NIGERIA
Medical Country of Origin Information Report

April 2022

Manuscript completed in April 2022
Neither the European Union Agency for Asylum (EUAA) nor any person acting on behalf of the
EUAA is responsible for the use that might be made of the information contained within thispublication.
Luxembourg: Publications Office of the European Union, 2022
PDF

ISBN 978-92-9465-536-3 doi: 10.2847/082990 BZ-05-21-271-EN-N© European Union Agency for Asylum (EUAA), 2022
Cover Photo: 1129582306, © iStock (photographer: zeljkosantrac), 15 February 2019, url: Doctor
meets African child.
Reproduction is authorised provided the source is acknowledged. For any use or reproduction ofphotos or other material that is not under the EUAA copyright, permission must be sought directlyfrom the copyright holders.

2EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Acknowledgements
The European Union Agency for Asylum (EUAA) acknowledges International SOS (Intl.SOS) as
the drafter of this report.
EUAA specialists from the following departments have reviewed the report internally:••

Country of Origin Information (COI) Sector, Country Information and Guidance Unit,
Asylum Knowledge Centre; andMedical Country of Origin Information (MedCOI) Sector, Country Information andGuidance Unit, Asylum Knowledge Centre.

3MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUMContents
Acknowledgements ........................................................................................................... 3Contents .............................................................................................................................4
Disclaimer ...........................................................................................................................9
Glossary and Abbreviations............................................................................................ 10
Introduction ...................................................................................................................... 14
Methodology .......................................................................................................................... 14
Defining the Terms of Reference ....................................................................... 14
Collecting information ......................................................................................... 14
Quality control ...................................................................................................... 16
Structure and use of the report .......................................................................... 16
Referencing .......................................................................................................... 16
Map ................................................................................................................................... 17
1 Context ........................................................................................................................... 18
1.1 Geography and demographics ....................................................................................... 18
1.2 Historical background ..................................................................................................... 19
1.3 Political context ................................................................................................................ 20
1.4 Economic overview.......................................................................................................... 21
1.5 Socio-cultural features .................................................................................................... 22
1.6 Global context for health development ........................................................................ 22
2 Health System Organisation ...................................................................................... 24
2.1 Impact of COVID-19 ......................................................................................................... 24
2.2 Health system overview ................................................................................................. 25
2.2.1 Public sector ............................................................................................. 25
2.2.2 Federal level ............................................................................................ 25
2.2.3 The state level ......................................................................................... 26
2.2.4 The local government level.................................................................... 27
2.3 Private sector................................................................................................................... 27
2.4 Healthcare Human Resources....................................................................................... 28
2.5 Pharmaceutical sector .................................................................................................... 29
2.6 Patient’s pathways .......................................................................................................... 31
3 Economic factors ......................................................................................................... 33
3.1 Risk-pooling mechanisms ............................................................................................... 33
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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

3.2 Health services provided by the state/public authorities........................................... 33
3.2.1 Primary Healthcare (PHC) ........................................................................ 33
3.2.2 Secondary and Tertiary Healthcare ...................................................... 36
3.2.3 Tertiary Healthcare.................................................................................. 37
3.3 Public health insurance, national or state coverage ................................................... 37
3.4 Community-based health insurance (CBHI) schemes ................................................ 38
3.5 Private health insurance schemes ................................................................................ 38
3.6 Other social security plans............................................................................................. 39
3.6.1 Occupational diseases and work injury ................................................. 39
3.6.2 Old age pensions and allocations for disabled persons (andsurvivors) ............................................................................................................... 39
3.6.3 Minimum wage......................................................................................... 40
3.6.4 Poverty alleviation measures ................................................................. 40
3.7 Out-of-pocket (OOP) health expenditure ..................................................................... 40
3.7.1 Cost of treatment ...................................................................................... 41
3.7.2 Cost of medication .................................................................................. 41
3.7.3 List of useful links .................................................................................... 41
4 Cardiovascular diseases ............................................................................................. 43
4.1 General information ......................................................................................................... 43
4.1.1 Epidemiological context ........................................................................... 43
4.1.2 National policies and programmes for CVDs........................................ 43
4.1.3 Healthcare provisions for CVDs ............................................................. 44
4.2 Access to treatment ........................................................................................................ 45
4.3 Insurance and national programmes ............................................................................ 46
4.4 Cost of medication .......................................................................................................... 48
4.5 Cost of treatment ............................................................................................................ 49
4.6 NGOs ................................................................................................................................ 51
5 Diabetes mellitus ......................................................................................................... 52
5.1 General information ......................................................................................................... 52
5.1.1 Epidemiological context ........................................................................... 52
5.1.2 National policies and programmes for DM ........................................... 53
5.1.3 Healthcare provisions for DM ................................................................. 53
5.2 Access to treatment........................................................................................................ 54
5.3 Insurance and national programmes ............................................................................ 55
5.4 Cost of medication .......................................................................................................... 56
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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

5.5 Cost of treatment ............................................................................................................ 58
5.6 NGOs ................................................................................................................................ 59
6 Topical Report: Hepatitis ............................................................................................. 61
6.1 General information ......................................................................................................... 61
6.1.1 Epidemiological context ........................................................................... 61
6.1.2 Strategies and policies for hepatitis....................................................... 61
6.1.3 Healthcare provisions for hepatitis ........................................................ 62
6.2 Access to treatment........................................................................................................ 63
6.3 Insurance and national programmes ............................................................................ 63
6.4 Cost of medication .......................................................................................................... 64
6.5 Cost of treatment ............................................................................................................ 65
6.6 NGOs ................................................................................................................................ 66
7 HIV/AIDS....................................................................................................................... 68
7.1 General information ......................................................................................................... 68
7.1.1 Epidemiological context ........................................................................... 68
7.1.2 Strategies and policies for HIV/AIDS ..................................................... 68
7.1.3 Healthcare provisions for HIV/AIDS ....................................................... 69
7.2 Access to treatment ........................................................................................................ 69
7.3 Insurance and national programmes ............................................................................ 70
7.4 Cost of medication .......................................................................................................... 71
7.5 Cost of treatment ............................................................................................................ 72
7.6 NGOs ................................................................................................................................ 73
8 Psychiatry ......................................................................................................................74
8.1 General information ......................................................................................................... 74
8.1.1 Epidemiological context ........................................................................... 74
8.1.2 Strategies and policies for psychiatry .................................................... 74
8.1.3 Healthcare provisions for psychiatry ..................................................... 75
8.2 Access to treatment........................................................................................................ 75
8.3 Insurance and national programmes ............................................................................ 76
8.4 Cost of medication .......................................................................................................... 77
8.5 Cost of treatment ............................................................................................................ 78
8.6 NGOs ................................................................................................................................ 80
9 Neurology: Epilepsy, Cerebrovascular Accident (Stroke), Multiple Sclerosis andParkinson’s Disease ........................................................................................................ 81
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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

9.1 General information ......................................................................................................... 81
9.1.1 Epidemiological context ........................................................................... 81
9.1.2 Strategies and policies for neurology .................................................... 82
9.1.3 Healthcare provisions for neurology ..................................................... 82
9.2 Access to treatment........................................................................................................ 83
9.3 Insurance and national programmes ............................................................................ 84
9.4 Cost of medication .......................................................................................................... 85
9.5 Cost of treatment ............................................................................................................ 86
9.6 NGOs ................................................................................................................................ 87
10 Nephrology ................................................................................................................. 89
10.1 General information ....................................................................................................... 89
10.1.1 Epidemiological context.......................................................................... 89
10.1.2 Strategies and policies for nephrology ................................................ 89
10.1.3 Healthcare provisions for nephrology .................................................. 89
10.2 Access to treatment ...................................................................................................... 90
10.3 Insurance and national programmes .......................................................................... 91
10.4 Cost of medication ........................................................................................................ 92
10.5 Cost of treatment ........................................................................................................... 93
10.6 NGOs .............................................................................................................................. 94
11 Pulmonology: Asthma and Tuberculosis ................................................................. 95
11.1 General information......................................................................................................... 95
11.1.1 Epidemiological context........................................................................... 95
11.1.2 Strategies and policies for pulmonology .............................................. 96
11.1.3 Healthcare provisions for pulmonology ................................................ 97
11.2 Access to treatment ....................................................................................................... 98
11.3 Insurance and national programmes............................................................................ 99
11.4 Cost of medication ....................................................................................................... 100
11.5 Cost of treatment .......................................................................................................... 101
11.6 NGOs.............................................................................................................................. 103
12 Haematology: Iron Deficiency Anaemia (IDA), Sickle Cell Anaemia (SCA) andBlood Clotting Disorders (BCDs).................................................................................. 104
12.1 General information...................................................................................................... 104
12.1.1 Epidemiological context........................................................................ 104
12.1.2 Strategy and policies for haematology .............................................. 105
12.1.3 Healthcare provisions for heamatology ............................................. 105
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12.2 Access to treatment .................................................................................................... 106
12.3 Insurance and national programmes......................................................................... 107
12.4 Cost of medication ...................................................................................................... 108
12.5 Cost of treatment ......................................................................................................... 109
12.6 NGOs............................................................................................................................. 110
13 Paediatrics ..................................................................................................................112
13.1 General information...................................................................................................... 112
13.1.1 Epidemiological context ........................................................................ 113
13.1.2 Strategy and policies for paediatrics .................................................. 114
13.1.3 Healthcare provisions for paediatrics ................................................. 115
13.2 Access to treatment .................................................................................................... 116
13.3 Insurance and national programmes ......................................................................... 116
13.4 Cost of medication....................................................................................................... 117
13.5 Cost of treatment ......................................................................................................... 118
13.6 NGOs............................................................................................................................. 120
Annex 1: Bibliography.....................................................................................................121
Annex 2: Terms of Reference ........................................................................................1418

EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Disclaimer
This report was written according to the EASO COI Report Methodology (2019). 1 It is based on
carefully selected publicly available sources of information, as well as on anonymous sources
based in Nigeria. The sources used are appropriately referenced.
The information contained in this report has been researched, evaluated, and analysed withutmost care within a limited time frame. However, this document does not claim to be
exhaustive. If a particular event, person, or organisation is not mentioned in the report, thisdoes not imply that the event has not taken place or that the person or organisation does notexist. Any event taking place during and after the finalisation of this report is not included.
Furthermore, this report is not conclusive as to access to medical care in Nigeria nor is it
conclusive as to the determination or merit of any particular application for international
protection. Terminology used should not be regarded as indicative of a particular legal
position.
‘Refugee’, ‘risk’ and similar terminology are used as generic terminology and not in the legal
sense as applied in the EU Asylum Acquis, the 1951 Refugee Convention and the 1967
Protocol relating to the Status of Refugees.
Neither EUAA nor any person acting on its behalf may be held responsible for the use that
may be made of the information contained in this report.
The drafting of this report was completed in July 2021. Any event taking place after this dateis not included in this report. More information on the reference period for this report can befound in the methodology section of the Introduction.

1

EASO, Writing and Referencing Guide for EASO Country of Origin Information (COI) Reports, June 2019, url

9MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUMGlossary and Abbreviations
AIDS

Acquired Immunodeficiency Syndrome

APC

All Progressives Congress

BHCPF

Basic Health Care Provision Fund

BMPHS

Basic Minimum Package of Health Services

BOI

Bank of Industry

CABG

Coronary Artery Bypass Grafting

CAD

Coronary Artery Disease

CAP

Common African Position

CBHI

Community-Based Health Insurance

CD4

Cluster of Differentiation 4

CHAI

Clinton Health Access Initiative

CHEW

Community Health Extension Worker

CHO

Community Health Officer

COI

Country of Origin Information

COVID-19

Coronavirus Disease 2019

CRF

Consolidated Revenue Fund

CVD

Cardiovascular Disease

DAN

Diabetes Association of Nigeria

DM

Diabetes Mellitus

DT

Diphtheria and Tetanus

EASO

European Asylum Support Office

ECA

Employee Compensation Act

EOC

Emergency Operations Centre

EPHS

Essential Package of Healthcare Services
10EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAFCTFederal Capital Territory

FGoN

Federal Government of Nigeria

FMoH

Federal Ministry of Health

FSI

Fragile States Index

FSSHIP

Formal Sector Social Health Insurance ProgrammeGDP

Gross Domestic Product

HBV

Hepatitis B Virus

HCV

Hepatitis C VirusHIV

Human Immunodeficiency Virus

HMO

Health Maintenance Organisation

HPV

Human Papillomavirus

HRH

Human Resources for Health

HSB

Health-Seeking Behaviour

ICU

Intensive Care Unit

IDP

Internally Displaced People

IEC

Information, Education and Communication

IHR

International Health Regulations

IPC

Infection Prevention Control

ISSHIP

Informal Sector Social Health Insurance Programme

JCHEW

Junior Community Health Extension Worker

LGA

Local Government Area

MDAs

Ministries, Departments and Agencies

MDDC

Mega Drug Distribution Centre

MedCOI

Medical Country of Origin Information

MNCH

Maternal, Newborn and Child Health

MSP

Minimum Service Package
11MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUMNAFDAC

National Agency for Food and Drug Administration

NASCP

National AIDS and STDs Control Programme

NBS

National Bureau of Statistics

NCDC

Nigeria Centre for Disease Control

NCDs

Non-Communicable Diseases

NCMPRP

Nigeria COVID-19 Multisectoral Pandemic Response Plan

NDHS

Nigeria Demographic and Health Survey

NGN

Nigerian NairaNGO

Non-Government Organisation

NHA

National Health Accounts

NHAct

National Health Act

NHIS

National Health Insurance Scheme

NMEP

National Malaria Elimination Programme

NPHCDA

National Primary Health Care Development Agency

NSTG

National Standard Treatment Guidelines

NTD

Neglected Tropical Disease

NTLCP

National Tuberculosis and Leprosy Control Programme

NSHDP II

Second National Strategic Health Development Plan

NSITF

National Social Insurance Trust FundOOP

Out-of-Pocket

PFC

Pension Fund Custodian

PHC

Primary Healthcare

PHCC

Primary Healthcare Centre

PHCUOR

Primary Health Care Under One Roof

PHEIC

Public Health Emergency of International Concern
12EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

PLWHA

People living with HIV/AIDS

PRA

Pension Reform Act

PTF

Presidential Task Force

SARA

Service Availability and Readiness Assessment

SCD

Sickle Cell Disease

SDDC

State Drug Distribution Centre

SIDCAIN

Strategies for Improving Diabetes Care in Nigeria

SMoH

State Ministries of Health

SKF

Sonny Kuku Foundation

STI

Sexually Transmitted Infection

SOP

Standard Operating Procedure

SRH

Sexual and Reproductive Health

SSA

Sub-Saharan Africa

TB

Tuberculosis

TT

Tetanus Toxoid

UHC

Universal Health Coverage

UK

United Kingdom

UN

United Nations

UNAIDS

Joint United Nations Programme on HIV and AIDSUSA

United States of America

USD

United States Dollar

VGSHIP

Vulnerable Group Social Health Insurance Programme

WDF

World Diabetes Foundation

WHO

World Health Organization

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

Introduction

The purpose of the report is to provide information on access to healthcare in Nigeria. This
information is relevant to the application of international protection status determination(refugee status and subsidiary protection) and migration legislation in EU+ countries. In
addition, this report aims to provide information about access to healthcare for specificdiseases and population groups.

Methodology

This report is produced in line with the EASO COI Report Methodology (2019) 2 and the EASO
COI Writing and Referencing Style Guide (2019). 3

Defining the Terms of Reference

The terms of reference for this MedCOI Report are based on the Belgian Desk ofAccessibility’s ‘Researcher’s Guide’, developed in the framework of the MedCOI4 project. The
guide includes a list of questions to be addressed in the report. This was used to develop a‘Questionnaire on access to healthcare’, which included a medication and consultation pricelist containing common treatment and medication questions.
For the specific terms of reference see Annex 2: Terms of Reference of this report.

