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Health sector overview

Structure

The Nigerian healthcare system is organised into primary, secondary and tertiary healthcare levels. The Local Government Areas (LGAs) are responsible for primary healthcare, the State Governments are responsible for providing secondary care while the Federal Government is responsible for policy development,regulation, overall stewardship and providing tertiary care. The LGA level is the least funded

and organised level of government and therefore has not been able to properly finance and organise primary healthcare, creating a very weak base for the healthcare system.

Burden of disease

 Nigeria is one of the developing countries faced with the “double burden” of persisting high prevalence of communicable diseases and rising prevalence of non-communicable diseases. Key health indicators such as maternal and infant mortality are worse than the Sub-Saharan African average and Nigeria is not on track to achieving most of the health-related MDGs by 2015. Malaria is Nigeria’s most important public health challenge and is responsible for 60% of outpatient visits to health facilities in Nigeria, 30% of childhood deaths and 11% of maternal deaths. Over 90% of Nigerians are at risk of malaria with over 100 million cases per year and about 300,000 deaths6 . The Federal Ministry of Health estimates a financial loss of approximately USD8.4 million per year.

Service provision

 Nigeria has five hospital beds per 10,000 population7 . The federal ministry of health’s (FMOH) health facilities (HFs) census of 2005 showed that Nigeria had a total of 23,640 public and private hospitals. A census of private health facilities conducted by USAID in six states (Abia, Benue, Edo, Kaduna, Lagos, and Nasarawa) in April 2014 revealed that approximately 32% of the private health facilities found by surveyors were not included in official government lists, while approximately 53% of the private health facilities included on official government lists could not be found by surveyors. This suggests that lists from government agencies are incomplete and largely inaccurate. The 2008 Demographic and health survey showed that the private sector provides over 65% of healthcare services. This is even more for the poorest quintile at 72%. Among the private sector providers, pharmacies and patent medicine vendors (PMVs) play a critical role. Pharmacies and PMVs provided 39% of the services to children with fever in 2008, compared to public clinics 37%, private clinics 13%, and shops 7%

Health expenditure

Total healthcare expenditure continues to rise in Nigeria and BMI estimated total healthcare expenditure (THE) at USD18.3 billion in 2014. Household out-of-pocket expenditure (OOP) has remained the major source, constituting about 70.3% of THE in 20098 . Government expenditure on health as a percentage of GDP is below the average for Sub-Saharan Africa. Lessthan 5% of Nigerians were covered by any form of health insurance at the end of 2013. (Source: /www.rvo.nl/sites) 

National Health Insurance.

The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost3. The NHIS provides health insurance coverage for employees of the federal government. HMOs act as purchasers under the NHIS and pay providers by a mix of capitation and fee-for-service; there is also a 10% coinsurance. According to report, registration of dependents (Children and Parents) typically cost around N9,000 per head. For private health care service, individual plans start from N35,000 to N220,000 and family plans range from N125,000 to N650,000.