Expanding the network: A number of new initiatives are under way to improve services

With a population of around 168.8m, and low levels of government spending on health care across the board, the provision of health services in Nigeria is defined by a series of challenges and constraints. The public network of health-related facilities, which includes clinics and hospitals at the community, state and federal levels, has been underfunded for decades. Consequently, a substantial percentage of Nigeria’s heath infrastructure is currently in a state of disrepair. “The public health care system is completely overburdened,” Dr Tolu Arowolo, a public health physician, told OBG.

IMPROVEMENT STRATEGIES: With this situation in mind, improving the country’s existing health facilities and building new clinics and hospitals has been a key area of focus among both government authorities and private sector players in recent years. Indeed, upgrading the health infrastructure is a key component of the National Health Bill (NHB), a potentially transformative piece of legislation that has been in discussion in the National Assembly for more than five years, and is expected to come into effect in the near future.

Other government initiatives in development or in the early stages of implementation are expected to result in an overhaul of the pharmaceuticals distribtion system and, more broadly, improvements to Nigeria’s power and transport infrastructure, the latter of which are expected to have a positive impact on health care provision throughout the country. Similarly, improving private sector health infrastructure is the goal of the five-year African Health Markets for Equity (AHME) programme, which was launched in 2012 by the US-based Bill and Melinda Gates Foundation, the UK’s Department for International Development (DFID) and the International Finance Corporation (IFC), the World Bank’s private sector development arm..

THE PUBLIC SYSTEM: The public health care system in Nigeria is organised into three tiers. At the national level, the Federal Ministry of Health (FMH) oversees health policies and overarching development plans and provides funding for all public health facilities. At the state level, secondary and tertiary care is provided at hospitals operated by 37 state health ministries – one in each of the country’s 36 states, plus one in Abuja, the federal capital territory. The state health ministries, which are funded by the FMH, oversee the national health workforce and are responsible for training new doctors, nurses and other staff members.

While the public health care system is theoretically meant to serve the entire population, most local players – private and public alike – agree that in its current state it is unable to do so. In a mid-August 2012 speech delivered at the announcement of a new programme to expand private sector services, Onyebuchi Chukwu, the minister of health, said, “In the circumstances, it’s quite obvious that the government alone cannot provide all the health facilities needed to provide adequate health care services to the teeming population.”

INEQUALITIES: While the public health system as a whole is in a state of disarray, some areas have fared worse than others. “Over the past 30 years public medical facilities have crumbled as a result of a lack of funding and the total lack of maintenance culture in Nigeria,” said Arowolo. “In rural areas, in particular, some public clinics are literally falling apart.” In general, urban health centres – and particularly those located in Lagos and Abuja – are in better shape than rural facilities, many of which are simply unreachable due to the poorly maintained national transport network.

In addition to working to expand private sector involvement in the industry, in recent years the government has introduced a number of new initiatives with the goal of improving the country’s public health care infrastructure. Under the NHB, for example, the state plans to establish a new federal development fund for health care, a substantial percentage of which is expected to be put toward maintenance costs for existing facilities and the construction of new hospitals and clinics. As of August 2013, the NHB had still not been passed after President Goodluck Jonathan refused to sign it into law in 2012, citing internal disputes.