The Political Economy of Orthopaedic Implant Procurement in Nigerian Teaching Hospitals: An Institutional Analysis

The availability, affordability, and quality of orthopaedic implants in Nigerian public teaching hospitals are shaped not only by clinical demand but by procurement processes, political economy dynamics, supply chain structures, and institutional governance arrangements. This study applies an institutional political economy framework to analyse orthopaedic implant procurement in six Nigerian university teaching hospitals located in Lagos, Kano, Enugu, Ibadan, Abuja, and Maiduguri. An embedded case-study design combines document analysis of procurement records, government tenders, and policy texts, with semi-structured interviews with 60 actors including procurement officers, orthopaedic surgeons, hospital administrators, suppliers, and health ministry officials. Network analysis will map supplier-hospital relationships and dependency structures. Qualitative comparative analysis (QCA) will identify necessary and sufficient institutional conditions for reliable implant supply. The study applies Ostrom's Institutional Analysis and Development (IAD) framework as its primary theoretical lens to explain variance in implant availability outcomes across sites. The study hypothesises that hospitals with functional multidisciplinary procurement committees and transparent vendor evaluation protocols demonstrate significantly more reliable implant supply. Findings will generate an original institutional theory of public orthopaedic implant procurement in Nigeria, contributing to health policy literature on procurement governance in sub-Saharan Africa. Recommendations will be submitted to the Federal Ministry of Health's Health Sector Procurement Reform Committee. Keywords: orthopaedic implants, procurement, political economy, institutional analysis, Nigerian hospitals.