Health minister’s intervention highlights Israel’s protekzia problem, healthcare gaps

The Protekzia Paradigm: Connections Over Clinical Need

Protezkia – derived from Hebrew and widely used in Israeli society – refers to the practice of using personal relationships or influence to bypass standard procedures and secure favourable outcomes. In the case described by the journalist, a direct appeal to the health minister resulted in an immediate appointment at Sheba Medical Center, circumventing a reported three-week wait. While this outcome brought relief to one family, it underscores a troubling inversion of priorities: access determined not by urgency or medical triage, but by proximity to power.

This dynamic is particularly perilous in healthcare, where delays can mean the difference between recovery and irreversible harm, or even life and death. When individuals with connections jump queues, others with equal or greater clinical need are displaced. The journalist’s account, though intended as praise, inadvertently revealed how normalised such interventions have become – to the point where they are seen as evidence of effective governance rather than symptoms of systemic failure.

In Nigeria and similar contexts, parallels are evident. Patients often rely on 'knowing someone' in a hospital administration to secure surgery dates, access scarce medicines, or avoid prolonged delays in diagnostic services. Whether through ethnic ties, religious affiliations, political allegiance, or financial incentives, these informal pathways erode trust in formal systems and penalise those without networks – frequently the poor, rural dwellers, and marginalised communities.

Why Systems Fail: The Root Causes Behind Protekzia

Protekzia does not emerge in a vacuum. It thrives where public services are under-resourced, poorly managed, or lacking in transparency. In Israel’s case, years of political fragmentation, repeated elections, and coalition instability have strained ministerial oversight and long-term planning in ministries like Health. The resignation of Shas from the government in July 2025 left Katz overseeing multiple portfolios, illustrating how stretched leadership can create gaps that personal intervention seeks to fill – albeit unfairly.

Similarly, in Nigeria’s public health sector, chronic underfunding, brain drain of medical professionals, and deteriorating infrastructure contribute to lengthy wait times and inconsistent service delivery. According to World Health Organization data, Nigeria has fewer than four doctors per 10,000 people – far below the recommended threshold – pushing patients toward informal channels when formal ones fail.

Compounding this is a lack of robust patient grievance mechanisms and weak enforcement of ethical standards. When there are no clear, auditable pathways to complain about unfair prioritisation, or when complaints go unanswered, patients and families learn that connections are not just helpful – they are essential. Over time, this breeds cynicism and disengagement from official processes, further weakening accountability.

The Hidden Cost: Equity, Morale and Systemic Erosion

The true cost of protekzia extends beyond individual cases of queue-jumping. When access to care is perceived as arbitrary or biased, it undermines the social contract between citizens and the state. In Israel, the journalist’s post sparked debate not because Katz acted improperly, but because it highlighted a two-tier system: one for the well-connected, another for everyone else. This perception risks discouraging adherence to formal procedures, as citizens may see them as pointless if influence always trumps protocol.

For healthcare workers, the impact is equally corrosive. Doctors and nurses tasked with implementing uneven access policies face moral distress – knowing they must delay treatment for a clinically urgent case to accommodate someone with political or social leverage. Over time, this contributes to burnout, reduced job satisfaction, and attrition, worsening the very shortages that enable protekzia to flourish.

In Nigerian teaching hospitals, anecdotal reports suggest similar tensions arise when senior officials’ relatives receive priority in ICU admissions or theatre slots, leaving clinicians torn between professional ethics and hierarchical pressure. Such scenarios damage institutional integrity and deter investment in quality improvement initiatives, as staff lose faith in the fairness of the system they are expected to uphold.

Lessons for Reform: Building Systems That Work for All

Addressing protekzia requires more than admonishing individuals who use connections – it demands systemic redesign. Transparent, rule-based access protocols are essential. Waiting lists should be managed objectively, using clinical urgency scores rather than social capital. Technologies such as digital queue management systems, already piloted in Lagos University Teaching Hospital and some Kenyan facilities, can help deprioritise bias by standardising referrals and tracking appointment timelines in real time.

Equally important is strengthening primary care as the first point of contact. When local clinics are well-stocked, staffed, and trusted, patients are less likely to bypass them in desperation for specialist care – reducing opportunities for protekzia to take root. In Rwanda, investments in community health workers and mutuelles de santé (community-based health insurance) have significantly improved equitable access, offering a model adaptable to Nigerian states through the Basic Health Care Provision Fund.

Finally, leadership accountability must be non-negotiable. Ministers and officials should recuse themselves from intervening in individual cases to avoid conflicts of interest, instead channelling concerns through official oversight bodies. Whistleblower protections and independent ombudsman offices can further safeguard against abuse. Until systems protect the powerless as reliably as they respond to the powerful, protekzia will remain a symptom – not a solution – to deeper governance failures.

What this means

The story of the health minister’s intervention, while well-intentioned, serves as a powerful reminder that no healthcare system can be considered truly effective if it depends on who you know rather than what you need. In Israel, as in Nigeria and countless other nations, the path to universal health coverage lies not in applauding exceptional interventions, but in ensuring that exceptional interventions are never required. By confronting the protekzia problem head-on – through transparency, equity-driven design, and accountable leadership – governments can begin to build systems where every patient, regardless of connections, receives timely, dignified care. For shoppers, business leaders, and policymakers alike, this is not just a matter of ethics; it is foundational to economic productivity, social stability, and long-term national resilience.