Nigeria has a public health system that is supported by a national insurance program. Public health care is getting better, but it still has a number of challenges, such as a low doctor-to-population ratio of only 1 per 2,000 people (poor on a worldwide scale, but higher than most of its African neighbors) and a strained infrastructure.
The nation spends 3.7% of its GDP on health care, which is lower than the global average but on par with many of its neighboring nations. Despite having a network of multi-discipline hospitals, mostly in the cities, doctors lament the poor remuneration. A number of initiatives, such as family planning and immunization programs, are improving life for residents, and the country’s prospects continue to change as its economy grows to become one of the largest in Africa, despite the fact that it is only ranked at 187 in the World Health Organization’s (WHO) league tables (World Health Report published in 2000) for the overall effectiveness of its health care system.
There are three different types of healthcare systems in Nigeria: tertiary, secondary, and primary care.
PRIMARY HEALTH CARE SYSTEM
The bulk of a person’s health needs throughout their lifetime, including physical, emotional, and social well-being, are taken care of by primary health care, which is a people-centered service rather than a disease-centered one. Primary care covers health promotion, illness prevention, treatment, rehabilitation, and palliative care, it is typically the first level of care people receive when they have medical problems or needs.
The healthcare outposts, clinics, health centers, and comprehensive health centers provide basic primary care services at the primary level, which is the lowest level and the point of entry to healthcare services. These services cover promotional, preventative, curative, and rehabilitative treatments. LGAs are in charge of this level of service and own and finance primary healthcare facilities. The National Health System is built on primary health care.
The management of primary care centers falls mostly under the purview of LGA health departments. With little assistance from the other levels of government, each level of government establishes its own health priorities and works to achieve them.
The bulk of the population in Nigeria often first interacts with the national health system through the primary health care system.
In order to bring health closer to the people, this form of healthcare system is located in each local government area. Primary healthcare addresses the population’s non-emergency, preventative healthcare needs. Primary health care offers treatments, encourages health education, and refers patients in need of more specialized services to secondary or tertiary health care. It also offers medical examinations to patients with all kinds of acute and chronic health problems.
Patients are normally treated by primary care physicians (also known as general practitioners or family doctors) at primary healthcare facilities, although in some circumstances, patients may be seen by other healthcare providers first, like a pharmacist or physiotherapist. The population’s accessibility to primary healthcare facilities makes it easier to provide a continuum of treatment that supports a full recovery, regular checkups, and preventative healthcare. Medical staff in primary health care centers usually have a lot of knowledge in a lot of different fields. This is so they can treat patients of different ages, genders, and health problems.
Unfortunately, only 20% of Nigeria’s more than 30,000 primary healthcare systems are fully operational to offer the population’s critical primary healthcare services, making the country’s primary healthcare system less than adequate. The primary healthcare system in Nigeria is in terrible shape for a variety of reasons, including inadequate personnel, a shortage of medical specialists, inadequate infrastructure, and an irregular flow of necessary medications.
There are significant access gaps to essential healthcare services due to the Nigerian PRIMARY HEALTH CARE system’s fragmented services, limited referral mechanisms, and inadequate infrastructure. The connections between the various levels of treatment are weak. The materials and equipment used in the primary health care facilities to offer services are hardly ever available or in good working order.
The majority of health centers no longer have working drug rotation programs, which causes a lack of necessary and vital goods and medications at the point of service delivery. Many primary healthcare components are not offered at the majority of service delivery locations. Professional conflicts within the healthcare system make all of these problems worse.
SECONDARY HEALTH CARE SYSTEM
Secondary health care, which is frequently provided in hospitals, is the specialized treatment and assistance offered by doctors and other health professionals to patients who have been referred to them for particular expert care. Although some services may be provided in the community, secondary care services are often located in a hospital or clinic. They could consist of planned procedures, specialized facilities like cardiology or renal clinics, or recovery treatments like physiotherapy. Numerous experts, including psychiatrists, cardiologists, obstetricians, dermatologists, pediatricians, and gynecologists, are part of secondary healthcare.
Secondary health care offers specialized services to patients through the outpatient and inpatient services of hospitals under the supervision of state governments. Secondary care hospitals receive patient referrals from primary healthcare providers. The state ministry of health offers technical support to the LGA health departments as well as medical services through secondary-level medical facilities. Each state is required to establish a single primary health care board made up of a board management team and a state-level governing body (which meets at least quarterly) (full-time employees).
