Healthcare in Nigeria

Healthcare in Nigeria is a concurrent responsibility of the three tiers of government in the country.^[1] Private providers of healthcare have a visible role to play in healthcare delivery. The use of traditional medicine (TM) and complementary and alternative medicine (CAM) has increased significantly over the past few years.^[2]

Healthcare delivery in Nigeria has experienced progressive deterioration as a result of under-investment by successive governments, to effectively solve several problems that have existed in the sector over many years. This directly impacts the productivity of citizens and Nigeria's economic growth by extension. As of February 2018, the country was ranked 187 out of 191 countries in the world, in assessing the level of compliance with Universal Health Coverage (UHC), as very little of the populace is health insured, whereas even government budget for health services is insignificant. Out-of-pocket payments for health causes households to incur huge expenditures. Private expenditure on health as a percentage of total health expenditure is 74.85%.

The implication of this is that government expenditure for health is only 5.03 percent of all the money spent on health across the nation. Of the percentage spent on health by the citizens (74.85%), about 70% is spent as out-of-pocket expenditure to pay for access to health services in both government and private facilities. Most of the remaining money spent by citizens on their health is spent on procuring 'alternatives'. Nigerian-trained medical personnel are some of the best medical practitioners in the world. But low wages and poor workplace culture have forced hundreds of thousands of them to flee to Europe and America. ^[3]However, considering its size and population, there are fewer health workers per unit population than are required to provide effective health services to the entire nation. The most common reason is the brain drain of health professionals in other countries, especially in Europe and America.^[4]

The federal government's role is mostly limited to coordinating the affairs of the university teaching hospitals, Federal Medical Centres (tertiary healthcare) while the state government manages the various general hospitals (secondary healthcare) and the local government focuses on dispensaries (primary healthcare),^[5] which are regulated by the federal government through the NPHCDA.

The total expenditure on healthcare as a percentage of GDP is 5.03, while the percentage of federal government expenditure on healthcare is about 1.5%.^[6] A long-run indicator of the ability of the country to provide food sustenance and avoid malnutrition is the rate of growth of per capita food production; from 1970 to 1990, the rate for Nigeria was 0.25%.^[6] Though small, the positive rate per capita may be due to Nigeria's importing of food products.

On December 12, 2023, key health sector stakeholders signed a new health sector renewal compact by all relevant stakeholders, including the federal and state governments, donors, and development partners, also known as the first Sector-wide Approach (SWAp) in the health sector in Nigeria, introduced by the Coordinating Minister for Health and Social Welfare Muhammad Pate.^[7]

In 2024, the Nigerian government held its first quarterly dialogue on the performance of the health sector across the country between the federal authorities and sub-national governments, and key stakeholders in the health sector. The dialogue was organised as a part of the nation's commitment to revamping the health system using the Health Sector Renewal Investment Initiative and the Sector-Wide Approach, backed by the National Health Act of 2014.^[8]

• The official body that registers doctors and dentists, the Medical and Dental Council of Nigeria, does not have an online register. They provide a service to confirm a doctor's status.
• The Pharmacists Council of Nigeria allows for searching for verified pharmacists and premises.
• Medpages: Healthcare providers by category and region. Search allows finding of providers by name or specialty.

Historically, health insurance in Nigeria could be applied to a few instances: free health care provided and financed for all citizens, health care provided by the government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers.^[6] However, there are few people who fall within the three instances; as of 2015 less than 5% of Nigerians have health insurance coverage.^[9]

In May 1999, the government created the National Health Insurance Scheme, encompassing government employees, the organized private sector and the informal sector. Legislatively the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of President Olusegun Obasanjo gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.^[10] 1.5 percent of Nigerians have been covered by the National Health Insurance Scheme since its establishment. In 2017, the House of Representatives Committee on Health Care Services in Abuja, organized a two-day investigative hearing; where the Minister of Health Isaac Folorunsho Adewole said that the sum of N351 billion had been expended on health management organizations so far^[when?] without commensurate result.^[11]

