Nigerian Healthcare Services

8/12/2019 Nigerian Healthcare Services

1/15

NIGFIXI

PRI A BGL

6th M

ERIANNG T

ATE Research

rch 2012

HEALE HE

ECTO

& Intellig

THCALTHC

R PARnce Repo

E SERE C

ICIP

rt fo r a H

VICEALLE

TION

ealth Ca r

: GES

Mandate

HRO

GH


2/15

NIGERI

PRIVA

Accordi

2009,

averag

surge i

decadebillion

includi

deman

50% of

from it

about

human

Globall

Ministr

care pa

provid

and inc

The pri

In a re

player.

50% of

of the

increas

funnel

N HEALT

E SECTOR

ng to a st

nly a few

of US$35

n foreign

. The study N3.7 trillio

g hospital

s of SubS

SubSahar

s largely p

1% of the

and financ

, almost 5

y of Financ

ckage is ab

s a huge o

rease finan

vate sector

gion wher

About 50

total healt

egions po

ed attentio

billions of

HCARE SE

ARTICIPA

dy conduc

ountries i

US$50 (N5

assistance

estimated n N4.5 tr

, clinics, a

haran Afri

n Africas

or people

orlds po

ial costs d

% of the d

e reported

out N3,84

portunity

cing and th

already d

public re

o health

expendit

or people,

n from ext

ollars to h

VICES: FI

ION

ted by the

SubSaha

,250 N7,

from seve

that over tillion) in n

nd distribu

ca. The Wo

otal health

. It is ther

ulation acc

spite com

eaths of ch

that the re

.00 (US$2

to leverage

e quality o

minates th

ources are

are financi

re goes to

both urba

ernal dono

elp combat

ING THE

IFC with

an Africa

00) per ye

ral multila

e next dew investm

tion ware

rld Health

expenditu

fore unde

ounts for a

anding le

ildren und

sources av

.65) per c

the privat

healthcar

e healthca

limited, t

ng in Afric

private he

and rural,

rs has res

the worst

HEALTHC

ssistance f

re able to

ar per per

teral agen

ade (2010 ent will be

ouses, to

rganisatio

re is financ

rstandable

bout 24%

ss than 1%

r five take

ailable for

pita. Low

e sector in

goods and

re sector in

e private

comes fr

lthcare pr

rely on pr

lted in so

health sco

Rese

ww

RE CHALL

rom McKin

expend th

on on heal

ies and d

2020), USneeded in

eet the

n (WHO) e

d by out

that SubS

f the globa

of global

place in Af

elivering t

ublic spen

ways that

services th

Africa

ector is al

m private

viders sinc

ivate healt

e remark

rges of th

rch and Int

w.bglgrou

ENGES T

sey & Co

WHOdet

lthcare des

onors duri

$25 billion healthcar

rowing he

timates th

f pocket p

aharan Afr

l disease b

ealth expe

rica. In Nig

he essenti

ding on he

ill improv

roughout

ready a si

sources, an

e the vast

h care. In

ble initiati

region, H

lligence

ng.com

ROUGH

pany in

rmined

pite the

ng that

US$30 assets,

althcare

t about

yments

ica with

rden in

nditure.

ria, the

l health

althcare

access

frica.

nificant

d about

ajority

ddition,

es that

IV/AIDS,


3/15

tuberc

facilitie

The re

worlds

perfor

further

to affo

HealtIndicatGovt. EPrivateNo. of No. of No. of No. of

Source:

The Ni

Infrastr

sector

system

centres

expend

capital

Key HeLife ExMaterBirth AUnder PrevalMalari

Source:

losis (TB),

s necessar

ion also fa

health wo

ance in Su

in the regi

dable heal

Expenditurors xpenditure Expenditur

Physician (PNurses & MiDentist (Per Pharmacist (

HO Health S

erian heal

ucture dec

characteris

have suffe

is estima

iture. How

expenditur

alth Statistiectancy at al Mortality

ttended by 5 Mortality nce of HIV i Mortality HO Health S

and mala

to provide

ces a seve

rkers depl

bSaharan

on. Hence

hcare servi

e and Reso

n Health ( on Health r 10,000 Pe

dwives (Per 10,000 peoper 10,000 tatistics 2011

hcare sect

ay, brain

e healthca

red. In 201

ted at N2

ever, only

e in spite o

cs

irth (Yrs) Rate (Per killed Persoate (per 10

n Adult (15ate (Per 10tatistics 2011

ia. Howev

and delive

re shortag

yed in Sub

Africa mea

here is a

ces in Afric

rce Adequa

of total) % of total) ople) 10,000 peole) eople)

or shares t

rain, ince

e services

1, national

04 billion;

