Public Health System
Excellent and quality health is recognized as a fundamental human right. The World Health Organization (WHO) identifies the goal of any healthcare system as providing good healthcare for its population, financial contribution in terms of services that the populace pays for, responsiveness to the healthcare providers (Oyibocha et al., 2014). The government’s mandate to providing healthcare, at least in the public sector, is administered through the three tiers of government: state, federal and local government. Healthcare is provided through the primary, secondary and tertiary healthcare system (Koce, Randhawa and Ochieng, 2019) either at the private or the public sector level. The primary level is under local government supported by the respective local government ministry of health; secondary is under the state-level ministry of health, while tertiary health is run by the teaching hospital and specialist hospitals (Oyibocha et al., 2014). The government also recognizes and regulates traditional medicine to be part of the healthcare system in Nigeria: the healthcare system includes orthodox, alternative and traditional.
The health sector is financed through revenue from the tax, donor funding, out of pocket funding and health insurance from private, public and community: the income is meant for healthcare providers and administrative cost such as overhead and personnel, which has been deemed to be unsustainable (Oyibocha et al., 2014). As of 2005, the country had 23,640 health facilities, 85% of which are managed at the primary level: the private sector owns 385 of these facilities (Oyibocha et al., 2014). The standards and regulation that pertains the national Health system are provided for under the National Health Bill of 2014.
The whole healthcare system is not void of challenges: despite a growing healthcare system, the country still struggles with providing essential health care services. Welcome (2011) describes the national healthcare system as poorly developed and needs adequate management to achieve success. The healthcare system is faced with challenges of human resources for healthcare (HHR): the World Health Organization estimates that the HRH ratio to be 1.95 per 1,000. The personnel challenges are due to attributed to the limited supply and inequitable distribution of health care workers. There is a lack of a clear policy framework, limited financing (Koce Randhawa and Ochieng, 2019). Facilities of health are also not sufficient, especially within the rural sector setting: the number of health centres is low, the healthcare workers are few, the existing personnel are poorly remunerated, and the available centres are short of the required medical equipment and supplies (Oyibocha et al., 2014; Welcome, 2014). A significant challenge of the healthcare system is the quality of care that the populace receives
The demographics of the country further expounds the challenges facing the healthcare system: more than half of the population is living in the rural areas; more than 70% of the healthcare is under the private sector, while the remaining public sector health facilities have over 70% of their drugs being substandard (Welcome, 2011). Moreover, as a large part of the population are poor faced with high out of pocket payments for services, this makes it hard for the poor to have access to basic health care services (Oyibocha et al., 2014): the national health Insurance only covers less than10% of the population.
Koce, F., Randhawa, G. & Ochieng, B. Understanding healthcare self-referral in Nigeria from the service users’ perspective: a qualitative study of Niger state. BMC Health Serv Res 19, 209 (2019). https://doi.org/10.1186/s12913-019-4046-9
Welcome, M. O. (2011). The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems. Journal of pharmacy & bioallied sciences, 3(4), 470–478. https://doi.org/10.4103/0975-7406.90100
Oyibocha, E., Irinoye, O., Sagua, E.O., Ogundige-Essien, O.T., Edeki, J.E., and Okome. (2014). Sustainable Healthcare System in Nigeria: Vision, Strategies and Challenges. IOSR Journal of Economics and Finance. 5. 28-39. 10.9790/5933-0522839.
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