Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy, private providers of health care have a visible role to play in health care delivery. The federal government’s role is mostly limited to coordinating the affairs of the university teaching hospitals, Federal Medical Centers (tertiary health care); while the state government manages the various general hospitals (secondary health care); and the local government focus on dispensaries (primary health care) which are regulated by the federal government through NPHCDA.
The total expenditure on health care as a percentage of GDP is 4.6%, while the percentage of federal government expenditure on health care is about 1.5%. A long run indicator of the ability of the country to provide food sustenance and avoid malnutrition is the rate of growth of per capita food production. From 1970–1990, the rate for Nigeria was 0.25%. Though small, the positive rate of per capita may be due to Nigeria's importation of food products.
Health Insurance
Historically, health insurance in Nigeria can be applied to a few instances: free health care provided and financed for all citizens; health care provided by government through a special health insurance scheme for government employees; and private firms entering contracts with private health care providers. However, there are few people who fall within the three instances.
In May 1999, the government created the National Health Insurance Scheme. The scheme encompasses government employees, the organized private sector and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of Obasanjo further gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.
Mental health
The majority of mental health services are provided by 8 regional psychiatric centers and psychiatric departments and medical schools of 12 major universities. A few General Hospitals also provide mental health services. The formal centers often face competition from native herbalists and faith healing centers.
The ratio of psychologists and social workers is 0.02 to 100,000.
Issues
Regulation of pharmaceuticals
In 1989 legislation made effective a list of essential drugs. The regulation was also meant to limit the manufacture and import of fake or sub-standard drugs and to curtail false advertising. However, the section on essential drugs was later amended.
Drug quality is primarily controlled by the National Agency for Food and Drug Administration and Control (NAFDAC).
Spatial inequality
Health care in Nigeria is influenced by different local and regional factors that impact the quality or quantity present in one location. Due to the aforementioned, the health care system in Nigeria has shown spatial variation in terms of availability and quality of facilities in relation to need. However, this is largely as a result of the level of state and local government involvement and investment in health care programs and education. Also, the Nigerian Ministry of Health usually spends about 70% of its budget in urban areas where 30% of the population resides. It is assumed by some scholars that the health care service is inversely related to the need of patients.
Emigration
Retaining health care professionals is an important objective
Migration of health care personnel to other countries is a taxing and relevant issue in the health care system of the country. From a supply push factor, a resulting rise in exodus of health care nurses may be due to dramatic factors that make the work unbearable; knowing and implementing changes to arrest the factors may stem a tide. However, because a large number of nurses and doctors migrating abroad benefited from government funds for education, it poses a challenge to the patriotic identity of citizens and also the rate of return of federal funding of health care education. The state of health care in Nigeria has been worsened by a physician shortage as a consequence of severe 'brain drain'. Many Nigerian doctors have emigrated to North America and Europe. In 2005, 2,392 Nigeria doctors were practicing in the US alone; in UK the number was 1529. Retaining these expensively-trained professionals has been identified as an urgent goal.
Commercialisation of Public Health Service delivery
Empirical evidences reveal the negative impact of commercialisation of public health service delivery on attainment of the MDGs in Nigeria.
Criticism
The World Health Organization's definition of health is not merely the absence of disease but the attainment of a state of physical, mental, emotional and social well-being.
· In 1993, adulterated paracetamol syrup entered into the health care system in Oyo and Benue States. The end result was the death of 100 children. A year after the disaster, batches of fake ethylene glycol, the major cause of the death, could still be purchased.
· In 1996, about 11 children died of contamination from an experimental trial drug: trovafloxacin. Nevertheless, the government delayed the prosecution of the perpetrators—another tragedy.
· The life expectancy of the country is low and about 20% of children die before the age of 5.
· The 2000 WHO report on the performance of health care systems rank the country 187 out of 191.
· Traffic congestion in Lagos, environmental pollution, and noise pollution are major issues that the government is faced with.
· In 1985, an incident of yellow fever devastated a town in Nigeria, leading to the death of 1000 people. In a span of 5 years, the epidemic grew, with a resulting rise in mortality. The vaccine for yellow fever has been in existence since the 1930s.
· In 2008-2009, at least 84 children died from a brand of contaminated infant teething medication.
Maternal and Child Healthcare
In June 2011, the United Nations Population Fund released a report titled The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Nigeria is 840. This is compared with 608.3 in 2008 and 473.4 in 1990. The less than 5 mortality rate, per 1,000 births is 143 and the neonatal mortality as a percentage of under 5's mortality is 28. The aim of this article/report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4: Reduce child mortality and Goal 5: improve maternal death. In Nigeria the number of midwives per 1,000 live births is unavailable and 1 in 23 shows us the lifetime risk of death for pregnant women.
Reviewed by ERU KOBE GODWIN
http://www.connectnigeria.com/articles/health-care-in-nigeria/557
