Health in Nigeria

Healthcare provision 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 health care delivery.

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 focus on dispensaries (primary healthcare),^[2] which are regulated by the federal government through the NPHCDA.

The total expenditure on healthcare as % of GDP is 4.6, while the percentage of federal government expenditure on healthcare is about 1.5%.^[3] 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 1970–1990, the rate for Nigeria was 0.25%.^[4] Though small, the positive rate of per capita may be due to Nigeria's importation of food products.

Health insurance

Historically, health insurance in Nigeria can be applied to a few instances: free health care provided and financed for all citizens, health care provided by 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.

In May 1999, the government created the National Health Insurance Scheme, the scheme encompasses government employees, the organized private sector and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of Obasanjo further gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.^[6] The number of Nigerians covered by the National Health Insurance Scheme (NHIS) since its establishment are 1.5 percent of the population. 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 (HMOs) so far without commensurate result^[7].

Cancer care

A new bone marrow donor program, the second in Africa, opened in 2012.^[8] 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.^[8]

Mental health

The majority of mental health services is 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 centres often face competition from native herbalists and faith healing centres.

The ratio of psychologists and social workers is 0.02 to 100,000.^[9]

Water supply and sanitation

Access to an improved water source stagnated at 47% of the population from 1990 to 2006, then increased to 54% in 2010. In urban areas access decreased from 80% to 65% in 2006, and then recovered to 74% in 2010.^[10]

Adequate sanitation is typically in the form of septic tanks, as there is no central sewerage system, except for Abuja and some areas of Lagos.^[11] A 2006 study estimated that only 1% of Lagos households were connected to general sewers.^[12]

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.^[13]

Drug quality is primarily controlled by the National Agency for Food and Drug Administration and Control (NAFDAC). Several major regulatory failures have produced international scandals:

• In 1993, adulterated paracetamol syrup entered into the healthcare system in Oyo and Benue State, the end result of 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.
• In 1996, about 11 children died of contamination from an experimental trial of the drug trovafloxacin.
• In 2008-2009, at least 84 children died from a brand of contaminated teething medication.^[14]

Geographic inequality

Healthcare in Nigeria is influenced by different local and regional factors that impacts the quality or quantity present in one location. 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 as a result of the level of state and local government involvement and investment in health care programs and education. Also, the Nigerian ministry of health usually spend about 70% of its budget in urban areas where around 50% of the population resides.^[15]

Emigration of healthcare workers

Retaining health care professionals is an important objective

Migration of health care personnel to other countries is a tasking and relevant issue in the health care system of the country. From a supply push factor, a resulting rise in exodus of nurses may be due to dramatic factors that make the work unbearable and knowing and presenting changes to arrest the factors may stem a tide.^[16]

Because a large number of nurses and doctors migrating abroad benefited from government funds for education, it poses a challenge to the patriotic identity of citizens and also the rate of return of federal funding of health care education. The state of healthcare in Nigeria has been worsened by a physician shortage as a consequence of severe 'brain drain'.

Many Nigerian doctors have emigrated to North America and Europe. In 2005, 2,392 Nigeria doctors were practising in the US alone, in UK number was 1,529. Retaining these expensively trained professionals has been identified as an urgent goal. It should be noted that the Brain drain cut across all healthcare Professionals, thousands of Nigerian Pharmacists and Nurses are practising in the UK and USA as well and so on.

Commercialisation of public health service delivery

Empirical evidences reveal negative impact of commercialisation of public health service delivery on attainment of the MDGs in Nigeria.^[17]

Health status

Life expectancy

The 2014 CIA estimated average life expectancy in Nigeria was 52.62 years.^[18]

HIV/AIDS

As of 2014 in Nigeria, the HIV prevalence rate among adults ages 15–49^[19] was 3.17 percent.^[20] The prevalence of HIV in Nigeria varies widely by region. In some states, the epidemic is more concentrated and driven by high-risk behaviors, while other states have more generalized epidemics that are sustained primarily by multiple sexual partnerships in the general population. Youth and young adults in Nigeria are particularly vulnerable to HIV, with young women at higher risk than young men.^[21]

There are many risk factors that contribute to the spread of HIV, including prostitution, high-risk practices among itinerant workers, high prevalence of sexually transmitted infections (STI), clandestine high-risk heterosexual and homosexual practices, international trafficking of women, and irregular blood screening.^[21]

Malaria

As of 2012 in Nigeria, the malaria prevalence rate was 11 percent.^[22][23] A part of this data is from the President's Malaria Initiative which identifies Nigeria as a high-burden country.^[24] Nigeria's branch dealing with this problem, the National Malaria Control Program, has recognized the problem and has embraced the World Malaria Day theme of "End Malaria for Good." ^[25]

Endemic diseases

In 1985, an incidence of yellow fever devastated a town in Nigeria, leading to the death of 1000 people. In a span of 5 years, the epidemic grew, with a resulting rise in mortality. The vaccine for yellow fever has been in existence since the 1930s.^[26]

Maternal and child healthcare

The 2010 maternal mortality rate per 100,000 births for Nigeria was 840. This is compared with 608.3 in 2008 and 473.4 in 1990. The under 5 mortality rate, per 1,000 births is 143 and the neonatal mortality as a percentage of under 5's mortality is 28. In Nigeria the lifetime risk of death for pregnant women 1 in 23.^[27] Nigeria’s abortion laws make it one of the most restrictive countries regarding abortion.^[28]

Pollution

Traffic congestion in Lagos, environmental pollution and noise pollution are major health issues.

See also

• Timeline of healthcare in Nigeria
• Nigerian Medical Association
• Federal Ministry of Health
• Smoking in Nigeria
• EMDEX (Essential Medicines InDEX) - A Reference Source of Drug & Therapeutic Information for Nigeria's Healthcare Professionals

References

External links

• "'A breakdown of our primary health care system'," Seattle Post-Intelligencer
• 'Asangansi Complex Dynamics in the Socio-Technical Infrastructure: the case of the Nigerian Health Management Information System'
• Health in Nigeria
• Health insurance
• The State of the World's Midwifery - Nigeria Country Profile