Healthcare outcomes have gradually improved over the past few decades, but an underfunded sector still struggles to provide a booming population with adequate access to care.
Nigeria has seen gradual progress in its healthcare outcomes over the past few decades, but the lack of widespread access to quality care is still one of the largest obstacles Africa’s largest country faces as it tries to achieve sustainable development. Healthcare professional densities are low and concentrated in urban areas, limiting access to care in rural regions. Nigeria has both a public and a private healthcare sector, but both have been plagued by a lack of adequate resources and poor management and communication that has eroded public trust. As a result, many Nigerians who are able travel outside the country to receive healthcare services, further preventing the sector’s ability to fund treatments. One of the primary challenges facing the sector is the lack of confidence in its services, and one of the first steps to any reform will be increasing public faith in the system.
Nigeria’s hopes for the future lie in its demographic profile, but the population boom that has made it the most populous country on the African continent has also stressed its healthcare system and kept it below regional and global averages in key healthcare metrics. Its average life expectancy of 53 years in 2016 was well below the average of 60 for Sub-Saharan African states, and while its infant mortality rate has fallen in recent years, at 69 deaths per 1,000 live births, it is still the 10th highest in the world. Nigeria faces challenges on all fronts; it faces what healthcare professionals refer to as the “double burden” of continued high rates of communicable diseases such as malaria and HIV while at the same time seeing rising rates of non-communicable lifestyle-related diseases like diabetes, heart disease, chronic respiratory diseases, and cancer. This pernicious combination has placed tremendous stress on a healthcare system already struggling to deal with a booming population. In 2010, Nigeria set a series of millennium development goals (MDGs) in conjunction with the United Nation’s Every Woman Every Child initiative, aiming to meet a set of mortality-related improvements by 2015. These goals include increasing access to contraceptives, raising the government’s annual commitment to reproductive healthcare spending, and improving communication between federal and state healthcare agencies to increase efficiency and quality of care. If achieved, these goals were estimated to save 1 million lives by 2015. When 2015 came around, however, Nigeria had made little progress toward these MDGs, with most of the blame falling on the primary healthcare system. Nigeria’s healthcare system has federal, state, and local tiers, all of which operate with a degree of autonomy. The Federal Ministry of Health is the highest-level federal agency and has primary control over the system. It oversees the National Primary Health Care Development Agency (NPHCDA), established in 1992 as Nigeria’s state-funded healthcare provider. The National Health Insurance Scheme (NHIS), founded in 1999, is the state-run insurance provider and offers a number of specialized benefit packages for public sector employees, children, and pregnant women, among others. These programs have gradually added capacity over the years, yet access to healthcare is still unavailable for many Nigerians in part due to underfunding. Nigeria’s healthcare expenditures as a share of GDP are among the lowest in the world, with spending equal to just 3.7% of total GDP in 2014. The 2017 Nigerian budget called for 4.17% of government spending to go the healthcare sector, or about NGN1,688 per capita. This is well below the level called for in the MDGs and below a previous commitment to raise healthcare spending to 15% of the annual budget. The WHO has estimated that only 25% of the needed healthcare funding is being spent, making the simple lack of funds one of the most important issues facing the country. The nation’s fiscal position has become more difficult in recent years with the loss of oil revenues, but the importance of the continued development of the healthcare sector for the future of the nation cannot be overstated.