Collecting information

EUAA contracted Intl.SOS to manage the report delivery including data collection. Intl.SOS
recruited and tasked a public health lead to author the report and two local consultants tocollect data. The public health lead was selected from Intl.SOS’ existing pool of consultants.
The consultants were selected based on their experience in leading comparable projects andon their experience working in Nigeria.
The ‘Questionnaire on Access to Healthcare’ was completed based on the knowledge of thelocal consultants and two medical doctors in Nigeria, as well as through literature review.
Key Informant Interviews:
Key informant interviews were carried out by the local consultant in Nigeria, between April
and July 2021. Interviews were conducted with two medical doctors who work in varied roles
related to healthcare delivery. This included individuals within the partner organisations withadequate contextual knowledge of Nigeria’s healthcare system, including clinic coordinators.
An anonymised list of interviewees is given in Table 1, which describes the core functions of
their roles.
Key Informant Code
EUAA1

Role Description
Medical Doctor and local consultant responsible for incountry data collection of the report.
EUAA2
Medical Doctor and local consultant responsible forsupporting in-country data collection of the report.
Table 1: Anonymised key informants

2
3

EASO, EASO Country of Origin Information (COI) Report Methodology, June 2019, url
EASO, Writing and Referencing Guide for EASO Country of Origin Information (COI) Reports, June 2019, url

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Literature review
The local consultant collected and compiled relevant policy documents and research
publications, for the process of report writing, in line with different sections of thequestionnaire. Supplementary information was gathered by the report author from publicly
available resources. Resources included national strategies, policies, grey literature, andjournal articles. The sources were carefully selected following the EASO COI Report
Methodology (2019) and are referenced in footnotes on each page and included in the
bibliography.
Medication and treatment prices
A comprehensive, although non-exhaustive, list of medication prices is given in each of the
topical reports. The data presented in these were collected by the local consultant between
April and June 2021 (although valid during the period of data collection medication andtreatment prices may undergo fluctuations). Medication and treatment prices are reported in
United States Dollars (USD) throughout the report to make it easier for information users who
are unfamiliar with the Nigerian naira (NGN), the focus country’s local currency, tocomprehend the costing component and compare with other contexts where necessary. 4
Prices of medications were gathered from six private pharmacies and eight hospitals (threepublic and five private facilities) across three geopolitical zones – south-south, north-central
and south-west. Medicines that are only available in the informal market have been
excluded. 5 The cost of medications was observed to be higher in the north as compared tothe south. Medications land at the southern ports and after clearance, these are transported
northwards, which incur more costs leading to increased drug prices. 6 The range of prices
and the average obtained for each medication, from the different regions, have been
described in each topical report. Therefore, given that the upper limit of the price range
includes the logistics costs of drug supply to the farthest northern regions, it can be assumed
that the approximated prices from the three regions reflect the true situation in Nigeria during
the reference period.7 The treatment costs were obtained from eight health facilities – five
privately owned facilities and three government facilities – across the north and south regionsof the country. The average cost from the facilities and price ranges (minimum to maximum)
were computed and incorporated into the report. No regional variations were noted as theseconcern treatment cost; rather differential cost across visited facilities were attributed to
management decision informed by contextual factors. 8
More information on the working methodology can be found in the Standard Operating
Procedures (SOPs) and the Accessibility Guidelines published on the EUAA MedCOI website 9
and in the EASO COI Report Methodology. 10

4

5

6

7

8

9
10

Prices were obtained in NGN but converted to USD using the OANDA’s internationally accepted exchange
rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from: url
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, August-November 2021
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
EUAA MedCOI, url
EASO, Country of Origin Information (COI) Report Methodology, June 2019, url

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

Quality control

Quality control of the report was carried out on both content and form.
The accuracy of information included in the report was reviewed, to the extent possible, using
information provided by the local expert through other contacts, reports, scientificpublications and articles.
Form and content were reviewed internally by EUAA (see Acknowledgements section).

Structure and use of the report

The report starts with a general introduction to the country and the healthcare systemorganisation. Separate sections are dedicated to human resources in healthcare, thepharmaceutical sector, patient pathways, insurance aspects and out-of-pocket expenditures.
Lastly, separate chapters contain accessibility information on specific disease groups:
cardiovascular diseases, diabetes, hepatitis, HIV/AIDS, psychiatry, neurology, nephrology,
pulmonology, haematology, and finally paediatric diseases.

Referencing

Recommended referencing for this report: ‘EUAA MedCOI, Medical Country of Origin
Information Report: Nigeria, March 2022, [hyperlink]’.

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Map

Figure 1: Map of the Federal Republic of Nigeria 11

11

Australian Government, Department of Foreign Affairs and Trade, DFAT Country Information Report: Nigeria,
December 2020, url, p. 2

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

1 Context
1.1 Geography and demographics
Nigeria is the 32nd largest country in the world and 13th in Africa with an estimated area of
923 768 square kilometres and a landmass of 910 770 square kilometres, which is about
thrice the size of Italy. 12 It is located in the western coast of Africa and it is bordered by four
countries: Niger to the north, Chad and Cameroon to the east, and Benin to the west, while
the southern border is formed by the Gulf of Guinea of the Atlantic Ocean. 13
In Nigeria, the main rivers are the Niger and the Benue, which converge at Lokoja and flow
into the Niger Delta. The climate is tropical, with wet and dry seasons associated with the
movement of the Intertropical Convergence Zone, north and south of the Equator. 14 Nigeria is
made up of five broad ecological zones – Swamp Forest, Tropical Rainforest, Guinea
Savannah, Sudan Savannah, and Sahel. Of the five zones, northern Nigeria is composed ofthree: Guinea Savannah, Sudan Savannah, and Sahel. Southern Nigeria comprises Swamp
forest and Tropical rainforest. Northern Nigeria is characterised by low rainfall and droughtlike conditions contrary to the situation in the South. 15
Nigeria is the most populous African country with a 2019 projected population of 201 million
with a 2.6 % annual rate of population change and a high fertility rate of 5.32 live births per
woman.16 Current projections estimate the total population would surpass that of the Unites
States of America to emerge as the third largest country in the world by 2050. 17 More
importantly, Nigeria has an enormous young population base – more than 54 % of all males
and more than 51 % of all females are younger than 20 years of age. 18 This ‘youth bulge’ has
the potential of yielding significant economic benefit – gains arising from a substantial
increase in the ratio of working-age adults relative to young dependants. 19 According to the
National Bureau of Statistics (NBS), the average Nigerian household comprises 5.06 persons
per family; in rural areas, the number is higher – 5.42 individuals compared to 4.50 in urban
areas. The total national dependency ratio – a measure of the number of dependants aged 0
to 14 and over the age of 65 – stands at 0.97; highest in Jigawa state (1.40 of dependants/1
working-age individual) and lowest in Lagos (0.63 of dependants/1 working-age person). 20

12
13
14
15

16

17

18

19

20

Worldometer, Largest Countries in the World (by area), n.d., url
Britannica, Nigeria, 2021, url
RGS with IBG, Climate 4 classrooms: National futures, Nigeria, n.d., url
Macaulay, B.M., Land degradation in Northern Nigeria: The impacts and implications of human-related andclimatic factors, 2014, url, pp. 267-268
UNDESA, Population Division, World Population Prospects 2019, Volume II: Demographic Profiles, Nigeria,
2019, url, p. 1
UNDPI, Press release, World population projected to reach 9.8 billion in 2050, and 11.2 billion in 2100 – says
UN, 2017, url, p. 1
Nigeria, NBS, Nigeria Living Standards Survey: A Survey Report by the Nigerian National Bureau of Statistics(2018 -2019), July 2020, url, p. 6
WEF, Prospects for Reaping a Demographic Dividend in Nigeria: A case study by the World Economic Forum’s
Global Agenda Council on Population Growth, May 2014, url, p. 3
Nigeria, NBS, Nigeria Living Standards Survey: A Survey Report by the Nigerian National Bureau of Statistics(2018-2019), July 2020, url, p. 5

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Nigeria is rapidly undergoing rural to urban migration. In 2003, the urban population stood at
49.2 million 21 and more than doubled by 2019 with an urbanisation rate of 4.2 %. 22
Nigeria is among the five countries in the world with the lowest life expectancy at birth; others
are Central Africa Republic, Chad, Lesotho and Sierra Leone. 23 Nigeria’s life expectancy of
54.7 is lower than the global average of 73.2 years; there is a small variation between men
and women, which stands at 53.8 and 55.6 respectively.24 Also, Nigeria performs poorly
across multiple indicators. 25 According to the 2018 Nigeria Demographic and Health Survey(NDHS), the infant mortality rate was 67 deaths per 1 000 live births for the 5-year period prior
to the survey, while under-5 mortality stood at 132 deaths per 1 000 live births. This implies
that more than one in eight children die within five years after birth. 26 Nigeria’s estimatedmaternal mortality ratio for the 7-year period before the 2018 NDHS is estimated at 512
maternal deaths per 100 000 live births; therefore, for every 1 000 live births in Nigeria during
this period, approximately five women died during pregnancy, during childbirth or within twomonths after delivery.27
The high maternal and under-5 mortality rate can be attributed to the three-phases of delay
posited by Thaddeus and Maine – two researchers who articulated the conceptual framework
for evaluating the majority of deaths that could have been prevented with prompt medical
intervention. These barriers encompass delay in deciding to seek care, delay in reaching careand delay in receiving high-quality care upon arriving at the health facility, including facilitatedreferral when required. 28

