By TBY | Nigeria | Mar 28, 2017
Though progress has been made, certain core challenges remain in Nigeria's health sector. Comprehensive public-private initiatives are the key to tackling things like poor distribution, questionable practices, and low insurance penetration.
As public institutions and private groups leverage synergies, cooperation promises to define health in Nigeria for years to come. These partnerships, along with the continued work of various community stakeholders and international aid organizations, will propel Nigeria ever closer to attaining its Millennium Development Goals.
According to the World Health Organization (WHO), women have a slightly longer life expectancy than men—56 years compared to 53—and men have a greater likelihood of dying between the ages of 15 and 60 than do women—357 per 1,000 compared to 325 per 1,000. Total expenditure on healthcare per capita is USD217 and total expenditure on health as a percentage of GDP is 3.7%. According to recent announcements from the National Health Insurance Scheme, only 4% of Nigerians have coverage. Since health insurance is not mandatory, many Nigerians opt to forgo the added expense, and experts in the medical and insurance industries feel that compulsory insurance could help stimulate development and growth in the healthcare sector, while simultaneously improving health across the country.
Historically, healthcare delivery in Nigeria has been split into three levels: primary care is overseen by local government, secondary care is the purview of state governments, and tertiary care is provided by the federal government. According to the WHO Country Cooperation Strategy for 2014-2019, there are 21,808 public and 8,290 private primary care facilities; 969 public and 3,023 secondary care facilities and 73 public and 10 private care tertiary facilities in Nigeria. The federal government is also tasked with national policy development and regulation. Various pressures have hampered the efficient distribution of care, and access to healthcare professionals and services can be problematic; the densities of doctors, nurses, and midwives is quite poor, totaling 1.95 per 1,000 people for all three. Though this ratio is still lower than the 2.28 per 1,000 the WHO established in 2006, it represents a strong improvement from the 0.336 per 1,000 the WHO found in 2013. Additionally, healthcare services are concentrated in the southern part of the country, especially Lagos and other similar urban environments, according to the WHO. Poor distribution of care has been a major issue for Nigeria, and citizens in northern states have often suffered from a serious lack of access to treatment.
Among non-communicable diseases, hypertension, heart disease, strokes, and diabetes are the most prevalent, and experts estimate that in the last decade the annual economic loss resulting from these diseases was USD800 million. Attacks by Boko Haram have led to the displacement of millions of people in the country’s northeast Borno State, and the WHO estimates that more than 3.7 million people are in need of urgent health assistance. A large scale healthcare mobilization on the part of the WHO, the government and other international and local aid agencies has made headway, and the WHO has 160 Early Warning, Alert and Response System reporting sites in the state and estimates that more than 1.8 million children have been vaccinated against polio.
The news is by no means all bad, and Nigeria has made gains in certain core areas. Over the last decade infant mortality rates dropped nearly 4.5% every year, and maternal mortality ratios have been declining across the country, dropping from nearly 545 deaths per 100,000 live births to 224 deaths per 100,000 live births, according to the most recently available statistics from Nigeria’s National Reproductive Health Survey. Gains in fighting communicable diseases have also been made. Progress has been made in reducing the instance of measles, wild polio, HIV/AIDS, and tuberculosis, and plans are being developed for more effectively fighting other neglected tropical diseases (NTDs), according to the WHO.
Perhaps the most important recent trend in the Nigerian health landscape has been the shift toward privatized care. In an effort to draw more people into the health system, provide higher-quality care, and keep Nigerians from going abroad to receive medical care the Nigerian Sovereign Investment Authority (NSIA) has announced Memoranda of Cooperation (MoC) with seven federal healthcare facilities. These agreements allow a group of private firms to develop and operate diagnostic firms and specialized hospitals across the country, and the NSIA hopes they will bring new standards of medical service and technical proficiency to Nigerian medicine.
With a limited and overburdened public healthcare sector, opportunities abound for private firms. According to the Nigerian Medical Association, there are only 600 pediatricians providing care for the country’s 70 million children and only 50 neurologists, 40 neurosurgeons, and 25 consultant oncologists for the entire country. Additionally, the association estimates that Nigerians spend between USD500 million and USD1 billion a year on medical services outside the country, and the most commonly sought types of care are oncology, orthopedic surgeries, and cardiology. By bringing in qualified doctors and providing top tier medical care, private firms hope to keep Nigerians in Nigeria.
In an interview with TBY, Dr. Olasimbo Davidson, VP of Clinical Administration & Operations at the Olive Multi-Specialist Hospitals, discussed the hospitals’ strategies for growth. “We realized that we had to bring specialists into the country to address the alarming brain-drain that this country has experienced over the last decade,” said Davidson. “We have to attract talented physicians and surgeons to Nigeria; hence, our first partnership was with Platinum Hospital in India, and they will be flying up to 10 surgeons here on two-year contracts.” Private hospitals across Nigeria recognize the value of partnerships with international healthcare firms and hospitals, and they are striving to sign agreements and develop close relationships. The Olive Multi-Specialist Hospitals are also leading the way in terms of integrating the latest telemedicine technologies into their service systems, and the government is taking notice. “In terms of response from the public sector, state governments are waking up to what is going on and what needs to be done,” said Davidson. “They are interested in what we are doing and what they can learn from us to create integrated healthcare delivery systems.
As Nigeria continues to develop, its health systems will be a core area of focus. By emphasizing and supporting public-private partnerships that more efficiently and effectively distribute care across Nigeria, officials, firms, and stakeholders can ensure that more Nigerians than ever before are living healthier, more prosperous lives. With low oil prices and depressed government revenues, private sector investment is likely to drive growth in coming years, bringing healthcare to traditionally underserved segments of Nigerian society while simultaneously setting new standards for care and expertise.