BETTER HEALTH BEGINS WITH TRUST.

From Reflection to Action: The Birth of Trust Renewal
By Dr. M. J. Abdullahi
Convener/CEO, Initiative for Health Accountability and Transparency (IHAT)
Author of Trust Renewal: The Integrity Call for Better Health for All
Introduction: A Journey Through Service and System Building
For over four decades, I have walked the path of health system development in Nigeria,
serving at different levels, engaging with diverse stakeholders, and witnessing firsthand
the evolution of our healthcare system. From my early years in Primary Health Care
(PHC) service delivery to management and leadership roles in governance and national
programme implementation, the journey has been both fulfilling and deeply instructive.
It has been a journey shaped by commitment, learning, and reflection, but also by a
growing realization: that beyond infrastructure, workforce, and financing, the true
foundation of a functional health system is trust.
The Promise and the Paradox
Nigeria’s health sector has not lacked investment, policy attention, or reform initiatives.
Over the years, we have seen significant efforts aimed at strengthening systems,
expanding access, improving infrastructure, training health workers, and introducing
financing mechanisms.
Yet, despite these investments, a troubling paradox persists:
progress in inputs has not consistently translated into public confidence or system
performance.
Across communities, one hears recurring concerns, about quality of care,
responsiveness, fairness, and accountability. These concerns are not abstract; they are
lived daily by patients navigating the system.

Walking the Patient Path
In recent years, particularly after my retirement from public service, I became deeply
interested in understanding healthcare through a different lens, the patient journey.
Every individual, at some point in life, walks this path:
Recognizing a health need
Seeking care
Interacting with providers
Receiving treatment
Experiencing outcomes
Reflecting on the care received
At each step, trust is tested.
Through deliberate efforts to collect and analyse patients’ lived experiences, I
encountered powerful stories of compassion and excellence, but also of neglect,
frustration, informal payments, poor communication, and systemic gaps.
These experiences revealed a critical insight:
the health system is ultimately judged not by policies or structures, but by how it
treats people.
The Integrity Crisis
What emerged from these reflections was what I describe as an integrity crisis within
the health system.
This crisis manifests in multiple ways:
Weak accountability mechanisms
Poor adherence to professional and ethical standards
Informal and unregulated practices
Inadequate grievance redress systems
Data inconsistencies and credibility gaps
When integrity is compromised, trust erodes.
And when trust erodes, utilization declines, outcomes suffer, and the legitimacy of the
system is questioned.

Why Trust Matters
Trust is not a soft concept; it is a core performance driver of any health system.
Without trust:
Patients delay or avoid seeking care
Compliance with treatment is reduced
Health programmes lose credibility
Public health interventions face resistance
Conversely, when trust is strong:
People engage earlier with the system
Preventive care is more widely accepted
Health outcomes improve
Systems become more resilient
This understanding shaped my central proposition:
Better Health Begins with Trust.
From Reflection to Action: The Birth of Trust Renewal
These reflections and insights led to the development of my book, Trust Renewal: The
Integrity Call for Better Health for All.
The book is grounded in patients’ lived experiences and presents a compelling argument:
that Nigeria’s health system challenges must be reframed as a crisis of trust driven by
failures of integrity.
It goes beyond diagnosis to offer pathways for reform, including:
Strengthening accountability and regulatory enforcement
Elevating patient voice and feedback systems
Promoting transparency in service delivery and financing
Embedding ethical standards in practice
Improving responsiveness at all levels of care

A Call to Leadership and Collective Responsibility
Restoring trust is not the responsibility of one group alone. It requires a collective
commitment from:
Policymakers and government institutions
Health professionals and regulatory bodies
Facility managers and service providers
Development partners and civil society
Communities and patients themselves
We must move beyond rhetoric to action, building systems that are not only functional,
but also fair, responsive, and people-centred.
The Way Forward: Embedding Trust in Reform
As Nigeria continues to pursue health sector reforms, including ongoing national
initiatives, there is a critical need to embed trust as a measurable and managed
outcome.
This means:
Developing indicators to track trust and patient experience
Strengthening grievance redress and feedback systems
Ensuring transparency and data integrity
Aligning incentives with ethical and patient-centred care
Building a culture of accountability at all levels
Conclusion: A Personal Reflection and a National Imperative
Looking back on a lifetime of service, I remain optimistic.
Nigeria has the capacity, the talent, and the opportunity to build a health system that
truly serves its people. But this will require a deliberate shift, from focusing only on
structures and systems, to prioritizing integrity, accountability, and trust.
Because in the end, every reform, every policy, and every investment must answer one
fundamental question:
Can the people trust the system that is meant to care for them?
Better Health Begins with Trust.
And restoring that trust is our collective responsibility.