Health care in Nigeria

Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy, private providers of health care have a visible role to play in health care delivery. The federal government's role is mostly limited to coordinating the affairs of the university teaching hospitals, while the state government manages the various general hospitals and the local government focus on dispensaries. The total expenditure on health care as % of GDP is 4.6, while the percentage of federal government expenditure on health care is about 1.5%. A long run indicator of the ability of the country to provide food sustenance and avoid malnutrition is the rate of growth of per capita food production; from 1970-1990, the rate for Nigeria was 0.25%. Though small, the positive rate of per capita may be due to Nigeria's importation of food products.

Health insurance
Historically, health insurance in Nigeria can be applied to a few instances: free health care provided and financed for all citizens, health care provided by government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers. However, there are few people who fall within the three instances.

In May 1999, the government created the National Health Insurance Scheme, the scheme encompasses government employees, the organized private sector and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of Obasanjo further gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.

Mental health
The majority of mental health services is provided by 8 regional psychiatric centers and psychiatric departments and medical schools of 12 major universities. A few general hospitals also provide mental health services. However, the formal centers have competition in native herbalists and faith healing centers.

The ratio of psychologists and social workers is 0.02 to 100,000.

Drug policy in Nigeria
In terms of drug regulation, Nigeria took an interesting step in 1989, when it passed a legislation to make effective a list of essential drugs in the country. The regulation was also meant to limit the manufacture and import of fake or sub-standard drugs and to curtail false advertising. However, the section on essential drugs list was later amended.

Drug quality is primary controlled by the agency for food and drug administration.

Spatial inequality
Health care in Nigeria is influenced by different local and regional factors that impacts the quality or quantity present in one location. Due to the aforementioned, the health care system in Nigeria has shown spatial variation in terms of availability and quality of facilities in relation to need. However, this is largely as a result of the level of state and local government involvement and investment in health care programs and education. Also, the Nigerian ministry of health usually spend about 70% of its budget in urban areas where 30% of the population resides. It is assumed by some scholars that the health care service is inversely related to the need of patients.

Emigration
Migration of health care personnel to other countries is a taxing and relevant issue in the health care system of the country. From a supply push factor, a resulting rise in exodus of health care nurses may be due to dramatic factors that make the work unbearable and knowing and presenting changes to arrest the factors may stem a tide. However, because a large number of nurses and doctors migrating abroad benefited from government funds for education, it poses a challenge to the patriotic identity of citizens and also the rate of return of federal funding of health care education. The state of health care in Nigeria has been worsened by a shortage of doctors as a consequence of severe 'brain drain'. Many Nigerian doctors have emigrated to North America and Europe. In 1995, 21,000 Nigeria doctors were practising in the US alone, about the same as the number of doctors then in the Nigerian public service. Retaining these expensively-trained professionals has been identified as an urgent goal.

Criticism
The World Health Organization's definition of health is not merely the absence of disease but the attainment of a state of physical, mental, emotional and social well being.
 * In 1993, adulterated paracetamol syrup entered into the health care system in Oyo and Benue State, the end result of was the death of 100 children. A year after the disaster, batches of fake ethylene glycol, the major cause of the death could still be purchased.
 * In 1996, about 11 children died of contamination from an experimental trial drug: trovafloxacin. Nevertheless, the long delayed action of the government to prosecute the perpetrators is considered another tragedy and its shows the lack of government regard for Nigerian lives.
 * The life expectancy of the country is low and about 20% of children die before the age of 5.
 * The 2000 WHO report on the performance of health care systems rank the country 187 out of 191.
 * Traffic congestion in Lagos, environmental pollution and noise pollution are major issues to the well being of Nigerians
 * In 1985, an incidence of yellow fever devastated a town in Nigeria, leading to the death of 1000 people. In a span of 5 years, the epidemic grew, with the resulting rise in mortality. However, the vaccine for yellow fever has been in existence since the 1930's.