Members of the governing body are women and men who represent their communities’ interests as well as their own professional, official, or political interests.
Additionally, they include individuals that particularly represent historically or currently marginalized groups, such as women and children. The Primary Health Care Board must meet frequently to oversee the provision of services in primary health care. The state governor appoints the executive secretary or director, who serves as the head of the board management team and directly answers to the board and whose responsibilities are laid out in legislation.
In Nigeria, general and public hospitals as well as private secondary facilities make up the secondary health care system. In-patient specialist treatment and support are the main goals of secondary health care for patients who have been referred by primary health care.
Secondary healthcare institutions employ healthcare experts who specialize in assisting patients who battle more serious medical issues that require specialized expert care, such as pneumonia, cancer, severe infections, and broken bones. Patients are typically seen by medical professionals at secondary healthcare facilities who are knowledgeable about their particular health issues. Specialists in secondary health care fields include gynecologists, cardiologists, psychiatrists, and pediatricians.
Medical evaluation, diagnosis, therapies, and surgical procedures are all provided as part of secondary health care. Since some patients typically choose the secondary health care system when the primary health care facilities are unable to meet their basic medical demands, this level of health care system in Nigeria accounts for a significant portion of the medical services provided to the Nigerian people. Most secondary healthcare facilities require referrals from primary healthcare facilities before a patient can get treatment, but some do not.
TERTIARY HEALTH CARE SYSTEM
The definition of tertiary care, which is a level above secondary health care, is highly specialized medical care that is typically offered over a long period of time and involves sophisticated tests, surgeries, and treatments carried out by medical experts in cutting-edge facilities. As a result, consultants working at tertiary care facilities have access to more advanced tools and knowledge.
The greatest level of specialized medical care in Nigeria is provided through the tertiary health care system. Typically, primary and secondary healthcare systems will refer patients with complicated and more serious medical conditions to tertiary healthcare facilities. Most of the medical care given in tertiary healthcare systems is carried out by qualified healthcare professionals using cutting-edge technology. The management of diseases; neurosurgery; diagnostics; heart surgery; palliative interventions; transplant surgery; intensive care; sophisticated diagnostics; and other medical services are provided in the tertiary health care system.
The Federal Teaching and Specialist Hospitals, which are spread out over every state in Nigeria, are the healthcare facilities that provide tertiary healthcare in the nation. Tertiary healthcare facilities in Nigeria include the University College Hospital, the Lagos University Teaching Hospital, the University of Port Harcourt Teaching Hospital, the University of Uyo Teaching Hospital, and many more.
The state of HealthCare in Nigeria
The provision of healthcare in Nigeria is not up to par, particularly in the primary and secondary healthcare systems. Numerous causes contribute to the country’s health system’s deficiencies. The first is the health sector’s inadequate funding. Members of the African Union (AU) convened in Abuja in April 2001 to discuss the appalling state of healthcare in their nations. To bridge the gap, the AU adopted the Abuja Declaration, which required that member nations devote at least 15% of their budgets to health care. Since the Abuja Declaration was made 21 years ago, no national budget allocation for health care has ever reached the agreed-upon 15 percent. In fact, the fiscal year 2023 budget includes the highest-ever healthcare spending allocation of 1.17 trillion naira, or 5.75 percent of the overall budget. There is still much to be done to raise the standard of healthcare service in Nigeria given the budget’s overall low allocation for healthcare.
In addition to a lack of basic amenities, Nigeria’s health care delivery system faces a lack of outdated equipment, poor maintenance practices, a poor and uncoordinated referral system, a lack of proper feedback mechanisms in the referral system, a lack of a proper health information system, a lack of capacity building for healthcare service providers, and a lack of citizen involvement in community participation and ownership in health care. The exodus of Nigerian medical and healthcare personnel is another significant issue. In a similar way, there aren’t enough qualified workers to take care of the majority of people who use primary health care as their first point of contact with the national health care system. This is because most of the workers are in the secondary and tertiary health care systems.
The health care system in Nigeria is underdeveloped and has faced numerous challenges, particularly at the local government levels. There are no effective and adequate surveillance systems in place, and as a result, there is no tracking system to track the spread of infectious diseases, bioterrorism, chemical poisoning, etc. A system well-grounded in regular monitoring and medical intelligence as the backbone of the health sector is important, in addition to competent management coupled with strong leadership principles, to achieve success in health care in this modern day. The suggestions made in this study may also be applicable to other nations (particularly African nations like Niger) who experience a similar issue.