Running head: Healthcare 1

HealthCare System of Nigeria

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HealthCare System of Nigeria

Introduction

Nigeria is the most populous country in Africa and the seventh most populous country in

the world, with a population of more than 170 million people. The country has more than 250

ethnic groups, 380 languages, and a diverse range of cultural and religious beliefs and practices.

Notably, addressing health issues proves to be a challenge but addressing them using public

health principles is essential to ensure the well-being of the citizens.

The Nigerian health care system has been reported to be poorly accepted by the

population because of poor access to care due to infrastructural and personnel deficiencies.

This shows the need for better patient-centered healthcare initiatives in health planning,

policy-making for health, as well as the delivery of healthcare programs and services to the

populace (Ephraim-Emmanuel et al., 2018).

History

According to Ephraim-Emmanuel and colleagues (2018), the pace of development of

quality healthcare services in Nigeria remains unsatisfactory, with a ranking of 187 out of 200

countries; it still has weak or non-existent healthcare standards and accreditation systems, poor

quality healthcare services, inequitably-distribution and insufficient health care service delivery.

Despite the investments into primary, secondary, and tertiary health care, coverage for

basic health care services is, especially for the rural communities of the country, yet to be

attained.
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Structure

Nigeria is a federation of 36 states and a federal capital territory, and there are 774 local

government areas (LGAs) across the country.

The healthcare system is largely public-sector driven, but there is substantial private-

sector involvement in the provision of health services. “There are some 34,000 health facilities,

66% of which are owned by the three tiers of government; federal, state, and local government

areas.” (Okpani & Abimbola, 2015, pg. 2)

The secondary and tertiary level health facilities are concentrated in urban areas, while

the rural population is served by primary health care facilities.

The National Health Insurance Scheme (NHIS) regulates health insurance as well as

accredits Health Maintenance Organizations (HMOs). The NHIS provides health insurance

coverage for employees of the federal government. HMOs act as the third party under the NHIS,

whereas they pay the healthcare providers by a mix of capitation and fee-for-service.

Public sector health facilities are not for profit thus, people can get services at a lower

cost compared to the private sector. However, those services are largely considered to be of poor

quality.

Financing

The financing of a country’s health care system is an important determinant for reaching

universal health coverage (UHC) (Uzochukwu et al., 2015). Notably, this determines whether the

health services that are available are affordable to those who need them.
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Health care in Nigeria is financed through various sources, including but not limited to

tax revenue, donor funding, out-of-pocket payments, cash payments, and health insurance

(Uzochukwu et al., 2015).

Recent data indicates that Nigeria spends 3.03% of its GDP on healthcare. The Per Capita

spending translates to $71.

Achieving UHC remains a challenge in Nigeria; thus, a need to review the system of

financing health and ensure that resources are used more efficiently by removing financial

barriers to access by shifting focus from out-of-pocket payments to other hidden sources.

Interventional

The current national health policies have concise statements on policies of health

programs such as Human Immunodeficiency Virus (HIV/AIDS), Malaria, Immunization,

Adolescent health, Elimination of Female Genital Mutilation, and Control of Onchocerciasis.

The National Emergency Response and Preparedness Team was constituted by the

Federal Ministry of Health (FMOH), Nigeria, in recognition of the significance of disease

prevention and control (Muhammad et al., 2017).

Preventive

The FMOH is a public health agency and service of the government, but its response

system is slow. The establishment of a National Public Health Agency (NPHA) will increase the

capacity of FMOH to provide prompt and effective public health interventions to Nigerians

(Ephraim-Emmanuel et al., 2018).

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The formulation of NPHA is imperative if the public health problems in Nigeria must be

addressed. This will increase the capacity of the Federal Ministry of Health (FMOH) to provide

prompt and effective public health interventions to Nigerians.

This must be done if the government is keen to reduce the incidence of disease and

disability since among the key responsibilities of the NPHA are surveillance, emergency,

preparedness, disease prevention, and control.

Resources

The Nigerian health care system faces serious challenges because of inadequate health

facilities, poor human resources, and management, poor remuneration and motivation, lack of

fair and sustainable health care financing, very low government spending on health, inadequate

mechanisms for families to access health care and shortage of essential drugs and supplies

(Obansa & Orimisan, 2013).

