Informal Payments and Institutional Trust: A Survey of Health System Governance and Corruption in Nigerian Public Facilities (2021–2026)

This survey research investigates the pervasive issue of informal payments and its corrosive impact on institutional trust within Nigeria’s public health facilities. The study quantifies the prevalence and patterns of these unofficial payments and analyses their association with patients’ trust. A cross-sectional survey was administered to 1,200 recent patients across the six geopolitical zones, using stratified random sampling of public secondary and tertiary hospitals. The questionnaire captured data on demographics, direct experiences of informal payments, and levels of trust in institutional fairness and integrity. Key findings indicate that 68% of respondents reported making at least one informal payment during their most recent visit, primarily to expedite services or secure perceived better care. Statistical analysis revealed a strong negative correlation between the experience of such payments and trust in the facility’s management and procedural fairness. The study concludes that informal payments, as a manifestation of weak governance, significantly erode public confidence, thereby undermining health system performance and the pursuit of universal health coverage. These findings necessitate urgent, multi-faceted policy interventions focused on improving transparency, enforcing accountability, and strengthening ethical frameworks within Nigeria’s public health institutions.