The distribution of health facilities across Nigeria is nonuniform. As such, a UHC strategy must be responsive to the variation in health facility distribution across the country. Additional investments are needed in some parts of the country to improve access to tertiary health facilities and leverage private sector capacity.

The 1970s saw the establishment of University Teaching Hospital Ibadan (UTHI) as a hospital of eminence with lofty vision: 'To be the flagship tertiary health care institution in the West African subregion: offering world-class training, research and services and the first choice hospital'. It indeed kept its promise to emerge as the main teaching hospital of the country. The 1990s witnessed the decline. The Government of Nigeria appointed Vesta Healthcare Partners to advise on transformation and sustainability. A number of suggestions of far-reaching consequences came up. These involved restructuring and the reporting system; motivational initiatives; offer of opportunities to those who showed performance; recognition to performance; installation of performance measurement metrics; remuneration system; and more. The case study describes at length the challenges before Professor Temi, who has recently joined as the Chief Medical Director of UTHI and who has to handle the implementation of the recommendations. Simultaneously, he has to arrive at decisions in areas of conflicts.

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