Nigeria has 74,543 registered physicians and 320,000 nurses. This translates to 4 doctors

and 16 nurses per 10,000 patients. Notably, the gap in the health sector has contributed to the

migration of healthcare workers seeking opportunities abroad. For instance, only 40,000

physicians are practicing in Nigeria. Therefore, there is a need for the government to increase

investment in the health sector and address the issue of its healthcare workers leaving the

country.

Major Health Issues

According to Muhammad and colleagues (2017), communicable and infectious diseases

are the major health problems in Nigeria.

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Malaria remains the leading cause of death, with over 25% of under-five mortality, 30%

of childhood mortality, and 11% of maternal mortality. According to the 2011 World Health

Statistics, malaria mortality in Nigeria is 146 per 100,000 population.

The country has the second higher HIV burden in the world, with about 3.4 million

Nigerians living with HIV. In addition,

Nigeria has one of the highest Tuberculosis burdens in the world (311 people per

100,000)

Despite considerable gains in the recent past, child survival in Nigeria is threatened by

nutritional deficiencies and illnesses, specifically diarrheal diseases, acute respiratory infections

(ARI), and vaccine-preventable diseases (VPD), which account for the majority of childhood

mortality.

Other leading causes of mortality are non-communicable diseases such as cancer,

cardiovascular disease, stroke, hypertension, coronary heart disease, and asthma.

Health Disparities

There are clear indications of disproportionate allocation of health care resources. When

comparing the availability of services in rural areas compared to urban areas, rural communities

suffer from a dire shortage of health services while urban areas have an abundance (Ephraim-

Emmanuel et al., 2018).

The consequent effects of these disparities can be best imagined, including the inability to

meet up with the Sustainable Development Goals (SDGs) initiatives and programs (Ephraim-

Emmanuel et al., 2018).

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Among the beneficiaries of the NHIS scheme are federal government employees, the

urban self-employed, children under five, the permanently disabled, and the armed forces. On the

other hand, the marginalized groups include the rural community, informal workers, and those

earning lesser wages.

Conclusion

Health insurance arose from the need to take caution from financial ruin that could result

from ill health. Whereas NHIS and private insurance have managed to provide coverage to

federal public sector workers, their families, and workers of large private organizations, the large

majority of Nigerians are without any form of coverage (Okpani & Abimbola, 2015).

Since the Nigerian constitution gives states autonomy in deciding their health care

priorities, greater federal government spending on health care may not achieve the desired

outcomes. Therefore, there is a need to formulate interventions that can enhance the inclusivity

of the healthcare system, particularly for the poor.

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References

Uzochukwu, B. S. C., Ughasoro, M. D., Etiaba, E., Okwuosa, C., Envuladu, E., & Onwujekwe,

O. E. (2015, June 1). Health care financing in Nigeria: Implications for achieving

universal health coverage. Nigerian journal of clinical practice, 18(4), 437-444.

https://www.ajol.info/index.php/njcp/article/view/117717

Muhammad, F., Abdulkareem, J. H., & Chowdhury, A. A. (2017, December 31). Major public

health problems in Nigeria: A review. South East Asia Journal of Public Health, 7(1), 6-

11. https://www.banglajol.info/index.php/SEAJPH/article/view/34672

Ephraim-Emmanuel, B. C., Adigwe, A., Oyeghe, R., & Ogaji, D. S. (2018, August). Quality of

health care in Nigeria: A myth or a reality. International Journal of Research in Medical

Sciences, 9, 2875-2881.

https://www.researchgate.net/publication/327230229_Quality_of_health_care_in_Nigeria

_a_myth_or_a_reality

Obansa, S. A. J., & Orimisan, A. (2013, January 1). Health care financing in Nigeria: prospects

and challenges. Mediterranean Journal of social sciences, 4(1), 221-221.

https://www.richtmann.org/journal/index.php/mjss/article/view/11577

Okpani, A. I., & Abimbola, S. (2015, Sept-Oct). Operationalizing universal health coverage in

Nigeria through social health insurance. Nigerian medical journal: journal of the Nigeria

Medical Association, 56(5), 305.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698843/