As organizations look to enter Nigeria’s healthcare and pharmaceutical sector, understanding the major challenges in the healthcare industry takes precedence. In an effort to provide some context for these challenges, gaining an understanding of how the Nigerian healthcare industry is set up, as well as how it currently functions, is a necessity.
The healthcare system in Nigeria is mainly driven by the public sector. Currently, 66 percent of the country’s 34,000 health facilities are owned by three tiers of government: federal, state, and local. Meanwhile, the private sectors still contribute substantially to the provision of health services. It is also important to note that secondary and tertiary healthcare facilities are mainly located in urban areas, while primary health facilities are prevalent in Nigeria’s rural areas.
This article is pertinent because of the major challenges in the healthcare sector in Nigeria, which are exacerbated by the current sector’s landscape.
Patients Are Uninformed
One of the major challenges in the healthcare sector in Nigeria is that people are not aware of the current health issues they have. Since most Nigerians rely heavily on medical opinions from unqualified individuals, such as authoritative family members, patients do not feel empowered to learn more about their health and they are not actively engaged in the decision-making process of improving their well-being.
Furthermore, due to the lack of clarity around what illnesses are plaguing citizens, many patients can be misdiagnosed especially when receiving care at facilities with inadequately trained staff. Because there is little investment in the workforce, misdiagnoses are so common, therefore, many Nigerians do not seek the medical expertise of a doctor until their condition significantly worsens.
Lack of Funding to Build and Maintain Infrastructure
Although Nigerian healthcare workers are highly-knowledgeable especially at tertiary care facilities, they, however, do not have adequate resources to keep up with the continuous development occurring in the global healthcare sector. This fact remains true despite the resources being dedicated to research and development within the global health arena – with a projected 9% of GDP globally allocated to health spending by 2040.
In general, healthcare is usually financed through public expenditure, private expenditure, or external aid. Public expenditure includes government expenditure spent by state-owned enterprises; private expenditure includes payments by individuals and employers; while external aid refers to the capital, which comes through bilateral aid programs or international, non-governmental organizations.
One of the major challenges in the healthcare industry in Nigeria is the inadequate allocation of financial resources to improve and maintain the general public’s health.
Currently, the existing health care resource allocation is skewed, with a high proportion going towards secondary and tertiary care facilities. This means that people tend to bypass the primary health care facilities in search of better care in the secondary and tertiary facilities.
This results to inefficiencies (because these centers are overburdened with medical issues that can be addressed at the primary level) and inequities (because care is more expensive at the secondary and or tertiary care center and average individual cannot usually afford this care.
The inadequate allocation of financial resources can be further illustrated when examining Nigeria’s domestic government health expenditure per capita in comparison to other countries.
Below is a 5-chart series showing how Nigeria lags behind the world average and other comparable countries in Africa in regards to healthcare financing.
Without the proper financing, gains in development in the Nigerian healthcare sector will continue to be stifled. With that said, the amount of money Nigeria should invest on healthcare depends on several factors, such as the health challenges the country’s population is currently facing, different health inputs (e.g., public health staff, existing technology, etc.), and the level of investment to maintain or improve the country’s health status.
The aforementioned factors must be taken into consideration alongside social challenges that demand the same resources. Without the proposed assessment of the countries health care needs, as well as the proper investment in health care, this sector will continue to suffer.
The sector’s growing challenges will lead to the unfortunate practice of medical tourism, where the more privileged Nigerians participate in the $1 billion industry by seeking better medical care outside of the country. Since the majority of Nigeria’s population is unable to participate in this practice, as a society, we have a moral obligation to take care of the population, because your place of birth should not determine your prognosis.
Healthcare is Too Expensive for Most Nigerians
Both the federal and state governments have to invest more in basic health care by expanding the national insurance scheme to reduce the cost of healthcare services. Currently, funding for the national insurance scheme is done through the taxing of federal employees and employers whose money is then used as a social health security system to cover the needs of the population.
As of today, 72 percent of total health expenditures in Nigeria are out-of-pocket expenditure. In fact, out-of-pocket payments for healthcare services account for a significant percentage of household expenditures in Nigeria. Nigeria is amongst the countries that rank high for out-of-pocket expenditure.
The Nigerian national insurance scheme only covers employees working in the federal government, which is roughly 3 percent of the population. Furthermore, only about 5 percent of the population have “prepaid” health care through government-provided health insurance or a voluntary private insurance plan.
If Nigeria chooses to strive for universal health care coverage, we should look at the countries in Latin America and the Caribbeans that have successfully implemented some sort of government-led financial reform, providing wider healthcare access to its citizens and reducing the financial burden each citizen has to pay for each medical procedure.
Lack of Properly Trained and Compensated Staff
Another major challenge in the healthcare sector is that there are not enough properly trained staff to meet demand. The few well-trained doctors are overburdened and most of the medical staff are not compensated well. These factors make staying and working in the healthcare system a less desirable option.
In fact, adequate compensation is lacking so much in this sector that the Joint Health Sector Union (JOHESU), an association of all health workers apart from medical doctors and dentists, called a nationwide strike to get the government to heed to some of its major demands.
These demands included salary adjustments, promotion arrears, and improved work environment for members. Unfortunately, these strikes have left a lot of Nigerians that rely on the public healthcare system without healthcare assistance during the duration of the strike.
Making healthcare a national priority
According to World Health Organizations’ health system performance ranking for 191 countries, Nigeria is currently ranked 187th. This ranking is used to determine the performance of countries in terms of meeting one important goal – that of maximizing population health.
To maximize the population health in Nigeria, the major challenges in the healthcare sector have to be overcome by increasing the national budget allocation (% per GDP) for healthcare to match the global standard, expanding the national healthcare scheme to reduce out-of-pocket spending, investing in training of more medical staff to alleviate current facility burdens, prioritizing continuous medical education for healthcare staff to improve their knowledge base, improving awareness campaigns regarding healthcare advice for the population. These are all factors that are affected by the limited resources that are allocated to the healthcare sector in Nigeria.
Being only four spots away from the bottom, it is obvious that healthcare is not a national priority in Nigeria. However, it has to be a priority for everyone – the government, the private sector, and the people, for Nigeria to improve the health care and standard of living of its citizens.