixing care delivery.