AN APPRAISAL OF THE TRENDS AND PROSPECTS OF FINANCING HEALTH CARE DELIVERY IN NIGERIA
Abstract
Fifty years after independence, Nigeria is still struggling with the provision of basic health services for its teeming population,
now estimated at over 150million. The health care sector is still a labour-intensive handicraft industry, in spite of advances in
technology, and health care provision has now become more complicated than in the past. Infant and under-five mortality rates
are near the highest in the world, and maternal mortality is extremely high. It has the second largest number of people infected
with HIV/AIDS in the world only next to South Africa and in 2008, between 3million and 3.5million people were estimated to be
living with HIV/AIDS. Nigeria has the fourth highest number of TB cases in the world, with a 2004 estimate of 293 new cases
per 100,000 population and 546 per 100,000 total cases. The reasons for a dysfunctional health system include: gross in
adequate infrastructural support, electricity, potable water and diagnostic laboratories, very low per capita health spending,
high out-of-pocket expenditure by citizens, and a total absence of a community-based integrated system for disease
prevention, surveillance and treatment amongst others. Some strategies to tackle health sector challenges in Nigeria may
include improved access to primary healthcare; strategic and purposeful leadership in health delivery services; increasing
funding to the health sector; amongst others.
- Introduction
The health sector in any country has been recognized as the primary engine of growth and development. But despite the
laudable contributions of the health sector to economic development, the Nigerian health sector has witnessed various
turbulence that has negatively revised the progress recorded at various times.
Nearly 15 percent of Nigerian children do not survive to their fifth birthday. Two leading causes of child mortality
are malaria (30 percent) and diarrhea (20 percent). Malnutrition contributes to 52 percent of death of children under five.
A household survey conducted by the government in 2003-2004 showed that 54.4 percent of the population is poor, with
a higher poverty rate in rural area of 63.3 percent (HERFON, 2006). The incidence of poverty in Nigeria is widespread
and increasing with some of the worst poverty linked health indicators in Africa. There has been a sharp increase in
poverty from 1992 to 1996, with an estimated third of the population living below $1 per day and nearly two thirds below
$2 per day (FMoH, 2005).
Some of the factors that affect the overall performance of the health system include; inadequate health
facilities/structure, poor human resources and management, poor remuneration and motivation, lack of fair and
sustainable health care financing, unequal economic and political relations, the neo-liberal economic policies of the
Nigerian state, corruption, illiteracy, very low government spending on health, high out-of-pocket expenditure in health
and absence of integrated system for disease prevention, surveillance and treatment, inadequate mechanisms for
families to access health care, shortage of essential drugs and supplies and inadequate supervision of health care
providers are among some of the persistent problems of the health system in Nigeria.
1.1 Problem Statement
In spite of huge government spending, coupled with bilateral and multilateral assistance in the health sector, the patterns - of health status in Nigeria mirror many other Sub-Saharan African nations but are worse than would be expected given
- Nigeria’s GDP per capita. The health system is in shambles, policy somersault and reversals tends to have under-mined
- several reforms in the health sector over the years. Poor human resources and policy management have led to
- unprecedented brain drain in the health sector as health professionals in search for better conditions of service abroad
- often vote with their feet in droves (FMoH, 2005). (Federal Ministry of Health).
1.2 Objective of the Study
The provision of accessible and affordable health care services on a sustainable basis in any country, including Nigeria,
is an important obligation of government and the fundamental right of the citizens, through direct participation in health
delivery system and good legislature on health. The government of Nigeria, through the Federal Ministry of health, has
been undertaking this responsibility, but with abysmal result (FMoH, 2005). In economic parlance it is believed that health
and education are the two important prerequisites for human capital development, and have been demonstrated to be the
basis of individual’s economic productivity. Health is the basis for job productivity, the capacity to learn in school, and the
capability to grow intellectually, physically and emotionally. As with economic well being of individual households, good
health is a critical input into poverty reduction, economic growth and long-term economic development at the scale of
whole societies (Sachs et al, 2001).
The broad objective of the study is to assess the challenges of health sector as it is expected to provide an
important role in national economic development strategy. Specifically, the study will address the following major issues:-
(i) The problems confronting the health sector in Nigeria
(ii) The measures to reverse the trend through reforms
(iii) The impact of reform on the health sector and the challenges
(iv) Health care financing for economic development
(v) Make recommendation on the way forward.
1.3 Organization of the Study
There are seven sections in this study and there are subsections in some of the sections. Section one deals with the
general introduction to the topic of research. It is further grouped into subsections. 1.1 is the problem definition, 1.2
explores the objective of the study, and 1.3 contains the organization of the study. Section 2 –Chronicled challenges of
the health sector in Nigeria. Section 3 looks into health sector reform process in Nigeria. Section 4 examines to what
extent, the health sector reform in Nigeria has helped in addressing the health sector challenges –achievements and
gaps. Section 5 appraises the health care financing mechanism in Nigeria. Section 6 compares the status of the health
sector with other sectors and its performance so far. Section 7 points the way forward while session 8 provides the references employed in the study.