1.2 Historical backgroundIn 1885, at the Berlin Conference, the political map of Africa was reorganised by colonial
forces to resolve their conflicts of interest by allotting areas of occupation amongst theleading European powers using the principle of “Dual Mandate” – which means that Europe’sand Africa’s interests would be better served through ensuring that the African continent wasaccessible for trade and what was described as “Europe’s civilising mission”. The conferees
formally acknowledged the British claims to the Niger Basin; subsequently, in 1900, Lord
Fredrick Lugard was appointed to the position of High Commissioner to the NorthernProtectorate, an office he held for six years before his resignation and redeployment to HongKong. On 1 January 1914, Lord Lugard, who had been reappointed two years earlier tooversee the northern and southern protectorates went on to amalgamate the two territories
into the modern-day Nigeria. 29
On 1 October 1960, through an act of the British Parliament, Nigeria emerged an independent
nation under a parliamentary system of government. The country held its first postindependence election in December 1964; this was truncated two years later by a coup,
The World Bank, Urban Population – Nigeria, 2021, url
The World Bank, Urban Population Growth (annual %) – Nigeria, 2021, url
23Worldometer, Life expectancy of the world population, 2021, url
24
UNDP, Human Development Reports, Nigeria, 2021, url
25
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
26
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. 163
27
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, pp. 371, 374
28
Thaddeus, S., and Maine, D., Too Far to Walk: Maternal Mortality in Context, 1994, url, pp. 1091-1092
29
Library of Congress – Federal Research Division, Country Profile: Nigeria, July 2008, url, p. 3
21

22

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which terminated the 1st republic, and then a 30-month civil war, which ended in January
1970. 30 Between 1970 and 1979, Nigeria experienced two additional coups before the military
handed over to a democratically elected government under a presidential system ofgovernment – which provides for a separation of powers among the executive, legislative,
and judicial arms. 31 This marked the beginning of the second republic, which was terminatedby another military coup on 31 December 1983. 32 It would take another 15 years with 3 military
coups and an unsuccessful attempt to restore civilian rule (1992-1993) before the country
successfully transitioned to a civilian government in February 1999 – marking the beginningof the 4th republic. 33
Between 1999 and 2019, multiple crises compounded Nigeria’s longest democratic rule – the
4th republic – starting from the adoption of Islamic Sharia Law by some northern states in theface of resistance from Christians to the rise of Boko Haram in the north-eastern region of thecountry. Also, ethnic clashes in Benue, Taraba, and Lagos left many dead and caused loss of
livelihood for a greater number. 34

1.3 Political context
Administratively, Nigeria operates a three-tier federal system of governance comprising 36
states, a Federal Capital Territory (FCT), and 768 local government areas (LGAs or councils).
The constitution allows for the creation of additional states. 35 The LGAs are further subdivided into 9 565 political wards. The country operates fiscal federalism characterised byrevenue sharing and extensive decentralisation of authority between the three tiers ofgovernment – federal, state, and local governments. 36
Beginning from the 2nd republic (1979-1983), Nigeria adopted a presidential system ofgovernment, and maintained this system even after several interruptions from military rule. 37
Under this form of government, the president doubles as the head of state and chief
executive, who is elected to a four-year tenure, and appoints the vice president, as well as
members of the cabinet. The constitution only allows for a maximum of two four-year tenures
for the president. In addition, the constitution allows for a two-house legislative system, which
encompasses the House of Representatives and the Senate. Each state elects ten individuals
and three members to the House of Representatives and the Senate, respectively, for arenewable four-year tenure. 38
Below the federal government, there are two tiers of government – the state and the local
governments. At the state level, the governor serves as the chief executive of the state whileelected representatives of the people serve in the state legislature for a four-year tenure. The
local governments have elected heads; however, their roles were usurped by the state

30
31
32
33
34
35
36

37
38

Library of Congress – Federal Research Division, Country Profile: Nigeria, July 2008, url, p. 4
Library of Congress – Federal Research Division, Country Profile: Nigeria, July 2008, url, pp. 4-5
Library of Congress – Federal Research Division, Country Profile: Nigeria, July 2008, url, p. 5
Library of Congress – Federal Research Division, Country Profile: Nigeria, July 2008, url, pp. 5-6
BBC, News, Nigeria profile - Timeline, February 2019, url
Nigeria, Constitution of the Federal Republic of Nigeria, 1999, url, p. 16
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
Library of Congress – Federal Research Division, Country Profile: Nigeria, July 2008, url, pp. 5-6
Britannica, Nigeria, Government and society, 2021, url

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

government until 1988 when the federal government decided to directly fund the local
governments. 39
From the 1st up to the 4th republic (1999-till date), Nigeria has had a multiparty system elected
to office by the population. In 2015, General Mohammed Buhari, Leader of the All
Progressives Congress (APC), was voted successor to the incumbent, Goodluck Ebele
Jonathan. Although there were allegations of electoral fraud, the sitting president who lostout did immediately reach out to his opponent to congratulate him on his electoral victory
thereby dousing tension on both sides of the divide. 40
Given the rise of organised non-state violence, such as farmer-herder crises, Boko Haraminsurgency and high spate of kidnapping, Nigeria has been characterised as a fragile state. 41
As of January 2015, there were approximately 981 416 IDPs in Nigeria, with more than 90% in
north-east Nigeria. 42 They often lived with diseases, reduced access to healthcare and basic
necessities – food, clean water, clothing and shelter. 43 The Boko Haram insurgency has
further worsened the socioeconomic indices in the north-eastern region of the country,
including inter-state migration of doctors, destruction of health facilities and disease
outbreak. 44 According to the Fragile States Index (FSI), which comprises 12 metrics (security
apparatus, factionalised elites, group grievance, economic decline, uneven economic
development, human flight and brain drain, state legitimacy, public services, human rights andrule of law, demographic pressures, refugees and IDP, and external intervention) for
evaluating the drivers of state vulnerability (political context, social context, economic context,
and social cohesion), 45 Nigeria has a 2021 FSI score of 98.0 ranking 12th out of 179 countries. 46

1.4 Economic overview
Nigeria is categorised as a lower middle-income country. 47 Although the proportion of the
population living below the poverty line has been reducing gradually since the 1990s, anestimated 2/5 of the population still lives on USD 1.90 per day. 48 The 2018 current healthexpenditure per capita is USD 83.75, slightly above the regional average, which stands at
USD 83.25. 49 In terms of spending on health, Nigeria is among 51 out of 55 countries in the
African Union that is yet to reach the 15 % commitment of its national budget allocated tohealth, which was agreed to in the Abuja declaration of 2001, implying a lower-than-expectednational spending on health. 50
Nigeria is the largest economy in Africa, with an estimated real gross domestic product (GDP)of USD 448.12 billion in 2019 and an annual growth of 2.2 %, up from USD 397.19 billion in
2018. 51 The GDP per capita was USD 2 229.9 in 2019, slightly higher than its value of USD
39
40
41
42
43
44
45
46
47
48
49

50
51

Britannica, Nigeria, Government and society, 2021, urlBBC, News, Nigeria Election: Muhammadu Buhari Wins Presidency, April 2015, url
FSI, Country Dashboard: Nigeria, 2021, url
OCHA, Nigeria: Northeast Crisis. Situation Report No. 1 (as of 30 January 2015), 30 January 2015, url, p. 1
Omole, O., et al., Boko Haram insurgency: implications for public health, March 2015, url, p. 941
The Conversation, How Boko Haram is devastating Health Services in North-East Nigeria, May 2017, url
FSI, Indicators, 2021, url
FSI, Country Dashboard: Nigeria, 2021, url
The World Bank, Nigeria, n.d., url
The World Bank, Country Profile: Nigeria, n.d., url
The World Bank, Current Health Expenditure per Capita (current US$) - Sub-Saharan Africa, 30 January 2022,
url
The World Bank, UHC in Africa: a framework for action, 2016, url, pp. 4, 15-16
The World Bank, Data, GDP growth (annual %) - Sub-Saharan Africa, n.d., url

