Nigeria finances its health care delivery through a combination of public and private sector initiatives. The first public-private partnerships (PPPs) in the health sector took place after the government released its 2005 National Policy on PPP for Health, which was initially aimed at addressing specific metrics such as high infant and maternal mortality rates.
In 2020 the health infrastructure gap amounted to some N3.7trn, illustrating the sizeable funding needs to cater to the growing health care requirements of Nigeria’s population of more than 200m. This deficit has seen Nigerians seek treatment abroad, which results in some $1bn in lost spending locally every year. Funding gaps have also led to so-called brain drain, as trained medical personnel look for more lucrative employment opportunities outside of the country.
Given the large share of the government health budget that goes towards recurrent expenditure – as well as the impact of fluctuating international energy prices on government revenue – there is ample opportunity for private sector participation in capital projects. There are already a number of hospitals operating under a PPP model in the country, including Garki Hospital Abuja, Lagos University Teaching Hospital, Ibom Specialist Hospital in Akwa Ibom, Lagos State University Teaching Hospital and University College Hospital Ibadan.
The Covid-19 pandemic has helped to create new opportunities to expand capacity in the sector: there is a plan to build 14 new medical centres and upgrade two intensive care units across the country’s six geopolitical zones, which the private sector is able to participate in. The $58m project, announced in mid-2020, will be partially financed through the state-owned Nigerian National Petroleum Corporation, with the rest of the funding to come from private players.
Furthermore, an initiative called Adopt a Health Care Facility, which was conceived in 2019 by private sector stakeholders and ramped up during 2020 due to the onset of the Covid-19 pandemic, aims to establish market-based, low-cost, primary health care centres across Nigeria’s 774 local government areas to provide services to uninsured residents. The programme is being led by the Private Sector Heath Alliance of Nigeria in partnership with actors including the Africa Business Coalition for Health, the Bill & Melinda Gates Foundation, the UN Economic Commission for Africa, the World Bank and the International Finance Corporation, among others.
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