- The Challenges
The poor health status of a large percentage of people in sub-Sahara Africa is widely known for years. Over the past
decade, however, Africa’s health care crisis has received renewed attention because of the greater awareness of the
militating factors and a greater understanding of the link between health and economic development (Lowel et al (2010).
The major factors that affect the overall contribution of the health system to economic growth and development in Nigeria
include inter alia; lack of consumer awareness and participation, inadequate laboratory facilities, lack of basic
infrastructure and equipment, poor human resource management, poor remuneration and motivation, lack of fair and
sustainable health care financing, Unequal and unjust economic and political relations between Nigeria and advanced
countries, the neo-liberal economic policies of the Nigerian State, Pervasive Corruption, Very low government spending
on health, High out-of-pocket expenditure on health, Absence of integrated system for disease prevention, surveillance
and treatment.
(i) Lack of consumer awareness and participation: The majority of consumers are ignorant or unaware of
available services and their rights regarding health service delivery mainly because of the absence of a bill of
rights for consumers (claim holders) and providers (duty bearers). The role of the family in preventing and
managing illness is also underestimated or inadequately supported by government programmes. It is now well
known that interventions should be implemented through the health system as well as at the household level.
The capacity of families and communities should be developed to increase awareness for meaningful
participation in their health care and that of their children.
(ii) Inadequate laboratory facilities: In many states of Nigeria, most of the laboratories in the primary and
secondary health care centers require some infrastructural upgrading to provide a safe, secure and
appropriate working environment. Some basic health centre laboratories are better equipped than those in
comprehensive health centers and some secondary level hospitals, but equipment was often minimal. Most
laboratory staff in secondary facilities were qualified as medical laboratory scientist or technicians, whereas
most of those in primary health care facilities were qualified as science laboratory technicians. There is
minimal quality control of laboratory test in secondary facilities and none in primary facilities because they lack
appropriate professional supervision.
(iii) Lack of basic infrastructure and equipment: Basic life-saving commodities are in short supply in most low
income health systems. This is, in part, a result of resource shortages, but, there are still problems even when
substantial increase in funding are available, as in the case of Global Fund to fight AIDS, Tuberculosis and
Malaria. Building effective and accountable national procurement and drug management systems is an
increasing prominent component of the health system action agenda.
The provision of health services relies on the availability of regular supplies of drugs and equipment, as
well as appropriate infrastructure at the facility level. Facilities without safe water and electricity, with nonfunctioning equipments, and inadequate deliveries of drugs, diagnostic and other supplies are all too common
in many states of the country. The Nigerian health system is characterized by inadequate and poorly
maintained health facilities, particularly at the PHC level. Poor state of infrastructure such as buildings,
equipments, materials, and supplies and inequitable distribution of available facilities is the norm in many
places. In some communities, people have to travel over 5 km to access health care because sitting of
structures is often based on political expediency rather than perceived need.
The drug system is plagued with ‘out-of-stock syndrome’. Fake, substandard, adulterated, and
unaffordable drugs are prevalent across the country. Erratic supplies, non-availability of some basis essential
and specialized drugs and other health supplies as a result of dependence on imported drugs are common. In
addition to this, the drug distribution system is chaotic because of adherence to pharmaceutical regulations
that need to be updated. Although very vital to provision of quality service, provision of drugs and vaccines
alone cannot build systems nor ensure quality of care, but without the appropriate facilities and materials to do
their job, health workers cannot function. Therefore, whenever health systems cannot deliver, people turn
elsewhere. This has contributed greatly to poor client satisfaction, which makes clients to turn to private sector
and unqualified health workers. This poor drug supply system has also led to drug resistance, the resistance
to anti-malaria drugs by the disease pathogens is clear example, (HERFON, 2006, FMoH, 2004, Travis et al,
2004).
(iv) Poor human resources and management: Although human resources are no panacea for the poor health
situation in any country, no health intervention can be successful without an effective workforce. Every country
should, therefore, have a national workforce plan to build sustainable health systems to address national
health needs. These plans should aim to provide access to every family to a motivated, skilled, and supported
health worker. To optimize health system performance, workers should be recruited from, accountable to, and
supported for work in their community where feasible. The 2003 and 2004 World Health Reports proposed
improving rewards to health workers to improve productivity, along with deploying community health workers
and engaging community in their health care. The 2004 report advocated using such approaches as
contracting local government financing, empowering community, using vouchers, etc., to subsidize key health
services for the poor.
