Chichi Menakaya is an award-winning Trauma and Orthopaedic Surgeon and CEO of Annomo Health, with experience across clinical care, healthcare management, emergency systems design and health transformation in the UK, Canada and Nigeria. In this interview with IFEOMA OKEKE-KORIEOCHA, the medical expert emphasised the need for a better emergency management system. Excerpts:
Recent events have once again drawn attention to emergency healthcare in Nigeria. From your perspective as a trauma and orthopaedic surgeon, what is the real issue?
The real emergency is rarely the incident itself. Yes, some people tragically die at the scene and cannot be saved, but, for the majority who survive the initial impact, the true emergency is what happens next. As trauma surgeons, we know that many injuries and acute medical events are survivable. What determines outcome is not only the injury, but how quickly, clearly, and coherently the system responds in the first hour, what we refer to as the golden hour. When emergency care works, it is almost invisible. When it fails, the consequences are immediate and devastating.
Many Nigerians believe the core problem is a lack of hospitals or equipment. Do you agree?
Infrastructure matters, but it is not the starting point. Emergency care is fundamentally about systems, coordination, and timing. You can have hospitals and highly skilled clinicians, but without clear pathways from first response to definitive care, lives will still be lost. Nigeria does not lack effort or talent, what we struggle with is integration.
What does integration mean in practical terms?
Integration means that emergency care functions as a connected chain rather than isolated pieces. From early recognition at the scene to immediate basic intervention, safe transfer and effective communication between facilities, each step must work in harmony. When even one link is weak, outcomes suffer. When those links are aligned, survival improves dramatically, often without major new infrastructure.
You have spoken about leveraging what already exists. Can Nigeria truly improve emergency outcomes with current resources?
Absolutely, and this is an important point. Trauma care does not wait for perfect conditions, it happens even in resource-scarce settings, including war zones. Nigeria already has skilled doctors and nurses, teaching and private hospitals, security agencies, community structures, and a large, capable workforce, despite brain drain and deteriorating infrastructure. What is
missing is coordination and clarity of roles. Countries that have improved emergency survival rates did so not by waiting for ideal systems, but by connecting existing assets, training people strategically, and standardising response pathways. Nigeria can do the same.
How important is human capital in this equation?
Human capital is Nigeria’s greatest untapped health asset. At almost every accident scene, there are people present and that presence is potential. In emergency care, the first responder is rarely a doctor; it may be a traffic officer, security agent, community volunteer, or passer-by. Training these people in basic, life-saving actions and safe transfer delivers outsized impact at relatively low cost. Emergency care is not about doing everything, but about doing the right things early. At Annomo Health, we are working with trauma surgeons globally to rethink emergency care in developing settings, beginning with Nigeria alongside countries such as Pakistan and India, to demonstrate what intentional system design can unlock.
Ambulance response is a frequent concern for Nigerians. What is the solution?
Ambulances are important, but coordination is the real issue. Nigeria’s national ambulance capacity is limited, and we cannot afford to wait for ambulances before saving lives. Existing services often operate in isolation. Without central coordination, clear dispatch criteria, and defined referral pathways, response times suffer. When public and private ambulance services are integrated into a single network, efficiency improves significantly. Ambulances alone are not the solution. In areas where they are scarce, the priority must be safe, coordinated transfer using whatever transport is available, minimising further injury and complications. Systems save lives, not just vehicles.
Some argue that improving emergency care is too expensive. How would you respond?
I am often puzzled by this argument. Is there truly a cost to staying alive? Emergency care is one of the highest-value investments a country can make. I speak about health as an investment because existence itself cannot be meaningfully priced. Preventable deaths and disabilities carry profound long-term economic, social, and human costs. Strong emergency systems reduce those losses by protecting the workforce, families, and communities. This is not about spending more indiscriminately, but about investing smarter.
Where does Annomo Health fit into this broader conversation?
At Annomo Health Africa, we are healthcare reformers focused on designing and strengthening systems that truly serve citizens. Our work in Nigeria centres on transforming existing healthcare structures into optimally functional systems that meet the standards expected in developed settings. We do this by understanding how care actually flows, identifying delays and gaps, supporting government, clinicians, and facilities, and facilitating collaboration between public and private providers. We are currently working with global experts to rethink trauma and emergency care models for developing countries, grounded in local realities. Healthcare reform works best when it is collaborative, data-driven, and locally
designed.
What would success look like for Nigeria in emergency care?
Success is quiet. It looks like faster response times, fewer preventable deaths, clear pathways when emergencies occur and health workers supported to do their jobs safely and effectively. When emergency care works, there are no headlines, just lives saved.
Finally, what message would you like Nigerians and leaders to take from this moment?
This is not a moment for blame. It is a moment for intentional system building. Nigeria does not need to start from zero. We need to connect what we already have, invest in people and treat emergency care as essential national infrastructure. When emergencies happen, as they inevitably will, the systems we build today will answer on our behalf. To Nigerians at accident scenes, instead of taking videos or photos, learn how to save a life because that knowledge may one day save someone you love.