N20.25 bil

insufficien

0,000 Birth)nnel (% of B00 Birth) 9yrs) ,000 Birth)

er, most o

r minimal l

of traine

Saharan

ns that de

ajor role f

a.

cy Nig

36634.

le) 160.1.

e same at

sant work

in Nigeria

spending

approxim

lion (10%

t medical

irth)

f the area

vels of he

medical p

frica. Furt

and for h

r the priv

ria A

Av.7 .3 0 .1 3 3

tributes wi

rs strikes

Collective

n teaching

tely 79%

of total ho

quipment.

Nigeri54

84039

1383.6146

Rese

ww

lacks the

lth service

ersonnel,

ermore, i

althcare is

te sector i

frica erage

I

9.8 0.2

2.3 0.9

0.3 0.8

h its Afric

and low i

ly, all tiers

hospitals a

of the go

spital expe

a A

Av

rch and Int

w.bglgrou

infrastruct

s and prod

ith just 3

proving e

poised to i

n enhancin

Low to Midcome Coun

Average45.4 54.6 10.1 16.8 0.9 3.5

n peers

nvestment

of the he

nd federal

vernment

nse) is all

rica rage

54 20

48 33 .7

94

lligence

ng.com

ure and

cts.

of the

onomic

ncrease

g access

dle tries

in the

althcare

medical

health

tted to


4/15

The str

Public

and te

health

health

change

and di

general

teachin

Inadeq

hospit

The tar

The ab

workerwho c

hospita

operati

medica

providi

Nigeria

Accordi

worst i

progre

indicat

bench

that a

govern

cture of N

ealth care

tiary facilit

facilities in

care faciliti

d significa

pensaries

hospitals

g hospitals.

uate infras

ls

get areas

sence of p

s have resun afford t

ls, physical

onal as a r

l professio

g consulta

n Health i

ng to the F

the worl

s towards

rs in Nige

arks due t

purposeful

ent, thus,

igerias pu

delivery s

ies. In 200

Nigeria o

es. 38% of

tly since t

spread th

nd matern

tructure a

or mass p

oper facili

lted in the em side

facilities

sult of po

nals are

ncy service

dicators a

ederal Min

. Nigeria s

achieving

ria have la

weaknes

reform o

initiated a

lic healthc

stem in N

5, the Fed

which 85.

these facil

en. Prima

oughout t

ity centres

d poor st

ocuremen

ies and in

coexistency side wit

re often d

er challen

ften foun

s in private

e very poo

istry of He

oulders 1

the 2015

rgely rema

es inheren

the Nati

process th

are syste

igeria cons

ral Minist

5% are pri

ities are o

y care wa

he countr

while terti

aff morale

of medic

dequate r

e of privath the pub

ecaying, a

es. The iro

d in publi

ly funded f

lth, the he

% of the g

targets fo

ined belo

t in the sys

nal health

at led to t

is multi la

ists of a n

y of Healt

mary, 14%

ned by th

largely p

. Seconda

ry care is h

lead to p

l equipme

munerati

lyowned lic healthc

d equipm

ny howeve

c employ

rms or in t

alth indica

lobal disea

the MDG

country t

tem. Henc

care deliv

e develop

Rese

ww

ered

twork of p

estimate

secondary

e private s

ovided thr

ry care is

andled thr

or service

t are the

n of publi

ospitals wre centres

nt is eithe

r, is that th

ent but

eir own p

ors for Nig

se burden

s on heal

rgets and

the gover

ry system

ent of th

rch and Int

w.bglgrou

rimary, se

a total o

and 0.2%

ector. This

ough healt

provided

ough the u

delivery i

teaching h

sector he

hich cater . In public

r obsolete

e few highl

re almost

rsonal clini

eria are a

and is mak

hcare. Th

internatio

ment is c

is necess

National

lligence

ng.com

ondary,

23,640

tertiary

has not

h clinics

through

iversity

public

ospitals.