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2 027.8 in 2018. 52 Despite the country’s huge dependence on the oil and gas sector, this
sector only accounts for 7.4 % of the GDP in 2019. 53 As part of the government’s efforts todiversify the economy, domestic agriculture, forestry and fishing have received appreciableattention; 54 it is a major source of income for most individuals accounting for 24 % of GDP. 55
However, agriculture which employs over 50 % of the labour force has suffered setbacks from
Boko Haram insurgency in the northeast and farmer-herder crisis in the north-central region –two regions that are responsible for a significant share of the crop production which accounts
for almost 90 % of the agricultural output (grains, beans, yams, cassava, potatoes, groundnuts,
sesame and soybeans). 56

1.5 Socio-cultural features
Nigeria is Africa’s most populous country and comprises over 250 ethnic groups. 57 The 3
major tribes are Hausa, Igbo and Yoruba; Hausas occupy the northern region, Igbos in thesoutheast and the Yorubas are based in the southwestern part of the country. 58 The 2018
population distribution of the different ethnic groups are estimated to be Hausa (30 %),Yoruba (15.5 %), Igbo (15.2 %), Fulani (6 %), Tiv (2.4 %), Kanuri/Beriberi (2.4 %), Ibibio (1.8 %),Ijaw/Izon (1.8 %), others (24.7 %). 59
Over half of Nigeria’s population (53.5 %) is Muslim, 45.9 % are Christians, and 0.6 % adhere
to other religions. 60 Hausas, usually grouped with the Fulanis, are mostly Muslims and havethe highest poverty rates in the country. The Igbos and Yorubas, of relatively high income, aremostly Christians, although a substantial number of Muslims are of Yoruba descent. 61

1.6 Global context for health development
At the global level, Nigeria has made several commitments to enable its national healthdevelopment agenda and they are as follows: 62
1.

Sustainable Development Goals (2015) – The country aims to address the outstanding
unattained targets within the Millennium Development Goals, especially as it relates touniversal access to health.

2. The Common African Position (CAP) on the Post 2015 Agenda (African Union 2014) –Aims to make significant gains as it concerns maternal, newborn and child health

52
53
54

55
56

57
58

59
60
61

62

The World Bank, Data, GDP per capita (current US$) - Sub-Saharan Africa, n.d., url
The World Bank, Data, Oil rents (% of GDP) - Nigeria, n.d., url
Nigeria, Federal Ministry of Agriculture and Rural Development, The Agriculture Promotion Policy (2016-2020):
Building on the Successes of the ATA, Closing Key Gaps; 2019, url, p. 5
The World Bank, Country Profile: Nigeria; n.d., urlWorld Bank Group, Jumpstarting Inclusive Growth: Unlocking the Productive Potential of Nigeria’s People andResource Endowments, 2019, url, p. 6
CIA, The World Factbook: Nigeria, 2021, urlWorld Bank Group, Does Exposure to Other Ethnic Regions Promote National Integration? Evidence from
Nigeria, October 2018, url, p. 12
CIA, The World Factbook: Nigeria, 2021, urlCIA, The World Factbook: Nigeria, 2021, urlWorld Bank Group, Does Exposure to Other Ethnic Regions Promote National Integration? Evidence from
Nigeria, October 2018, url, p. 12
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 3

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA(MNCH), as well as sexual and reproductive health (SRH), including family planning withemphasis on the indigent and vulnerable populations.
3. Abuja 2001 Declaration and Abuja+12 Declaration (2013) – The country committed toallocate at least 15 % of its annual national budgets to health.
4. Ouagadougou Declaration on Primary Health Care (2008) – The country committed
to rejig its primary healthcare (PHC) system through the health system strengtheninglens.
5. Universal Health Coverage (UHC) – Nigeria was a signatory to the World Health
Assembly Resolution 58.33 in 2005, which required countries to articulate strategies foradvancing the UHC agenda/access for all without the risk of financial ruin at the point ofaccessing care or after accessing care.
6. International Health Regulations (IHR) (2005) – Nigeria has committed to the IHR
guidelines to enable it to accelerate key actions required to mitigate public healthemergencies.
7. Paris Declaration on Aid Effectiveness (2005) – The Declaration seeks to improve thequality of aid effectiveness and its impact on development through ownership,alignment, harmonisation, results, and mutual accountability.
Although the above commitments may signal political will and strategic direction, no policy
evaluation studies were found that depict the current situation.

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

2 Health System Organisation
2.1 Impact of COVID-19
The first cases of atypical pneumonia later confirmed to be caused by the novel coronavirus
disease 2019 (COVID-19) were identified in December 2019 in Wuhan City of China. 63
Consequently, the rapid global spread of the outbreak informed decision of the World HealthOrganisation (WHO) to declare the COVID-19 outbreak a ‘Public Health Emergency ofInternational Concern (PHEIC)’ on 30 January 2020 and thereafter, declared it a pandemic on
Monday, 11 March. 64 The Nigerian government announced its first case of COVID-19 in Lagos
State on 27 February 2020; on 21 June 2021, the Nigeria Centre for Disease Control (NCDC)
reported a cumulative total of 167 155 confirmed cases out of 2 266 591 tested samples and2 117 deaths nationally. 65
NCDC activated the health-focused national Emergency Operations Centre (EOC) upon
confirmation of the first case with the mandate of overseeing the COVID-19 response. 66
Immediately afterwards, the ‘Presidential Task Force (PTF)’ for the control of COVID-19’ wasinaugurated on 9 March 2020, to lead the government’s multisectoral approach to tackle thepandemic. 67 The PTF developed and released the six-month Nigeria COVID-19 Multisectoral
Pandemic Response Plan (NCMPRP) articulating the country’s response strategy towards
halting the pandemic, which was scaled up to the states with the establishment of state
emergency operation centres and response task teams. 68
Though the PHC was enormously expanded since the start of the pandemic, there were fears
that its limits and restrained critical-care capacities such as lack of beds, oxygen supply andventilators in intensive care units (ICUs) and health workers, may lead to an overwhelmed
health system unable to cope with the strain of containing the disease. 69 The delivery ofessential health services was challenged by the COVID-19 outbreak partly attributable to fear
and trepidations because of possibility of infection by the health workers and patients at
health-facilities. It was also challenged by the diversion of resources and staff away fromessential services to support the COVID-19 outbreak. For example, based on Nigeria’s healthmanagement information system data analysis, outpatient care-seeking reduced by 18 % in
April 2020 in line with previous trends. 70 It is estimated that there is a likelihood of a rise in
non-COVID-19-related deaths: an estimated 42 000 additional maternal and under-5 deathsin Nigeria due to earlier disruptions in mobility and care-seeking. 71 In addition, the pandemic
led to increased price of food and commodities in Lagos, southwestern Nigeria. For example,
63
64
65

66

67

68

69

70
71

WHO, Novel Coronavirus (2019-nCoV): Situation Report - 1, January 2020, url, p. 1
Chatham House, Coronavirus: Public health emergency or pandemic – Does Timing matter? May 2020, url
Nigeria, NCDC, COVID-19 Nigeria, accessed on June 2021 (updated after), url, original website update after, olddata available at url
Nigeria, NCDC, Weekly Epidemiological Report: Nigeria records first case of COVID 19: NCDC activates
Emergency Operations Centre, February 2020, url
Nigeria, NCDC, One Year After: Nigeria’s COVID-19 Public Health Response, February 2020-January 2021,
February 2021, url, p. vi
Nigeria, Presidential Task Force on COVID-19, National COVID-19 Pandemic Multi-Sectoral Response Plan, May
2020, url, pp. 5-11
Kavanagh, M.M. et al., Access to life-saving medical resources for African countries: COVID-19 testing andresponse, ethics, and politics, May 2020, url, p. 1735
World Bank Group, Rising to the Challenge: Nigeria’s COVID Response, December 2020, url, pp. 50-51
World Bank Group, Rising to the Challenge: Nigeria’s COVID Response, December 2020, url, p. 51

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

a bag (50 kg) of rice was USD 44 before the lockdown, increased to USD 55 during the
lockdown (confinement was a measure implemented by government between 30 March and3 May 2020 to lower transmission of COVID-19 infections through total restriction of nonessential activities), and to USD 61 in the period post-lockdown, representing about 50 %increment in price in just over a one-month period. 72
A nationwide survey conducted by the National Bureau of Statistics (NBS) between 20 April
and 11 May 2020 found that 42 % of people had stopped working due to the COVID-19
crisis. 73

