Purpose The recent COVID-19 pandemic has exposed the declining conditions of many of the hospital buildings, especially in developing countries. Past studies have shown inadequate maintenance practices but how far regarding Nigerian public hospital buildings is yet to receive empirical research. This paper aims to investigate the underlying issues leading to inadequate maintenance practices and proffers policy options to improve Nigerian public hospital buildings via an unexplored dimension. Design/methodology/approach The study used a mixed research design method involving both qualitative and quantitative data. First, results from the qualitative phase were analysed and verified at the quantitative phase through a well-structured questionnaire, developed from the qualitative findings across hospital maintenance experts (work/maintenance department, health-care provider, design team and health-care building/service contractor) in Abuja, Lagos and Benin City. Findings Insufficient funds for maintenance works, absence of planned maintenance programmes, inadequately trained personnel, etc., emerged as the maintenance inadequacies in the public hospital buildings across the cities covered. The paper categorised the cause of inadequate maintenance practices of public hospital buildings into six groups: statutory requirements, design stage, construction stage, budget for maintenance task, managing maintenance unit activities and user’s perception regarding maintenance management. Research limitations/implications This paper is limited to maintenance practices of Nigerian public hospital buildings. Future research is needed to evaluate factors that will enhance outsourcing maintenance and the use of the 4th industrial revolution (building information modelling for refurbishment and building automation systems) amongst others in maintenance practices of public hospital buildings. Practical implications As part of the practical implication, the government and hospital administrators should make provision for adequate funding and accountability of annual maintenance budgetary allocation. Also, the government should establish a national maintenance policy for public infrastructure with an emphasis on preventive maintenance and contractor’s reputation, outstanding pedigree, technical and financial soundness during build maintenance contract award, etc., were recommended. Originality/value This paper reveals that the stakeholders, especially hospital administrators, policymakers and political office holders that are concern with maintenance budget, approval and disbursement concerning maintenance practices in public hospital buildings need to reawaken to her responsibility because of the inadequate implementation across the cities covered.

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