althcare

o those funded

or non

y skilled

always

cs.

ong the

ng slow

health

allyset

nvinced

ry. The

trategic


5/15

Health

manne

But t

The NS

improv

(US$26

period.

develo

Organi

More i

Nation

a majo

be kno

finance

value;

additio

Over t

require

the tot

budget

Bill up

govern

guaran

expend

already

bad sta

Developme

in 2010.

e Nationa

HDP 2010

e the heal

.6 billion)

Funding

ment part

ations (NG

mportantly

l Health Bi

paradigm

wn as the

d from the

ith grants

nal funding

e 6 year

ment is N6

al health

s

and less t

n which t

ent reso

eed alloca

iture to th

eight mo

rt and is un

nt Plan 20

Strategic

2015, deve

th status

ould be re

sources a

ners via O

Os) and Phi

, significa

ll currently

shift in he

National

consolidat

by interna

.

implement

66.16 billi

ector budg

an half of

e spendin

rces conti

ion that is

sector in

ths into it

likely to de

02015 (N

ealth Dev

loped to s

f Nigerian

uired to r

re limited

fficial Deve

lanthropist

t funding

awaiting P

lth financi

rimary He

d fund of

tional don

ation peri

n . Unfortu

et is

only

the require

g is based

nues to m

proposed i

the future.

first impl

liver result

HDP) whic

elopment

rengthen

, estimate

position t

largely t

lopment A

s.

of the pl

esidential

g in Nigeri

alth Care

he Federa

r partners

d of the

nately, in t

257.87 bi

d annual s

is yet to

ake it diff

the bill as

The plan

mentation

as intend

h was deve

lan 2010 2

he nationa

s that a t

e Nigerian

governm

ssistance (

n is expe

assent. The

a through t

evelopme

ion, at an

and funds

NSHDP, th

he first ye

llion. This

ending. In

ecome la

icult for a

well as po

as deliver

year. The

d.

Rese

ww

loped in a

015 has no

l health sy

tal amou

Health syst

ent spend

DA) and

ted via th

National

he establis

t Fund. T

mount no

from other

estimate

r of imple

epresents

addition, t

. The risi

y sector t

ential incr

ed in Augu

efore the

rch and Int

w.bglgrou

ighly parti

t taken off

stem and

t of N3.9

em over th

ing at all

Non Gover

e recently

ealth Bill p

ment of a

he Fund w

less than

sources se

annual s

entation

5.75% of

t

he Nationa

g competi

o get the

ase in gov

st 2010 w

plan alread

lligence

ng.com

cipatory

yet

o vastly

trillion

e 6 year

levels,

mental

passed

roposes

Fund to

ould be

% of its

rving as

pending

in 2011,

he total

l Health

tion for

kind of

rnment

ich was

y had a


6/15

Even t The Na

to imp

establi

schem

cost sh

the fin

quality,

in 2005

In 201

(3.73%

individ

employ

level o

univers

povert

Unstab

Anothe

of Afric

to 201

outloo

unsust

play a

The sec

e National tional Heal

ove access

hed the s

is designe

aring arran

ancing of

more org

.

, five full

of the po

als workin

ed. Even i

progress

al enforce

and low le

le global e

r source o

as health

. The chall

suggests

inable sou

igger role i

tor require

Health Insh Insuranc

to quality

heme whi

d to facilit

gements f

ealthcare

nised priv

ears into

ulation) w

g in the fo

the form

expected.

ent of t

vel of awa

onomic ou

financing

are expen

enging glo

dwindling

rce of heal

n the devel

s provision

rance Sche Scheme (

healthcare

h is a fed

te fair fin

r individua

in Nigeria,

te sector p

the schem

ere benefi

rmal secto

l sector, it

he factor

e scheme,

eness.

