Do they know their rights? Exploring the healthcare duty of care owed to citizens in Nigeria, through the lens of the social contract

This study explores the Nigerian healthcare system through the theoretical framework of the social contract, examining the reciprocal relationship between citizens and the government in healthcare provision. The social contract refers to the implicit agreement in which citizens relinquish certain rights to the government to protect their remaining rights and maintain social order. The thesis explores the government's responsibility in fulfilling this duty and the people's expectations within this agreement. A constructivist-interpretivist approach formed the philosophical basis of the research, focusing on the subjective experiences and interpretations. Using a qualitative methodology, data was predominantly collected through focus group discussions with 27 diverse stakeholders, including healthcare professionals, policymakers, and outpatients in Agbor, Delta State of Nigeria. Thematic analysis revealed that the Nigerian government’s failure to provide adequate healthcare infrastructure, accessibility, and quality services has eroded citizens’ trust in the healthcare system, leading to a perceived breach of the social contract. The overall outcome of the study is that Nigerians generally do not know their healthcare rights and the Universal Healthcare tools aimed at fulfilling the social contract are not judiciously implemented, especially in the rural areas. The research outcomes highlight the need for policy reforms, increased healthcare funding and community engagement to revitalize the social contract and improve healthcare delivery. The findings provide a foundation for future research and policy direction, including the development of context-specific healthcare policies and interventions that prioritize citizen needs and expectations. This study contributes to the discourse on healthcare reform in Nigeria, emphasizing the importance of reconstituting the social contract to ensure a more equitable and responsive healthcare system.