Find Health and Medical expertise in Nigeria

All three tiers of government – federal, state and local – have responsibility for providing health care. The federal government provides policy guidance, planning and technical assistance, managing state-level implementation of the National Health Policy and establishing health management information systems. It is also in charge of disease surveillance, drug regulation, vaccine management and the training of health professionals, as well as directly managing some medical centres, teaching hospitals, psychiatric facilities and orthopaedic hospitals.

Individual states operate general (secondary) hospitals, some tertiary hospitals and some primary health care facilities. The training of nurses, midwives and technicians is also managed by state authorities.

Government expenditure

Less than a third of health care in Nigeria (31%) was government funded in 2012. The remaining 69% was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 6.1% of GDP in 2012. Expenditure by government amounts to US$29 per capita. Public spending on health care in 2013 was 1% of GDP.

Primary health care continues to be the priority for health development in Nigeria. A 2013 study in the Journal of Public Health in Africa found that the most common barriers to people accessing primary health care were lack of essential drugs at clinics, the high cost of services and lack of facilities close enough to their homes for them to access without a long journey. Most were more likely to visit the nearest pharmacy instead. There are also major differences in the quality and provision of health care between the different states and between rural and urban areas.

The Nigerian National Health Insurance Scheme, financed by employer and employee contributions, is intended to ensure that every Nigerian has access to good health care services and to protect families from the financial hardship of a large medical bill. However, only about 3% of the population is covered by it (2012). The government is currently trying to broaden the scheme to ensure a far greater proportion of the population is covered. It is a stated aim of the Nigerian government to achieve universal health coverage.

The WHO Country Co-operation Strategic Agenda (2014–19) identified strengthening health systems based on a primary health care approach as one of its main priorities.

Communicable and non-communicable diseases

Communicable diseases along with maternal, perinatal and nutritional conditions accounted for an estimated 66 per cent of all mortality in Nigeria in 2012. The prevalence of HIV in Nigeria, as a percentage of people aged 15–49 years, was 3.2% in 2012. There was no notable overall change in HIV prevalence in the period 2000–09. However, the period 2010–12 saw a consistent and gradual decrease in the prevalence of the disease. In 2010 there were 551,187 reported cases of malaria. Confirmed cases of malaria rose in the period 2001–11, while numbers of deaths fell slightly before almost doubling in 2011–12. There was an overall increase in the estimated incidence of tuberculosis (TB) in the period 1990–2013 and a slight decrease in estimated mortality (when mortality data excludes cases comorbid with HIV) from the disease in the period 1990–2013.

There was a brief outbreak of Ebola in Nigeria in 2014, but the country won international praise when it quickly brought the disease under control by declaring a national public health emergency as soon as the first case was identified. Only eight people died before the country was declared Ebola free.

Non-communicable diseases (NCDs) accounted for an estimated 24% of all mortality in 2012. The most prevalent NCDs in Nigeria are cardiovascular diseases, which accounted for 7% of total deaths across all age groups in 2012. Cancer, diabetes and non-communicable variants of respiratory diseases contributed 3%, 2% and 1% to total mortality, respectively (2012). Injuries accounted for 10% of deaths in 2012.

The most commonly diagnosed mental illnesses in Nigeria are mood disorders.

In the most recent survey, conducted between 1997 and 2010, there were 40 doctors, and 161 nurses and midwives per 100,000 people. Additionally, in 2013, 38% of births were attended by qualified health staff and in 2013, 59% of one-year-olds were immunised with a dose of measles. In 2014, 68% of people were using an improved drinking water source and 29% had access to adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Nigeria has 11 pharmaceutical personnel per 100,000 people.

Millennium Development Goals

For Nigeria to achieve its Millennium Development Goal targets for the reduction of child mortality, it should have reduced under-five deaths per 1,000 live births to 71 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 117 deaths per 1,000 live births and measles immunisation at 59 per cent. Although substantial progress in terms of child mortality has been made since 1990, Nigeria is unlikely to meet this target when the 2015 data is analysed. The target for measles immunisation is also unlikely to be met.

The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by three-quarters between 1990 and 2015. In Nigeria, maternal mortality should fall to 275 cases per 100,000 live births. In 2013 Nigeria had an adjusted maternal mortality ratio of 550 deaths per 100,000 live births (this figure was estimated at 630 deaths per 100,000 by UN agencies/World Bank in 2010). This target is unlikely to be met. Part of the goal also stipulates that 100% of births must be attended by a skilled health professional, so this is very unlikely to have been achieved in the specified timescale.

MDG 6 aims for a reduction in the prevalence of HIV, malaria and other communicable diseases. Nigeria’s prevalence of HIV was 3.2% in 2014 (in the 15–49 age group). While this figure is still high, the period 2010–12 has seen a consistent and gradual decrease in the prevalence of the disease. The number of deaths from malaria in the country has seen an improvement since 2007. There has been an overall increase in estimated incidence of tuberculosis (TB) in the period 1990–2013 and a slight decrease in estimated mortality (when mortality data excludes cases comorbid with HIV) from the disease in the period 1990–2013. Consequently, Nigeria is unlikely to achieve MDG 6.

Nigeria was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1993 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.

In 2009, the Pharmaceutical Manufacturing Group of the Manufacturers’ Association of Nigeria (PMG-MAN) estimated the size of the total pharmaceuticals and healthcare products market to be in excess of US$2 billion annually. Most of the medicines produced in Nigeria are consumed domestically. Nigeria also provides 60% of the health products consumed in the Economic Community of West African States (ECOWAS) by volume (2010). According to the International Finance Corporation (IFC), in the course of the 2000s the pharmaceutical manufacturing sector in Nigeria enjoyed a steady annual growth of between 10% and 15%. The amount of counterfeit medicine in Nigeria was estimated at 17% in 2005 but this had significantly fallen by 2009. The central aim of the pharmaceutical sector in Nigeria remains the achievement of self-sufficiency in the provision of quality and affordable essential medicines to its population. The government has enacted a number of policies designed to promote local production, such as the import prohibition of 18 essential medicines. In an effort to eradicate the inflow of substandard and counterfeit products, pharmaceuticals can only be imported through the approved ports/channels.

There are more than 100 pharmaceutical manufacturers in Nigeria (2011). Some local drug manufacturers, such as Evans Medical Plc and Afrab-Chem Limited, are upgrading their facilities in conformity with WHO prequalification and WHO cGMP requirements. This is expected to enable them to boost the export of medicines produced in Nigeria to ECOWAS countries and beyond. The pharmaceutical industry in Nigeria is regulated by two agencies, both of which come under the supervision of the Federal Ministry of Health: the Pharmacists’ Council of Nigeria (PCN) and the National Agency for Food and Drug Administration and Control (NAFDAC). PMG-MAN is the umbrella organisation for drug manufacturers in the country. Pharmaceutical research in Nigeria is co-ordinated by the National Institute for Pharmaceutical Research and Development (NIPRD). One recent breakthrough is the development of a phytomedicine for the management of sickle cell anaemia. It was then licensed to an American company, Xechem Inc, which gave it a generic name of Nicosan.