There are three main levels of healthcare system in Nigeria, unlike in some advanced countries, that have four tiers of healthcare system, including quaternary healthcare.
The structure or levels of healthcare system in Nigeria follow the structure of the government. The federal government handles the tertiary healthcare, the state handles the secondary healthcare, while the local government takes charge of the primary healthcare.
The National Health Bill (2014) determines the standards and also regulates health service delivery in Nigeria, both private and public health providers.
The major stakeholders in the healthcare delivery in Nigeria are the federal government, Health Maintenance Organizations (HMOs), Donors, NGOs, National Health Insurance Scheme, State Ministries of Health (SMOHs) National Primary Health Care Dev. Agency (NPHCDA), Local government areas, Ward Health Authorities.
In Nigeria, most patients fund their medicare out of their pocket, unlike in advanced countries, where there are insurance schemes and taxes. The National Health Insurance Scheme (NHIS) does not cover the health insurance of most of the population.
Healthcare system in Nigeria suffers from a lack of proper health funding and investment, with the government committing only about 5% of the budget to health. WHO ranked Nigeria as low as 156th out of 191 countries, based on the quality of medical system and healthcare delivery.
The three levels of healthcare system in Nigeria are:
- Primary Health Care
- Secondary Health Care
- Tertiary Health Care
Primary Health Care
Primary Health Care (PHC) operates at the community level and is the first point of contact for patient. In Nigeria, most of the healthcare providers in the primary healthcare centres are nurses and community health workers rather than qualified doctors.
Most patients bypass the primary healthcare in Nigeria and self-refer themselves to higher levels of healthcare, creating an overload of patients at the referral facilities (secondary and tertiary facilities). This creates problems as minor illnesses which the PHC can handle moves to facilities suited for severe conditions.
The National Primary Health Care Development Agency (NPHCDA) is supposed to streamline the referral system of patients from the PHC to the secondary or tertiary healthcare, though they are not effective in this function.
In Nigeria, the Primary Healthcare are the health centres in the LGA, communities, wards, villages. They have more public health centres. Examples of primary care are health centers, clinics, dispensary.
Secondary Health Care
This is an intermediate healthcare level of healthcare. The states government through their ministries of health, handle the secondary healthcare system while also providing technical support for the primary healthcare.
The different secondary health care facilities are general hospitals, comprehensive health center, district hospital, specialist and general hospitals. At the secondary level, there are good number of both public and private sector involvement in the provision of healthcare.
Tertiary Health Care
At the federal healthcare level, the Federal Ministry of Health (FMOH) handles the policy making, technical support, national health management, health services delivery. The federal government handles the tertiary health care in Nigeria through institutions such as teaching hospitals, federal medical centres (FMCs), national laboratories.
The federal government also helps to coordinate the activities of the other lower health care tiers such as the secondary and primary healthcare.
The tertiary healthcare has a high percentage of public facilities just as the primary healthcare.
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Dear Editorial Staff,
The write-up on the healthcare system in Nigeria is a good effort especially against the background of limited literature on the subject. It is interesting to read that the primary care still exists in Nigeria. You may want to update the article and perhaps provide relevant references where applicable. Well done!
Dr. Ozichi Alimole (PhD)
Alimole PharmD & Associates, LLC.
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