On May 19, 2022, President Muhammadu Buhari signed the National Health Insurance Authority Bill 2022 into law “to ensure coverage of 83 million poor Nigerians who cannot afford to pay premiums as recommended by the Lancet Nigeria Commission”.^[12] This law “repealed the National Health Insurance Scheme Act, Cap N42, Laws of the Federation of Nigeria 2004”.^[12] In 2024, the National Health Insurance Authority (NHIA) announced an increase in healthcare costs, introducing a 60% rise in capitation and a 40% adjustment in Fee-For-Service (FFS) fees, reportedly due to healthcare cost inflation and the need to maintain quality of care, even as the adjustment could also impose a financial strain on patients and employers.^[13]

There is immense private sector participation in the scheme^[14] with HMOs like Health Partners HMO, Total Health Trust, Police HMO, Clearline HMO, Multi Shield Nigeria, Expatcare Health International, Oceanic Health Management and Zuma Health Trust.^[15]

In 2024, the Federal Government reportedly disbursed a total of N37billion to relevant health agencies through the Basic Health Care Provision Fund (BHCPF) for designated Primary Health Care (PHC) facilities.^[16]

Over one million Nigerians are pushed into poverty every year due to health-related expenses, according to a World Bank Human Capital Public Expenditure Review and Institutional Review.^[17]

A new bone marrow donor program, the second in Africa, opened in 2012.^[18] In cooperation with the University of Nigeria, it collects DNA swabs from people who might want to help a person with leukemia, lymphoma, or sickle cell disease to find a compatible donor for a life-saving bone marrow transplant. It hopes to expand to include cord blood donations in the future.^[18][19][20]

About 80,000 Nigerians die of cancer annually and over 100,000 are diagnosed with cancer annually.^[21][22] More people are dying of cancer in Nigeria because cancer and non-communicable diseases are not given priority in the country's health budget.^{[dubious – discuss]} There are only seven cancer radiotherapy centers in Nigeria.^[20]

Many of the cancer-related deaths in Nigeria can be attributed to a lack of knowledge regarding this family of diseases.^[23] For example, women are not provided with sufficient guidance to identify the signs and symptoms of breast cancer, and healthcare providers lack the capability to diagnose breast cancer, even after women have actively sought medical examinations.^[24]

Moreover, the absence of sufficient knowledge regarding both the prevention and early detection of cancer, coupled with a societal environment that can promote silence and attaches a negative social stigma to such illnesses, has resulted in over 33% of avoidable cancer fatalities. Research showed that many women with breast cancer had their needs met in less scientific and indirect ways. Some believed that breast cancer could be the fault of evil spirits and many women chose to use a complementary and alternative medicine alongside standard treatment.^{[25][23][26][27]}

The majority of mental health services are provided by 8 regional psychiatric centers and psychiatric departments and medical schools of 12 major universities. A few general hospitals also provide mental health services. The formal centers often face competition from native herbalists and faith healing centres.

The ratio of psychologists and social workers is 0.02 to 100,000.^[28]

In 1989 legislation made effective a list of essential drugs. The regulation was also meant to limit the manufacture and import of fake or sub-standard drugs and to curtail false advertising. However, the section on essential drugs was later amended.^[29] In 2005, it was estimated that about 16.7% of pharmaceutical drugs in the country were counterfeit. In 2012, a new study concluded that the proportion had fallen to 6.4%, of which 19.6% were Anti-Malaria medicines. In 2014 that had fallen to 3.6%.^[30] About N29 billion worth of counterfeit drugs were destroyed between 2015 – 2017.^{[citation needed]}

Drug quality is primarily controlled by the National Agency for Food and Drug Administration and Control. The agency has established a Mobile Authentication Service. A team of girls from the Regina Pacis Secondary School in Onitsha devised a better technological solution, an app called the FD Detector which uses barcode technology to verify drug authenticity and expiration dates. This won them a place in the Technovation Challenge 2018.^[31]

Several major regulatory failures have produced international scandals:

• In 1993, adulterated paracetamol syrup entered into the healthcare system in Oyo and Benue State, the result was the death of 100 children. A year after the disaster, batches containing poisonous ethylene glycol, the major cause of the deaths, could still be purchased.^{[citation needed]}
• In 1996, 11 children died after a clinical trial by Pfizer involving the drugs trovafloxacin and ceftriaxone during a meningitis outbreak.^[32]
• In 2008–2009, at least 84 children died from a brand of contaminated teething medication.^[33]