2.2 Health system overview
Nigeria operates a pluralistic healthcare system with healthcare provided jointly by the public
and private sectors, as well as by modern and traditional systems. 74 The management of thenational health system is decentralised into a three-tier arrangement with clear mandate to
the federal, state and local governments. 75 Donors also play a key role in management anddelivery of health services across the three levels of care; 76 of note is financial contribution,
which equals 7.5 % of the total institutional sources of financing for health. 77

2.2.1 Public sector
The public sector is the responsibility of the three tiers of government, and they are all
involved, to varying levels, in the major health system functions of stewardship, financing andservice provision. 78

2.2.2 Federal level
The Federal Ministry of Health (FMoH) holds the mandate for policy development andtechnical support to the entire health system, national health management information systemand health-related international engagements. 79

72

73
74

75
76

77
78

79

Human Rights Watch, Between Hunger and the Virus: The Impact of the Covid-19 Pandemic on People Living in
Poverty in Lagos, Nigeria, July 2021, url
Nigeria, NBS, COVID-19 from the ground up: What the crisis means for Nigerians, 2020, url, pp. 3, 17, 20
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 6
WHO, The Nigerian Health System, n.d., url, pp. 21-22
Uzochukwu, B.S.C. et al., Health care financing in Nigeria: Implications for achieving universal health coverage,
May 2015, url, p. 6
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 6
WHO, The Nigerian Health System, n.d., url, p. 21

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

Figure 2: Nigeria's health system 80
Also, the Federal Government of Nigeria (FGoN) (see Figure 2 above), is responsible for theprovision of health services through the tertiary teaching hospitals, federal medical centres
and national laboratories. 81 Furthermore, the FMOH coordinates and manages theimplementation of multiple public health programmes, including National AIDS and STDs
Control Programme (NASCP), National Malaria Elimination Programme (NMEP), and National
Tuberculosis and Leprosy Control Programme (NTLCP). Of note, the FMoH and stateministries of health (SMoH), and Ministries, Departments and Agencies (MDAs) co-manage theroll-out of these interventions at all levels of care. 82

2.2.3 The state level
The state governments through SMoH oversee the secondary level – general hospitals – andthe regulation of technical guidance to PHC services. 83 Support to PHC includes close
collaboration between the leadership of SMoH and the State Primary Healthcare Boards – a
sub-national structure responsible for management and coordination of PHC service delivery
at the state level. 84

80

81
82

83
84

Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 6
WHO, The Nigerian Health System, n.d., url, p. 21
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 6
WHO, The Nigerian Health System, n.d., url, p. 21
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

2.2.4 The local government level
The PHC service delivery falls within the mandate of the local government where healthservices are organised through the Ward Health System. 85 Each LGA, known as districts insome countries, is subdivided into 7 to 15 wards with an average of one primary healthcare
centre (PHCC) per ward. 86 The PHCCs are the first port of entry into Nigeria’s healthcare
system. 87
As shown in the table below, in 2011, there were 34 176 facilities identified in the country, of
which 88.1 % (30 098) were primary facilities. 88 The government owns and runs 76 out of the
86 existing tertiary care facilities in the country. 89
Public21 808969
76
22 853
46.5
66.9

Primary facilities
Secondary facilities
Tertiary facilities
TOTAL
Share of delivery of essential services (%)
Share of healthcare facilities (%)

Table 2: Distribution of health facilities and service delivery 90

Private
8 290
3 023
10
11 323
53.5
33.1

Total
30 0983 992
86
34 176100.0
100.0

2.3 Private sector
The private sector is divided into the non-profit and for-profit, 91 with the former including
facilities managed by non-government organisations (NGOs) and faith-based organisations,while the later comprises modern, alternative and traditional medical providers. 92 Private
facilities constitute approximately 33.1 % of total facilities, and deliver more than 50 % ofessential health services across the primary (8 290 facilities), secondary (3 023 facilities) andtertiary (10 facilities) levels of care.93
Broadly, private facilities are believed to have better basic resources and infrastructure,including electricity, and provide a wider range of services. 94 Therefore, there is a consensus
that private health centres deliver better quality care with reduced patient waiting time;hence, they are the preferred service providers for those with sufficient financial resources
required to access care in these centres. 95
The Second National Strategic Health Development Plan (NSHDP II) recognises traditional
medicine practice and faith-based organisations as part of the private sector but does notdefine any clear plan for coordinating their activities. 96
85
86
87
88
89
90
91

92
93
94

95

96

Nigeria, NPHCDA, Minimum Standards for Primary Health Care in Nigeria, n.d., url, p. 10
WHO, The Nigerian Health System, n.d., url, p. 22
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, pp. 7-8
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, pp. 7-8
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 8
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 8
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, pp. 7-8
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 8
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 7

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2.4 Healthcare Human Resources
Nigeria, like most African countries, is experiencing critical shortage of human resources forhealth (HRH) professionals. Although it has one of the largest stocks of health workforce, thedensities of doctors, nurses and midwives are insufficient (1.95 per 1 000). 97 According toWorld Bank estimates, there were approximately 0.4 doctors per 1 000 population in 2018
while nurses and midwives were estimated to be 1.5 per 1 000 people in 2019. 98 Other HRH
challenges include maldistribution of the health workforce across states, funding gaps andmigration of skilled HRH to other countries. 99 According to a 2018 survey conducted by the
Nigeria Health Watch and NOIPolls, two independent research organisations, about 88 % of
doctors were seeking work opportunities abroad, with the United Kingdom (UK) and the USA
as the top destinations. 100 In the same year, a total of 1 551 medical doctors requested lettersof verification from the Medical and Dental Council of Nigeria to support migration efforts. 101
Registered Health Workers by Cadre
Medical doctors
Dentists
NursesMidwives
Pharmacists
Pharmacy techniciansCommunity health officers (CHOs)
Community health extension workers (CHEWs)
Joint community health extension workers (JCHEWs)
Dental technologists
Dental therapists
Dental Nurses
Dental surgery technicians
Dental surgery assistants
Environmental health officers
Health information managers
Health record techniciansRadiographers
Physiotherapists
Occupational therapists
Occupational therapist assistants
Speech therapists
Audiologists
Physio-technicians
Prosthetists and orthotists
Prosthetists and orthotists assistants
Optometrists
Dispensing opticians
Medical laboratory scientists
Medical laboratory technicians
Medical laboratory assistants
Chartered chemists
Public analysts

2013
65 7593 129
148 291
101 275
16 9791 849
5 986
42 93828 458
730
3 253
266
1 885
886
6 542
2 692
8 739
1 286
2 818
34
104
28
25
65
8
28
2 676
168
19 2258 202
11 067
2 533
717

2018
74 5434 358
180 709
120 870
24 6685 793
8 533
61 66846 253
1 823
6 165
349
10 734
2 058
9 957
7146
27 247
2 516
4 971
98
132
79
N/A
118
7
52
4 429
942
29 24626 67715 3462 854
922

Global Health Workforce Alliance, Nigeria, 2022, url
The World Bank, Data: Nurses and midwives (per 1,000 people) - Nigeria; 2022, url
99
Adeloye, D. et al., Health workforce and governance: the crisis in Nigeria, May 2017, url, pp. 3-5
100
Nigeria Health Watch and NOIPolls, Emigration of Nigerian Medical Doctors: Survey Report, July 2018, url, p. 9
101
Nigeria, FMoH, Nigeria Health Workforce Country Profile 2018, n.d., Available from: FMoH official (unavailable
online), p. 16
97

98

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Table 3: Nigeria's health workforce country profile 102
Nigeria has laws, policies and strategic implementation frameworks (National Health Act,
National Human Resources for Health Policy, National Human Resources for Health StrategicPlan, and Task Shifting and Task-Sharing Policy) to guide HRH development, as well as SOPs
to optimise the available HRH. 103 As part of efforts to ensure a data-driven health workforce
planning, the federal government in collaboration with the World Health Organization (WHO),
launched the Nigeria Health Workforce Country Profile 2018 (see Table 3 for breakdown by
cadre) and the Health Workforce Registry. The registry serves as a platform for timely andcomprehensive HRH information to guide decision-making and better HRH management. 104
Type of Institution
Medical Schools
Nursing/Midwifery Schools
Colleges of Health Technology
Pharmacy Schools
Nigerian Universities Faculties of
Health Technology and Faculties of
Health Management
Regulatory Bodies

