By Abiola Ayilara

There is a crisis in Nigerian healthcare that has no ward, no budget line and no name in our national conversation.

It does not happen in hospitals. It happens after them, behind the doors of ordinary homes. I have spent twenty years in nursing, and in recent years I have confronted this crisis at close range.

Let me show you what it looks like.

The family that inherits a hospital’s job

A man in his fifties is discharged after a stroke with a bag of medications and a family that loves him fiercely. Nobody taught them how to prevent pressure sores, or which symptoms mean call for help now.

Stroke ranks as the second leading cause of death among noncommunicable diseases in Nigeria, conditions that together account for an estimated 29 per cent of all Nigerian deaths, with hypertension affecting an estimated 25 to 40 per cent of adults. Every survivor eventually comes home.

The hospital did its work and closed the file. The family inherited a clinical responsibility with no clinical training, and this man’s recovery now depends on luck.

The daughter nobody sees

Somewhere in Nigeria right now, a daughter has quietly become a full time caregiver. She has left her job or is failing at it. She sleeps in fragments and lifts a body heavier than her own several times a day.

Her siblings abroad send money and instructions. She absorbs both with a resentment she is ashamed of.

We call this love, and it is love. The International Labour Organization has measured it too: women perform 76.2 per cent of the world’s unpaid care hours, more than three times the share carried by men. We have built a shadow health system on the unpaid, untrained labour of women, and we call it tradition so we never have to call it what it also is.

Behind the door the hospital closes is either a system or a gamble. Nigerian families have been gambling for too long.

The stranger behind a closed door

Then there is the caregiver hired from nowhere. No vetting, no training, no supervision, left alone with the most vulnerable person in the family.

Sometimes it ends well. Sometimes it ends in medication errors, falls, abuse or quiet indignity no one ever discovers. There is no register to check, no standard to meet, no regulator watching.

The scale of official neglect is measurable. Nigeria has fewer than ten geriatricians for a country whose over 60 population is projected to reach about 25.3 million by 2050, and the 2021 National Policy on Ageing has never been implemented.

And it is not only the elderly

Homecare is spoken of as an old age matter. It is not. The ILO counted 2.1 billion people needing care worldwide in 2015, and 1.9 billion of them were children under 15. The WHO estimates 1.3 billion people, one in six of us, live with significant disability.

In my own practice the faces are every age. The child with complex needs. The young woman recovering from surgery. The man in his fifties rebuilding his speech after a stroke. The person living with a mental health condition. The grandmother in her final season. All of them need care at home.

And none of them are counted. Nigeria lacks comprehensive national data on caregiving, and routine health data systems lack the age disaggregated indicators that would let planners even see who needs care.

A country that does not count its carers cannot claim a care policy. What is not measured cannot be planned.

I have seen a system that chose differently

None of this is inevitable. I know, because I have worked inside a system that made another choice.

My nursing training began here in Nigeria. Further study took me to the United Kingdom, where I worked as a care personnel across NHS and homecare settings, supporting elderly people, people with learning disabilities and people living with mental health conditions.

There, care at home is organised. Trained carers arrive on schedule, standards are enforced, information flows, and families are supported rather than abandoned.

When I returned home and started a homecare business, I met the same human needs stripped of every structure I had taken for granted. The difference between the two countries is not compassion. Nigerian families overflow with compassion. The difference is infrastructure.

What I have built, and why it is not enough

As a health informaticist, I built technology that makes homecare seamless and coordinated for vulnerable people. It connects the family, the trained caregiver and the clinician around one patient, so care at home stops being guesswork.

But no technology fixes a country with no standards, no required training and no policy that recognises the home as a site of healthcare.

That is why I wrote The Homecare Framework. Its argument runs from the first page to the last: care is infrastructure for everyday life, and Nigeria must plan it the way we plan roads and power.

Join me in Lagos

Because a book is an argument, not an assembly, I convene The Care Conference through The Purple Global Mission, the nonprofit I founded. It holds every two years, and this edition meets in Lagos on 18 and 19 November 2026.

Someone you love will one day need care at home. The question is whether this country will offer them a system or a gamble.

I have made my choice. I invite you to make yours in Lagos this November.

Abiola Ayilara is a registered nurse, health informaticist, author of The Homecare Framework and founder of The Purple Global Mission, convener of The Care Conference, Lagos, 18 and 19 November 2026.