In this post, we take a look at the health care sector in Nigeria.
The healthcare sector in the country is primarily made up of systems and companies specialized in the production and delivery of products and services that improve the well-being of the nation from pills and medication to hearing aids devices.
The Healthcare Sector in Nigeria: A General Overview
In a country like Nigeria, one of the major functions of the healthcare sector is to tackle the high incidence of both infectious and non-communicable diseases (NCDs) in the country.
In terms of disease burden, Nigeria has a large number of cases of widespread communicable diseases such as HIV/AIDS, malaria and tuberculosis (TB).
The British NGO, Save the Children revealed that 30% of newborn deaths in Nigeria are attributable to infections. The prevalence of HIV among adults aged 15-49 is 3.2%, and there are an estimated 2.8m adults aged 15 and up living with HIV.
Also, the US Centres for Disease Control and Prevention (CDC) disclosed that 97% of the population is at risk for malaria and the disease accounts for more deaths in Nigeria than anywhere else in the world.
There are three tiers in the healthcare sector that are involved in health management in the country. These three distinct levels are tertiary care, secondary care and primary health care.
The Federal Government is responsible for tertiary care, which is mainly provided by university teaching hospitals and federal medical centres. The secondary care facilities are overseen by each of the state government of Nigeria. These facilities are mainly in the form of general hospitals.
The basic level which is the primary health care is overseen by the 774 local government areas and health care is primarily administered through dispensaries.
This delineation looks good on paper, but so far, it has been characterized by budgetary leakages, overlap inefficiencies and blame passing.
Generally, the healthcare system is characterized by a marked discrepancy in the availability and quality of services between private and public facilities and between urban and rural areas. Also, the tertiary and general hospitals tend to be overcrowded because the primary health care centres are functioning below par.
Nonetheless, significant progress has been made in the reduction of life-threatening infectious diseases and there has been an improvement in the performance of key health indices.
The best way to compare progress is with the UN’s Millennium Development Goals (MDG) which is in view of 2020. Currently, Nigeria ranks 153rd out of 187 countries on the UN’s Human Development Index, with some of the highest infant, child and maternal mortality rates in the world.
One of the major challenges with healthcare delivery in the country is budgetary allocation which has been hovering between 5 to 6% of the country’s annual budget.
Although the allocation to health is one of the highest based on value, it is believed that the amount is still far less than what is needed. Also, when compared to the 2001 Abuja declaration where Nigeria and 21 other African nations pledged to commit 15% of their federal budget towards health needs, this is a far cry.
However, the country has enjoyed support from international aid organizations. Each year, Nigeria receives about $2bn annually in health-related foreign aid from these organizations (NGOs).
These efforts combined with that of the government have led to successes in reducing the prevalence of diseases in the country.
In July 2014, the Joint UN Programme on HIV and AIDS released a study showing that new HIV infections have decreased by 35% over the past three years, due in part to the fact that the number of treatment centres offering free antiretroviral therapy expanded from just 25 in 2001 to more than 800 as at the time of the report.
Additionally, the incidence of malaria is also down, with strategies employed including the subsidized distribution of antimalarials as well as the provision of insecticide-treated mosquito nets to vulnerable communities.
The lack of quality facilities in the country has led to an increase in medical tourism with Nigerians spending as much as $2 billion per annum on outbound medical tourism. The prime destinations include the US, the UK and India. Efforts are now underway to reverse this trend.
In 2012, a policy mandating those civil servants receiving government medical coverage undergo treatment in Nigeria, but this is yet to be fully implemented. Consequently, it is quite common to see public officials travel abroad to seek treatment.
Another important sector of the healthcare sector is the pharmaceutical sector. In 2011, a survey by the WHO discovered that 64% of antimalarial drugs in the market were fake. In addition to the social cost of substandard, ineffective and potentially dangerous products being sold in the open market, it is estimated that the local pharmaceuticals industry loses around N200bn ($1.2bn) annually to counterfeit medicine.
It was during this period that the National Health Bill was signed. One of the objectives of the bill was to implement a new framework for drug distribution which will eventually reduce the sale of counterfeit and sub-standard medicine in the local market.
Based on this format, pharmaceuticals manufacturers and importers are only permitted to sell drugs directly to mega drug distribution centres (MDDCs), state drug distribution centres (SDDCs) and the national health programme. From there, MDDCs can only sell on to wholesalers, while SDDCs can re-distribute to public health facilities and in some instances the national health programme, as well as wholesalers. However, as of 2018, the guideline is yet to be implemented.
Beyond distribution, there is also the need to produce drugs locally. But the journey toward manufacturing self-sufficiency by the pharmaceutical sector has been laced with hurdles and obstacles. But it is a necessary endpoint for the drug sector has the country is said to lose an estimated N1.5bn ($9.2m) annually to the importation of active pharmaceutical ingredients (APIs).
These high costs associated with procuring raw materials have deterred pharmaceutical investors from investing in local production capacity.