Nigeria, Africa’s most populous country, is a land of immense potential. Yet, despite its vast human and natural resources, one of the most pressing issues the nation faces is the state of its healthcare system. Decades of underfunding, poor infrastructure, and brain drain have left millions of Nigerians without access to quality healthcare. In this article, we will examine the state of healthcare in Nigeria, highlighting its major challenges, government efforts to address them, and the way forward for a healthier nation.
Current State of Nigeria’s Healthcare System
Nigeria’s healthcare system is a mix of public and private providers, with public healthcare being the primary source for most Nigerians. The country’s health system is divided into three tiers: primary, secondary, and tertiary care.
Primary healthcare is managed by local governments and focuses on basic health services, including immunizations, antenatal care, and health education.
Secondary healthcare is provided by general hospitals and is managed by state governments.
Tertiary care involves specialist hospitals, teaching hospitals, and federal medical centers, which are managed by the federal government.
Despite these tiers, healthcare delivery remains uneven, with significant disparities between urban and rural areas. A World Health Organization (WHO) report from 2022 revealed that Nigeria’s healthcare system ranked 187th out of 191 countries. Life expectancy in the country is just 55 years, significantly lower than the global average of 73 years. The infant and maternal mortality rates are among the highest in the world, with 512 deaths per 100,000 live births according to the Nigerian Bureau of Statistics (NBS).
Major Challenges Facing Healthcare in Nigeria
Nigeria’s healthcare system faces numerous challenges, from infrastructure deficits to human resource shortages. Some of the key issues include:
Inadequate Funding
Nigeria’s healthcare system is grossly underfunded. Although the government allocates funds to healthcare annually, it is often insufficient to meet the growing needs of the population. The Abuja Declaration, signed by African Union (AU) member states in 2001, recommended that countries allocate at least 15% of their annual budgets to healthcare. However, Nigeria has consistently fallen short of this target, with healthcare receiving less than 6% of the national budget in recent years.
Poor Infrastructure
Many healthcare facilities, especially in rural areas, lack basic infrastructure. There is a shortage of functional hospitals, clinics, and diagnostic centers. Most primary healthcare centers are dilapidated, and equipment is often outdated or non-functional. In some cases, healthcare workers have to improvise with makeshift solutions due to the lack of essential tools and supplies. This poor infrastructure limits the quality of care patients receive, forcing many to travel long distances for treatment or seek care abroad.
Shortage of Healthcare Professionals
Nigeria has a severe shortage of healthcare professionals. The doctor-patient ratio in Nigeria is about 1 doctor to 5,000 patients, far below the WHO recommendation of 1 doctor to 600 patients. This is partly due to brain drain, with many Nigerian doctors and nurses emigrating to countries like the United States, the United Kingdom, and Canada in search of better opportunities and working conditions. In 2022, it was estimated that over 9,000 Nigerian doctors were practicing in the UK alone. This exodus has led to a massive gap in healthcare delivery in Nigeria.
Limited Access to Medicines and Vaccines
Access to essential medicines and vaccines is another significant issue. The National Health Insurance Scheme (NHIS), intended to provide universal coverage, reaches only about 5% of the population. This leaves millions of Nigerians paying out-of-pocket for healthcare, making essential treatments unaffordable for many. Additionally, there have been frequent shortages of vaccines and medications, exacerbated by supply chain disruptions, corruption, and poor distribution networks.
High Disease Burden
Nigeria carries a heavy disease burden, with high rates of communicable and non-communicable diseases. Infectious diseases such as malaria, tuberculosis, and HIV/AIDS remain major public health concerns. According to the National Malaria Elimination Programme (NMEP), malaria alone accounts for approximately 60% of outpatient visits in Nigerian hospitals. Meanwhile, non-communicable diseases like hypertension, diabetes, and cancer are on the rise, straining the already overstretched healthcare system.
Government Efforts and Reforms
In recent years, the Nigerian government has introduced several initiatives aimed at improving healthcare delivery and access. However, progress has been slow, and the challenges remain significant. Some key initiatives include:
The Basic Health Care Provision Fund (BHCPF)
Introduced in 2019, the BHCPF is a part of the National Health Act (2014) aimed at improving healthcare funding, particularly at the primary care level. The fund is intended to strengthen primary healthcare services and ensure the provision of a basic minimum package of health services for all Nigerians. However, the implementation has been plagued by bureaucratic delays, corruption, and poor coordination.
National Health Insurance Authority Act (2022)
In May 2022, the National Health Insurance Authority (NHIA) Act was signed into law, replacing the previous NHIS. The goal is to provide mandatory health insurance coverage to all Nigerians, with a focus on expanding coverage to informal sector workers and vulnerable populations. While this is a step in the right direction, achieving universal health coverage remains a long-term goal, requiring significant political will and resources.
Efforts to Combat Brain Drain
The Nigerian government has also made efforts to address brain drain through various retention and incentive programs. For instance, some state governments have introduced policies to improve the working conditions of healthcare workers by offering better salaries, training opportunities, and infrastructure upgrades. However, more needs to be done to create a conducive environment for healthcare professionals to thrive and remain in the country.
Public-Private Partnerships (PPPs)
In recognition of the limitations of the public healthcare system, the government has increasingly turned to public-private partnerships (PPPs) to improve healthcare infrastructure and service delivery. These partnerships are aimed at leveraging private sector expertise and investment to modernize healthcare facilities and expand access to care. Successful examples of PPPs include the Lagos State Health Scheme and the Garki Hospital in Abuja, which have improved access to quality care for many Nigerians.
The Way Forward:
Recommendations for Improving Healthcare in Nigeria
Despite the challenges, there are several strategies that can help improve healthcare delivery in Nigeria:
Increased Healthcare Funding
Nigeria must prioritize healthcare in its national budget, increasing its allocation to meet or exceed the 15% target set by the Abuja Declaration. This funding should be targeted at improving infrastructure, training healthcare workers, and ensuring the availability of essential medicines.
Strengthening Primary Healthcare
Primary healthcare must be strengthened as the backbone of the healthcare system. This involves upgrading primary health centers, ensuring they are fully equipped and staffed, and focusing on preventive healthcare, particularly in rural areas.
Addressing Brain Drain
The government should offer competitive salaries and better working conditions to healthcare professionals to reduce brain drain.
Creating career advancement opportunities and improving infrastructure in healthcare facilities will help retain talent.
Expanding Health Insurance Coverage
Efforts should be made to ensure that the NHIA Act is fully implemented, expanding access to health insurance for all Nigerians, particularly the most vulnerable populations.
Public Awareness and Health Education
Improving public awareness about health issues and preventive care is essential. Investments in health education programs can help reduce the burden of diseases, especially preventable ones like malaria and diarrhea.
The state of healthcare in Nigeria remains a complex and multifaceted challenge. While progress has been made, there is still much work to be done to ensure that all Nigerians have access to quality healthcare. A commitment to increased funding, better infrastructure, and innovative policy solutions is essential for transforming Nigeria’s healthcare system and improving the health and well-being of its citizens.