In 2024, the Coordinating Minister of Health and Social Welfare, Prof Muhammad Pate, lamented the pervasive corruption in the health sector and the country at large, such as a case where therapeutic food donated for children was diverted and the matter reported to police.^[34]

Nigeria is heavily reliant on the import of medicines as well as the import of ingredients required for local medicine production. In 2023, the pharmaceutical companies GlaxoSmithKline and Sanofi ceased their local drug manufacturing, citing various operational challenges.^[35] In 2024, amidst a record 27-year high inflation rate of 28.92% and a significant decline in the value of the Naira,^[36] the cost of antibiotics witnessed a more than tenfold increase in price.^[37] Other medicines, such as asthma inhalers and diabetic medications, were also significantly affected.^[38]

Healthcare in Nigeria is influenced by different local and regional factors that impact the quality or quantity present in one location.^{[citation needed]} Due to the aforementioned, the healthcare system in Nigeria has shown spatial variation in terms of availability and quality of facilities in relation to need. However, this is largely a result of the level of state and local government involvement and investment in healthcare programs and education. Also, the Nigerian Ministry of Health usually spends about 70% of its budget in urban areas where around 50% of the population resides.^[39]

Survey shows looming brain drain in Nigeria's health sector in the rising trend of emigration of healthcare personnel – physicians, pharmacists, nurses, laboratory scientists, physiotherapists and many others have difficulty getting into paid employment. Many fresh doctors, out of medical schools, and managed to get housemanship positions, the situation occurs every year. The problem persists beyond the period of housemanship or internship, when it comes to securing well-deserved employment. There are generally not enough job positions to go around. The challenge of this is clear. The problem of Sk distribution, with the few available personnel being mostly in the urban areas, where almost all the large facilities like General Hospitals and Teaching Hospitals are located. The underlying issues for this may include the political dimension, with some states unwilling to recruit large numbers of workers from other parts of the country as an act of deliberate policy, preferring to employ their own indigenes, or, where there is a short-fall, employ foreigners mostly from North Africa on short-term contracts.^[4] In 2007, a National Human Resources for Health Policy was formulated by the Federal Ministry of Health and approved by the National Council on Health. Subsequently, a Human Resource for Health Strategic Plan 2008–2012 was drawn up to guide implementation of the policy at all levels. The ultimate aim was to ensure that adequate numbers of skilled and well-motivated health workers were available and equitably distributed throughout the nation in order to ensure provision of quality health services. The situation appears set to get worse. As the era of Sustainable Development Goals commences and the target of 2030 begins to come into focus, the statistics are far from providing reassurance.^[4]

There are 4000 Nigerian doctors practicing in the United States and 8000 practicing in the United Kingdom.^[40] Retaining these expensively trained professionals has been identified as an urgent goal. The brain drain cuts across all healthcare professionals; thousands of Nigerian pharmacists and nurses are practicing in the UK and USA as well.^[40]

Public health services in Nigeria are of poor quality and are not adequately available, accessible, and affordable to many people who need these services.^[41] The search for solutions has led to the idea of privatization and commercialization of public health services. This development is greatly favored by the idea that it will increase competition and result in the lowering of unit price of health services and make such services more affordable to the poor.^[41] However, the argument against it is that privatization and commercialization in Nigeria will be a mirage unless institutional reforms take place.^[42]

As recent reports have shown, in addition to the many benefits there are also risks associated with the different types of traditional medicine /complementary or alternative medicine.^[43] Although consumers today have widespread access to various TM/CAM treatments and therapies, they often do not have enough information on what to check when using TM/CAM in order to avoid unnecessary harm.^[2] While traditional medicine has a lot to contribute to the health and economy, much harm has resulted from the unregulated sale and misuse of traditional/alternative medicine and herbs in the country and has delayed patients' seeking professional healthcare.^[44]

• Health in Nigeria
• Mental health policies in Nigeria
• Nigerian Medical Association
• EMDEX (Essential Medicines InDEX) - A Reference Source of Drug & Therapeutic Information for Nigeria's Healthcare Professionals

• Vogel, Ronald J. (1993). Financing Health Care in Sub-Saharan Africa. Greenwood Press. ISBN 978-0-313-28993-4.
• Akhtar, Rais (1991). Health Care Patterns and Planning in Developing Countries. Greenwood Press. ISBN 978-0-313-26745-1.