tlook migh

or healthc

iture was

al econo

aid in th

hcare fina

opment of

of physica

me has nNHIS) is on

for the Ni

erally fund

ncing of h

ls. The sch

thereby e

roviders. T

, it was e

ing from t

leaving la

is arguabl

responsib

, inadequa

t affect fut

re is dono

inanced di

ic scenari

e coming

cing. This

the health

assets an

t deliveree of severa

gerian peo

ed social h

ealthcare c

eme has e

ncouraging

he implem

stimated t

he scheme

ge gaps a

e that the

le for its s

cy of med

ure donor

r assistanc

ectly by

d

in recent

years ma

suggests a

sector in Ni

training o

Rese

ww

optimally l attempts

ple. In 199

ealth insu

osts throu

ormous p

the devel

ntation of

at only 5.

, the majo

ong the p

scheme ha

low growt

ical faciliti

ssistance

. Overall,

nor aid

in

times as w

ing donor

need for th

geria.

additiona

rch and Int

w.bglgrou

by the gov

9, the gov

ance sche

h risk poo

tential to

opment of

the schem

3 million

rity of whi

oor and in

s not achie

include t

es in man

o healthca

approxima

he decade

ell as the

aid a po

e private s

l health w

lligence

ng.com

rnment

rnment

e. The

ling and

mprove

higher

e began

igerians

h were

ormally

ved the

he non

areas,

re

ely 10%

of 2000

nstable

tentially

ector to

rkers


7/15

The bi

sector

the exi

nurses,

from e

distrib

facilitie

The pri

Existin

public

social

both f

individ

the ricprofit a

the po

sector

as adva

Fundin

need f

Obviou

govern

persist.

labour

fiscal p

private

gest area

physical a

sting base

and com

xisting me

tion and

s will also b

vate sector

elements

ntities tha

nterprises.

rmally an

al medicin

, but the nd social e

r and rur

requently

nced medi

challeng

r private s

sly, fundin

ent even

The wellb

force will

olicy regim

participati

for privat

ssets. A lar

especially i

unity hea

dical colle

etail syste

e strong.

has been i

of the priv

t include f

Individual

informall

e sellers al

pposite is nterprises,

l populati

rovides se

al equipm

is limitin

ctor parti

g the hea

as clamou

eing of the

e more p

e, and an

n in the p

sector in

e number

n under se

th worker

es and tr

ms and f

volved in

te sector i

rprofit co

public sec

y, and an

so exists. T

often the play an im

ns unders

rvices or p

nt and pro

g govern

ipation lthcare sys

rs for incr

citizenry s

oductive a

increasing

ovision of

volvement

of addition

rved areas

required

aining inst

r pharma

every facet

volvemen

mmercial

tor health

informal h

he private

ase. In facortant soc

rved by t

roducts th

cedures.

ents prov

tem in Ni

ases in h

hould be v

nd will aid

illingness

ritical infr

will be in

al hospital

. In additi

exceeds th

itutions in

eutical an

of Nigeria

in the hea

ompanies,

workers pr

ealth sect

sector is o

t, private sial role i.e.

e public s

t might ot

ision of h

geria has

alth work

ry import

economic

of the pre

structure

Rese

ww

building

beds will n

n, the nu

e number

Nigeria.

medical

s healthca

lthcare sec

non profit

ovide priv

r of heal

ten percei

ctor provimeeting th

ctor. In a

erwise no

althcare s

become b

rs remune

nt to any l

growth. Gi

sent gover

uch as hig

rch and Int

w.bglgrou

nd impro

eed to be a

ber of ph

that will g

emand fo

supply pr

e sector

tor consist

organisati

te sector

rs, midwi

ed as serv

ders, inclue medical

dition, the

be availa

ervices; he

rdensome

ration con

eader, as a

ven the ti

nment to

ways and

lligence

ng.com

ing the

dded to

sicians,

raduate

better

duction

of non

ns, and

ervices,

es, and

ing only

ing foreeds of

private

le, such

nce the

to the

inue to

healthy

htening

mbrace

irports,


8/15

we rec

health

Nigeria

been c

In Mar

where

FCTA a

the PP

healthc

more r

Succes

Partne

the heinvest

operati

the he

technic

incenti

Partne

able to

PPPs c

implem

and ti

respon

the pa

private

mmend a

ector.