Category of health professionals produced
Medical Doctors and Dentists
Nurses and Midwives
Community Health Extension Workers andTechnicians
Pharmacists
Medical Laboratory Scientists,
Physiotherapists, Radiographers, Nutritionists,
Health Managers
Regulation of practice of health professionals
in Nigeria

Accredited institutions
27
89
56
35
>50
14

Table 4: Institutional HRH production capacity 105

The training of medical personnel is delivered through government and privately owned
institutions, including medical schools, nursing and midwifery schools, colleges of healthtechnology, pharmacy schools and specialised faculties within Nigerian Universities (seenumber of accredited facilities in Table 4). To support health workforce development at the
PHC level, 10 % of the Basic Health Care Provision Fund (BHCPF) 106 has been earmarked forthis purpose within the National Health Act – the legal framework for the regulation,
development, and management of Nigeria’s health system. 107

2.5 Pharmaceutical sector
Nigeria has a national essential drug list which is reviewed periodically. Currently, the seventh
edition of Nigeria’s Essential Medicines List – a list that is frequently reviewed by the National
Drug Formulary and Essential Medicines List Review Committee established by Decree

Nigeria, FMoH, Nigeria Health Workforce Country Profile 2018, n.d., Available from: FMoH official (unavailable
online), pp. 16-27
103
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 32
104
WHO, Nigeria launches the National Health Workforce Country Profile towards achieving universal healthcoverage, March 2020, url
105
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 33
106
The BHCPF is established by section 11 of National Health Act (NHAct) 2014 which stipulates that 1% of theConsolidated Revenue Fund (CRF) is statutorily allocated to primary health care.
107
Nigeria, FMoH, National Health Policy 2016: Promoting the Health of Nigerians to Accelerate Socio-economic
Development, September 2016, url, p. 13
102

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Number 48 of 1989 – is available and in circulation. 108 In addition, the National Agency for
Food and Drug Administration (NAFDAC) maintains a database for registered medications. 109
The supply and provision of medications is achieved through the National Supply Chain
Product Management Programme which was set up to enhance the integration of logistics
and supply chain system for drugs and other health products to health facilities with support
from the Global Fund. 110
A 2018 study reported a total of 3 768 registered community pharmacies in Nigeria; unequallydistributed in the states, and higher in Lagos (29 %) as compared to Jigawa (northwest), Yobe
(northeast) and Zamfara (northwest) with less than 5 pharmacies each (median = 50; MinimumMaximum: 2-1 096). Nationwide, about half of the states have less than 50 pharmacies each. 111
Regionally, the northeast has the lowest number of pharmacies while the southwest has thehighest – more pharmacies than the three regions of the north combined. 112
Region
Northeast
Northwest
Southeast
South-south
North-central
Southwest

Number of Community Pharmacies (% Total)
72 (1.9)179 (4.7)
377 (10)794 (21.1)
809 (21.5)
1 537 (40.8)

Table 5: Regional distribution of community pharmacies in Nigeria 113

The overall goal of FMoH’s national drug distribution guidelines is to operationalise a wellordered drug distribution system that will enhance citizens’ access to high-quality andaffordable drugs at all levels. 114 Thus, state governments are expected to establish the State
Drug Distribution Centres (SDDCs) while the private sector should introduce the Mega Drug
Distribution Centres (MDDCs) in addition to wholesale and retail outlets. 115 It was reported in2015 that only two states – Ekiti and Kano – had established their SDDCs while others were
yet to commence implementation. 116 No information was found on the status of private sector
implementation of the MDDCs. In terms of drug production, the following pharmacies were
found to have obtained approval to manufacture and supply drugs locally but no information
was found on their production capacity and status: 117
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•

A & J Pharmaceutical Nig. Ltd, Owerri, Imo State
Abumec Pharmaceuticals Ltd, Kaduna, Kaduna StateAC Drugs Limited, Abakpa Nike, Enugu State
Adler Products Limited, Ikeja, Lagos
Afrab-Chem Limited, Lagos State

Nigeria, FMoH, Nigeria Essential Medicines List, 7th edition, 2020, url
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, n.d., url
110 Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 36
111 Ekpenyong, A. et al., An analysis of pharmacy workforce capacity in Nigeria, September 2018, url, p. 4
112 Ekpenyong, A. et al., An analysis of pharmacy workforce capacity in Nigeria, September 2018, url, p. 6
113 Ekpenyong, A. et al., An analysis of pharmacy workforce capacity in Nigeria, September 2018, url, p. 6
114 Nigeria, FMoH, National Drug Distribution Guidelines, 2nd Edition, 2012, url, p. 13
115 Ogbonna, B.O., National Drug Distribution In Nigeria; Implications for the Goals Of National Drug Policy,
January 2016, url, p. 1
116 Vanguard, Implement national drug distribution guidelines now, FG told, May 2015, url
117 EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
108
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Afrik Pharmaceuticals Plc, Awo-Omamma, Awo-Omamma
Agary Pharmaceutical Limited, Amuwo Odofin, Lagos State
Alben Healthcare Industries Limited, Ogidi, Anambra State
Archy Pharmaceutical Nigeria Limited, Lagos-Abeokuta Expressway
Asad Pharmaceuticals Ltd, Kano
Avro Pharma Limited, Ajao Estate, Lagos
BCN Plc (Formerly The Boots Company Nigeria Limited), Ikeja, Lagos
Bentos Pharmaceutical Products Limited, Ibadan
Best Pharmaceutical Company, Enugu, Enugu State
Biopharma Nigeria Limited, Ikorodu, Lagos State
Bioraj Pharmaceutical Limited, Ilorin, Kwara State
Bond Chemical Industries Limited
Multi-Bond Ventures Limited, Awe, Oyo State
Brian Munro Limited, Ikeja, Lagos State
Bulger Pharmaceuticals, Enugu State
Cardinal Drugs Limited, Agege, Lagos
Ceenek Pharmaceutical Limited, Nike Enugu
Chazmax Pharmaceutical Industries Limited, Anambra State
Chemiron International Limited, Lagos
CHI Pharmaceuticals Limited, Lagos
Chidoomerit Pharmaceutical Ltd, Amaifeke Orlu, Imo State
Chris Ejik Pharmaceutical Ltd, Oregun, Lagos
Cinnamon Drugs Limited, Emene Enugu
Clatess Limited, Ago Okota, Lagos State
Copac Nigeria Limited, Oshodi, Lagos State

2.6 Patient’s pathways
Although a PHCC is the first point of entry into the health system, patients have been known
to self-refer to secondary and tertiary centres due to lack of trust in the PHCCs mostly locatedin rural areas. However, about half of the total population that resides in rural areas does
resort to this level of care. In such cases, from initial consultation to simple laboratory tests,
patients may receive referrals to higher levels of care. 118 Treatment protocols, such as the
National Standard Treatment Guidelines (NSTG) to guide physicians at the secondary andtertiary facility level on standardised approaches for managing different ailments, as well as
simplified protocols of community health extension workers, are available and in circulation. 119
However, a recent study in the southern region of the country has noted its low awarenessand use amongst doctors for whom it was intended. 120
Patients are able to move frequently between different health facilities, from public to private
for-profit and private not-for-profit, which further complicates the complexity of referral
pathways. 121 Currently, no nationally approved system is in place for archiving and transferring
patient records electronically. 122

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
119
Nigeria, FMoH, Standard Treatment Guidelines, 2008, url
120
Ayinbuomwan, A.S. and Isah, A.O., Standard Treatment Guidelines: Perception and Utilization in a Tertiary
Health Care Facility in South-South, Nigeria, March 2019, url, pp. 48-50
121
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
122
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
118

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For complex cases, individuals with sufficient financial resources almost exclusively choose totravel out of the country for treatment. Key medical destinations include the US, the UK,
Egypt, Pakistan, China, the Philippines, South Africa, and India. 123

123

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
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3 Economic factors
3.1 Risk-pooling mechanisms
The National Health Insurance Scheme (NHIS) is the parastatal of FMoH responsible for riskpooling as part of the country’s effort to halt what is described as catastrophic healthexpenditure (health spending that is greater than or equal to 40 % of a household's nonsubsistence income, i.e. income available after basic needs have been met) and achieve
universal health coverage. NHIS pools funds at the federal level, and allocates them toselected health maintenance organisations (HMOs). 124 The HMOs, on behalf of the NHIS,
make capitation payments for service reimbursements to healthcare providers assigned tothem by the NHIS. 125 So far, the NHIS Formal Sector Social Health Insurance Programme(FSSHIP) only covers 5 % of the population while 70 % finance their healthcare through out-ofpocket (OOP) spending.126 According to the 2017 National Health Accounts (NHA) report,
household OOP spending increased from 75.2 % in 2016 to 77.5 % in 2017 – far higher than
the government’s target of 30-40 % of total institutional sources of health financing. 127

