Global health narratives often cast state intervention as public health’s foundational architect, relegating private care to a modern capitalist anomaly. In contrast, this paper investigates private health care in Anyigba, Kogi State, Nigeria, to show that private provision is a long-standing structural feature and not a recent anomaly. By applying a historical interpretive approach, empirical evidence was obtained from colonial records, scholarly works, and interviews. The study finds that private provision of health care in Anyigba is founded on a well-developed pre-colonial framework of specialized, independent medicine (Amadogwu Igala). This dominance was perpetuated colonially through state withdrawal of financial commitment, resulting in a religious ‘mission subsidy.’ Post-colonially, persistent state fracture and infrastructural collapse forced private hospitals to assume quasi-public utility roles as uncompensated social anchors. Yet, despite preventing a regional healthcare collapse, private providers are systematically undermined by a predatory state apparatus enforcing double taxation, neglect, and security threats. We conclude that the state must transition from treating private healthcare as an extractive revenue stream to protecting and subsidizing it as an indispensable partner in public health survival.
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Abraham et al. (2026) studied this question.
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