s experie

nsidered s

h 2007, th

a concessi

d NISA M

model wo

are servic

liable med

ful implem

ing with th

lth sector. ents of sc

onal efficie

lth sector,

al or man

es), and sp

ing can als

manage co

an be ben

ented, and

ely manne

ibilities, ri

tners in a

partners a

applicati

ce with P

uccessful

e PPP mo

n agreeme

dical Grou

uld have n

s provide

ical diagno

entation o

e private s

Potential brce public

ncy, and b

partnerin

agement

urring tech

o reduce o

sts and sch

eficial for

monitore

r. PPPs sh

k allocatio

vance. In

nd, in so

n of the p

blicPriva

el was suc

nt for its

after a co

merous u

, updated

is and trea

PPP arran

ector can

enefits inclfunds are

etter man

can also

xpertise (

nology tra

r better all

edule over

the healt

, including

uld includ

, and othe

that regar

e cases, b

ublicpriva

te Partner

cessfully i

anagemen

mpetitive

sides for t

medical f

tment pro

gements c

ave subst

ude reduceliminated,

gement o

be particul

for examp

sfer, all of

ocate risks

uns.

sector

being adj

welldefin

r transacti

, the quali

tween pa

e partners

hip (PPP)

plemente

t and oper

idding pro

e country

cilities, inc

ess.

uld be be

ntial bene

d governmgreater ef

hospital s

arly valuab

le, perfor

which can

since the

hen they

sted when

ed objecti

n element

ty of cont

tners and

Rese

ww

ip approa

in the hea

at the Ga

tion was s

ess. Sect

including: i

reased sta

eficial to

its for the

nt spendiiciency fro

ervices an

le as a me

ance base

lead to qua

rivate par

are well j

necessary

es, clear di

s to be agr

acts betw

third parti

rch and Int

w.bglgrou

h to the c

lthcare se

rki Hospit

igned bet

rwide ado

mproved q

ff efficienc

igeria

public par

g as large private p

infrastru

thod of le

d monitor

lity improv

ner may b

ustified, p

, in an app

ivision of r

eed upon

en the pu

s is critica

lligence

ng.com

ountrys

tor has

l Abuja,

een the

ption of

uality of

and a

ner and

pfront artners

ture. In

eraging

ing and

ements.

e better

epared,

ropriate

les and

etween

blic and

l to the


9/15

succes

experie

Howev

Levera

govern

Collabo

may n

involve

proces

Theref

Accordi

require

stemmineed t

separa

accredi

provid

Approp

import

indicat

upfron

public

needed

to ope

quality

perfor

of a PPP.

nce to the

er, there a

ing partne

ents face

rations ma

t be the

s careful r

es and res

re careful

ngly, an a

d to appr

ng from in be addre

e reform

tation syst

rs perfor

riate moni

nt in he

rs, targets

, built into

artner ha

. External

ate a facili

standards)

ance.

ost impor

contracting

e also imp

ships and

in health

y take a l

most effec

view of t

onsibilitie

evaluation

ccurate u

priately d

adequate rsed either

underta

ms, updat

ance.

toring and

lthcare P and outp

contracts,

sufficient

versight m

ty or a spe

in ensurin

tantly, all p

process.

rtant risks

ollaborati

are today

ng time to

tive or eff

e allocati

, and the a

of the con

front eva

sign and

egulatory through s

en by th

ing patient

manage

Ps. Monit

ts, as well

and refine

capacity f

ethods can

cific health

continuit

arties in a

to conside

ns with th

may not

establish

icient opti

n of finan

pplicable r

itions for

luation of

ro activel

ramework ecial prov

e govern

rights poli

ent of qu

oring and as any pe

at the pil

r oversigh

also be uti

technolog

in the mo

PPP should

r

private se

e easy. P

nd bring t

n availabl

cial risks

gulatory a

uccess an

the likely

manage

or low insisions built

ent. The

cies and en

ality and

evaluatio

rformance

ot stage, if

t and for

lised (for e

, and accr

nitoring an

Rese

ww

bring adeq

ctor to add

blicPrivat

o fruition,

e. Plannin

nd reward

d contract

sustainab

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15/15

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