Healthcare in Nigeria

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Life expectancy at birth in Nigeria Life expectancy development in Nigeria.svg
Life expectancy at birth 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]

Contents

Healthcare delivery in Nigeria has experienced progressive deterioration as a result of weakened political will on the part of 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. Over half of Nigeria's population lives on less than $1.90 a day ('Poverty Head-count'), making them one of the poorest populations in the world. 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 provision for health 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 25.15 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' which cost a lot. Nigeria has better health personnel than most other African countries. 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. Sadly, the most commonly advertised reason is the brain drain of health professionals in other countries, especially in Europe and America. [3]

Health infrastructure

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), [4] which are regulated by the federal government through the NPHCDA.

The total expenditure on healthcare as a percentage of GDP is 4.6, while the percentage of federal government expenditure on healthcare is about 1.5%. [5] 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%. [5] Though small, the positive rate per capita may be due to Nigeria's importing of food products.

Online databases of healthcare providers

Health insurance

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. [5] However, there are few people who fall within the three instances; as of 2015 less than 5% of Nigerians have health insurance coverage. [6]

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. [7] 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. [8]

There is immense private sector participation in the scheme [9] 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. [10]

Bone marrow surgeries

A new bone marrow donor program, the second in Africa, opened in 2012. [11] 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. [11] [12] [13]

Cancer care

About 80,000 Nigerians die of cancer annually and over 100,000 are diagnosed with cancer annually. [14] [15] 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. [13]

Many of the cancer-related deaths in Nigeria can be attributed to a lack of knowledge regarding this family of diseases. [16] 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. [17]

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. [16] [18] [19]

Mental health

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. [20]

Issues

Regulation of pharmaceuticals

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. [21] 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%. [22] 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. [23]

Several major regulatory failures have produced international scandals:

Access to medicines

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. [25] In 2024, amidst a record 27-year high inflation rate of 28.92% and a significant decline in the value of the Naira, [26] the cost of antibiotics witnessed a more than tenfold increase in price. [27] Other medicines, such as asthma inhalers and diabetic medications, were also significantly affected. [28]

Geographic inequality

Malian Fulani immigrant selling herbal medicines in a Nigerian market Mali woman selling herbal medicines.jpg
Malian Fulani immigrant selling herbal medicines in a Nigerian market

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. [29]

Emigration of healthcare workers

Retaining health care professionals is an important objective Nurses in Nigeria.jpg
Retaining health care professionals is an important objective

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. [3] 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. [3]

There are 4000 Nigerian doctors practicing in the United States and 8000 practicing in the United Kingdom. [30] 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. [30]

Privatization and commercialization of public health service

Public health services in Nigeria are of poor quality and are not adequately available, accessible, and affordable to many people who need these services. [31] 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. [31] However, the argument against it is that privatization and commercialization in Nigeria will be a mirage unless institutional reforms take place. [32]

Traditional and alternative medicine

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. [33] 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. [34]

See also

Related Research Articles

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

<span class="mw-page-title-main">Comparison of the healthcare systems in Canada and the United States</span> Healthcare system comparison

A comparison of the healthcare systems in Canada and the United States is often made by government, public health and public policy analysts. The two countries had similar healthcare systems before Canada changed its system in the 1960s and 1970s. The United States spends much more money on healthcare than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on healthcare in that year; Canada spent 10.0%. In 2006, 70% of healthcare spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on healthcare was 23% higher than Canadian government spending. U.S. government expenditure on healthcare was just under 83% of total Canadian spending.

<span class="mw-page-title-main">Healthcare in Canada</span>

Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."

The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.

...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.

<span class="mw-page-title-main">Healthcare in Pakistan</span> Overview of the health care system in Pakistan

The healthcare delivery system of Pakistan is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. Healthcare is delivered mainly through vertically managed disease-specific mechanisms. The different institutions that are responsible for this include: provincial and district health departments, parastatal organizations, social security institutions, non-governmental organizations (NGOs) and private sector. The country's health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. Pakistan's gross national income per capita in 2021 was $4,990 and the total expenditure on health per capita in 2021 was Rs 657.2 Billion, constituting 1.4% of the country's GDP. The health care delivery system in Pakistan consists of public and private sectors. Under the constitution, health is primarily responsibility of the provincial government, except in the federally administered areas. Health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. Service delivery is being organized through preventive, promotive, curative and rehabilitative services. The curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. Preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities. The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions. Some government/ semi government organizations like the armed forces, Sui Gas, WAPDA, Railways, Fauji Foundation, Employees Social Security Institution and NUST provide health service to their employees and their dependants through their own system, however, these collectively cover about 10% of the population. The private health sector constitutes a diverse group of doctors, nurses, pharmacists, traditional healers, drug vendors, as well as laboratory technicians, shopkeepers and unqualified practitioners.

<span class="mw-page-title-main">Health policy</span> Policy area that deals with the health system of a country or other organization

Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.

Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products.

<span class="mw-page-title-main">Healthcare in the United Kingdom</span> Overview of healthcare in the United Kingdom

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<span class="mw-page-title-main">Philosophy of healthcare</span>

The philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon of human civilization whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of their life. This perennial concern is especially prominent in modern political liberalism, wherein health has been understood as the foundational good necessary for public life.

<span class="mw-page-title-main">Healthcare in Singapore</span> Healthcare in Singapore

Healthcare in Singapore is under the purview of the Ministry of Health of the Government of Singapore. It mainly consists of a government-run publicly funded universal healthcare system as well as a significant private healthcare sector. Financing of healthcare costs is done through a mixture of direct government subsidies, compulsory comprehensive savings, national healthcare insurance, and cost-sharing.

