Contemporary African medicine faces complex challenges affecting healthcare delivery. Understanding these issues within specific national contexts is crucial for developing effective strategies. Nigeria, with its large population and diverse health system, presents a critical case for analysis. This study aimed to identify and analyse the key systemic issues affecting medical practice in Nigeria. Its primary objective was to delineate the most pressing challenges as perceived by healthcare professionals and to assess their perceived impact on clinical care. A mixed-methods approach was employed, using a cross-sectional survey of medical practitioners and in-depth, semi-structured interviews with senior clinicians and hospital administrators. Purposive and snowball sampling recruited participants from tertiary and secondary healthcare facilities across multiple geopolitical zones. Thematic analysis was applied to qualitative data, while survey data were analysed descriptively. Analysis revealed a predominant theme of systemic resource constraints, cited by most survey respondents as the most significant barrier to effective practice. This encompassed shortages in essential medicines, diagnostic equipment, and human resources. A consistent negative impact on patient outcomes, particularly in maternal and neonatal care, was reported. The foundational challenges within the studied healthcare system are predominantly structural and resource-based. These issues significantly impede the quality of medical care and contribute to adverse health outcomes. Immediate priorities should include targeted investment in health infrastructure and supply chain logistics. Long-term strategies must focus on human resource capacity building, retention policies, and the development of context-specific clinical guidelines. Health systems, medical practice, resource constraints, Nigeria, healthcare delivery, maternal health This research provides an empirical, ground-level analysis of systemic issues in a major African healthcare system, offering evidence to inform policy and strategic planning.