<span class="mw-page-title-main">Healthcare in Taiwan</span>

Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 ; 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2019 was averaged at 81 years.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

<span class="mw-page-title-main">Healthcare in Ghana</span>

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Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.

Examples of health care systems of the world, sorted by continent, are as follows.

Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.

<span class="mw-page-title-main">Healthcare in India</span> Overview of the health care system in India

India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services.

References

  1. ↑ Akhtar 1991, p. 264.
  2. 1 2 "Medicinedocs(PDF)" (PDF). Archived from the original (PDF) on September 29, 2009.
  3. 1 2 3 Okboh, Anthonia (28 January 2019). "Examining Nigeria's healthcare challenges".
  4. ↑ "Federal Medical Centre Abeokuta: A Case Study in Hospital Management pp 1". docstoc. Retrieved 13 June 2011.
  5. 1 2 3 Vogel, Ronald J. (1993). Financing health care in sub-Saharan Africa. Contributions in Afro-American and African studies. Westport, Conn.: Greenwood Press. ISBN   978-0-313-28993-4.
  6. ↑ Awosusi, Abiodun; Folaranmi, Temitope; Yates, Robert (1 September 2015). "Nigeria's new government and public financing for universal health coverage". The Lancet Global Health. 3 (9): e514–e515. doi: 10.1016/S2214-109X(15)00088-1 . PMID   26275321.
  7. ↑ Monye, Felicia N (September 2006). "An Appraisal of the National Health Insurance Scheme of Nigeria". Commonwealth Law Bulletin. 32 (3): 415–427. doi:10.1080/03050710601074450. S2CID   144728225.
  8. ↑ Ovuakporie, Emma; Nwabughiogu, Levinus. "Health insurance: FG calls for scrapping of HMOs". Vanguard Newspaper. Retrieved 5 July 2017.
  9. ↑ "Failures of Nigerian Health Insurance Scheme: the way forward" . Retrieved 2018-03-15.
  10. ↑ "Top 40 Health Insurance Companies in Nigeria | GHC Nigeria". GHC Nigeria. 2017-09-12. Retrieved 2018-03-15.
  11. 1 2 McNeil, Donald (11 May 2012). "Finding a Match, and a Mission: Helping Blacks Survive Cancer". The New York Times. Retrieved 15 May 2012.
  12. ↑ Onogu, Sanni (August 27, 2016). "The burden of Cancer in Nigeria". Vanguard Media Limited. Vanguard Newspaper. Retrieved 24 December 2017.
  13. 1 2 Chidebe, Runcie (August 27, 2017). "Cancer patients paying with their blood in Nigeria". The Cable. The Cable. Retrieved 24 December 2017.
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  17. ↑ "The age of information: Ensuring better health". spotlight.leeds.ac.uk. Retrieved 2024-03-11.
  18. ↑ Grady, Denise (15 October 2013). "Uganda Fights Stigma and Poverty to Take On Breast Cancer". The New York Times.
  19. ↑ "The age of information: Ensuring better health". spotlight.leeds.ac.uk. Retrieved 2024-03-11.
  20. ↑ Ayonrinde, Oyedeji; Gureje, Oye; Lawal, Rahmaan (June 2004). "Psychiatric research in Nigeria: Bridging tradition and modernisation". The British Journal of Psychiatry. 184 (6): 536–538. doi: 10.1192/bjp.184.6.536 . PMID   15172949. S2CID   12541525.
  21. ↑ Ransome Kuti, O. (1992). "National Drug Policy in Nigeria". Journal of Public Health Policy. 13 (3): 367–373. doi:10.2307/3342734. JSTOR   3342734. S2CID   68197988.
  22. ↑ "3.6% Fake Drugs Circulation in Nigeria, Not 70%, NADFDAC Clarifies". This day live. 13 November 2017. Retrieved 10 October 2018.
  23. ↑ "From Onitsha To Silicon Valley: Teen Girls' App May Save Nigerians From Fake Drugs". Nigeria Healthwatch. 14 August 2018. Retrieved 10 October 2018.
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  25. ↑ "GSK, Sanofi Exit Nigerian Market Amid Lingering Foreign Exchange Crisis". BioSpace. Retrieved 2024-03-04.
  26. ↑ "Nigeria Inflation Rate Climbs to 27-Year High on Transport Costs". Bloomberg.com. 2024-01-15. Retrieved 2024-03-04.
  27. ↑ Bokinni, Yemisi (2024-03-01). "Antibiotic costs rise 1100% as big pharma exits Nigeria". BMJ. 384: q328. doi:10.1136/bmj.q328. ISSN   1756-1833.
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  29. ↑ Akhtar 1991, p. 265.
  30. 1 2 Ehigiator, Sunday (2022-04-17). "Brain Drain Overstretching Health Workers, NMA Laments". THISDAYLIVE. Retrieved 2022-04-21.
  31. 1 2 Olomola, Aderibigbe Stephen (1 November 2009). "Privatization Commercialization of Public Service Delivery: Implications for Pro-Poor Growth and Attainment of MDGs in Nigeria". SSRN   2765483 .
  32. ↑ Stephen, Chukwuma Chukwudumebi; Omokhudu, Odiwo Williams; Anthony, Kifordu Anyibuofu (1 September 2016). "The Impact of Privatization and Commercialization in Nigeria". International Research Journal of Management, IT & Social Sciences. 3 (9): 107–119.
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  34. ↑ "Excessive intake of local herbs causes kidney damage-Expert". Daily Trust. 19 March 2018. Archived from the original on 19 March 2018.

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