3.2 Health services provided by the state/publicauthorities
Public health services are provided at three levels: primary, secondary and tertiary. 128 The
NSHDP II details the services that should be available at each level of care as part of the
Essential Package of Healthcare Services (EPHS). The essential services include the minimum
service package (MSP) which should be available at the PHC level. 129 However, the 36 states,
including FCT are at different stages of implementation. This implies that services available atthe PHCC in one state may be unavailable in another. 130

3.2.1 Primary Healthcare (PHC)
One of the key goals of NSHDP II is to upgrade at least one primary health centre per ward to
improve uptake and utilisation of the MSP. 131 Thus, the National Primary Health Care
Development Agency (NPHCDA) – a parastatal of the FMoH responsible for coordination of
PHC activities nationwide – articulated the Primary Health Care Under One Roof (PHCUOR)
policy, which provides the road map for integrating PHC structures and programmes at the

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
125
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
126
Alawode, G.O. and Adewole, D.A., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers, January 2021, url, p. 1
127
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 37
128
Nigeria, FMoH, National Health Policy 2016: Promoting the Health of Nigerians to Accelerate Socio-economic
Development, September 2016, url, p. 12
129
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 53
130
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
131
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 53
124

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sub-national level. 132 The PHCUOR has nine pillars, one of which is the effective
implementation and provision of the basket of services as contained within the MSP at thethree categories of care at the PHC level – health post, health clinic and health centre. The
services as contained in the MSP are as follows:133
1) Reproductive, Maternal, Newborn, Child, Adolescent, and Elderly Health Plus Nutrition
A. Maternal Health Services••••

Antenatal care
Normal delivery services
Basic emergency obstetrics and newborn care
Postnatal care (mother’s care)

B. Newborn and Child Health Services••

Newborn careo Essential newborn careo Emergency newborn careo Management of human immunodeficiency virus (HIV) exposed newborn
Child health careo Child nutrition (infant and young children feeding, detection and management ofsevere acute malnutrition)o Integrated management of childhood illnesses (detection and treatment of
diarrhoea, malaria and pneumonia)
o Immunisation

C. School health services
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School feeding
Deworming
Tetanus toxoid (TT), and human papillomavirus (HPV) vaccines to adolescent girls
Monitoring growth and development of school children
Screening for disabilities
Treatment of minor ailments

D. Adolescent health
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Comprehensive sexual and reproductive health education
Prevention of unwanted pregnancy and other family planning services
Prevention and treatment of anaemia
Prevention, and control of sexually transmitted infections (STIs) (including HIV)
Menstrual hygiene promotion
Prevention and management of substance abuse and other mental health conditions
Prevention and management of rape
Immunisations (diphtheria and tetanus (DT) and HPV)
Nutrition supplementation

Nigeria, NPHCDA, Primary Health Care Under One Roof Implementation Scorecard III Report; November 2015,
url, pp. 15-16
133
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
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2) Sexual and reproductive health••Family planning
Post-abortion care

3) Prevention and control of communicable diseases
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Prevention, diagnosis and treatment of malaria, tuberculosis (TB), HIV/acquired
immunodeficiency syndrome (AIDS), hepatitis and neglected tropical diseases (NTDs)
Integrated vector control
Periodic mass/targeted Preventive chemotherapy
Case management of NTDs
Treatment of snake bites with polyvalent anti-snake venom
Rabies post-exposure vaccination

4) Prevention and control of non-communicable diseases (NCDs)
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Prevention, screening and management of cardiovascular diseases, goitre, diabetes
mellitus, hypertension, cancers, chronic respiratory tract diseases, sickle cell disease(SCD)
Eye health
Oral health
Mental healthCare of the elderly

5) Emergency medical services•••

Prevention of accident, injury, and violence
Treatment of minor ailments, accidents, and injuries (first aid)
Triage, basic/pre-referral treatment, and referral of emergencies

6) Public health emergencies, including outbreaks••••

Mitigation/resilience measures, including infection prevention control (IPC)
Emergency planning
Emergency response
Outbreak response

7) Health promotion
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Promotion of healthy living behaviour and harm reduction
Development, production, and dissemination of information, education, andcommunication (IEC) on various relevant health issues
Provision of segmented behavioural change communication
General check-up and routine physical fitness check
Promotion of physical activity
Promotion of nutrition/healthy diet8) Social determinants of health••

Food safety and hygiene services
Water and sanitation services
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Physical environment, chemical products and medical waste management

In principle, doctors, nurses, midwives, CHEWs and other support staff should be available toprovide services at the PHC level. 134 However, due to multiple HRH challenges, nurses,
midwives and CHEWs are usually the ones available to provide care while doctors are not. 135
A 2017 study assessed 2 480 PHC facilities from 12 states across 6 geopolitical zones in order
to ascertain their readiness to deliver primary healthcare services and found that medical
disposables such as hand gloves and male condoms were available in 77.2 % and 44.0 % of
all PHCCs respectively, while 86.6 % provided immunisation services. 136 In addition, 68.1 %and 77.2 % had functional sphygmomanometer and functional stethoscopes, while 10.5 %,25.2 %, 21.9 % and 17.1 % of facilities had basic drugs, such as Azithromycin, Nifedipine,
Betamethasone or Dexamethasone, and Misoprostol, respectively. 137 Furthermore, drugs andmedical equipment availability increased significantly in the period 2013-2014 among states insouthern Nigeria as compared to their norther counterparts. 138 A 2021 study performed
capacity and readiness assessment of 60 PHCCs in FCT for hypertension implementation
control programme in Nigeria and found that 59 % and 92 % of facilities had zero 30-day
treatment regimens of any blood pressure-lowering medications in stock and one or morefunctional blood pressure apparatus present respectively. 139

3.2.2 Secondary and Tertiary Healthcare
At this level, patients can expect to receive advanced and complex care following referral
from the PHCCs. One of the objectives of the NSHDP II is to strengthen one secondary health(general hospital) facility per LGA to serve as a referral point for all the PHCs within the
district.140 Of the total health facilities in Nigeria, 14.4 % are secondary 141, with 1 231 public
facilities distributed across the 774 LGAs in Nigeria – less than 1 general hospital per
district. 142
The NSHDP II does not clearly distinguish between the suite of services that should beavailable at secondary and tertiary levels, rather it uses the term “referral” for services thatmight require expert management or can be provided in situations where the individual seeks
assistance at a higher level of care. 143

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
135
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
136
Oyekale, A.S., Assessment of primary health care facilities’ service readiness in Nigeria, March 2017, url, pp. 3-5
137
Oyekale, A.S., Assessment of primary health care facilities’ service readiness in Nigeria, March 2017, url, pp. 5,
7
138
Oyekale, A.S., Assessment of primary health care facilities’ service readiness in Nigeria, March 2017, url, pp. 8-9
139
Orji, I.A., et al., Capacity and site readiness for hypertension control program implementation in the Federal
Capital Territory of Nigeria: a cross-sectional study, April 2021, url, pp. 7-8
140
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
p. 53
141
Nigeria, FMoH, Nigeria Health Facility Registry (HFR), Distribution of Hospitals and Clinics in Nigeria, 2019, url
142
Nigeria, FMoH, Nigeria Health Facility Registry (HFR), Hospitals and clinics, 2019, url
143
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
pp. 55-79
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3.2.3 Tertiary Healthcare
At this level of care, patients can receive expert care from specialists at teaching hospitals,
federal medical centres, and the country’s national hospital. This serves as the last referral
point for cases that cannot be managed at the secondary level. 144
All services available at primary and secondary healthcare centres are available at the tertiarylevel. Additional services include: TB services (diagnosis of multidrug resistance), obstetricservices (obstructed deliveries, corticosteroids to delay premature deliveries and induced
pregnancies), surgical services (basic emergency surgery) and paediatric services (neonatal
sepsis, meningitis, and exchange blood transfusion). 145

3.3 Public health insurance, national or state coverage
NHIS was established by Decree No. 35 of the 1999 constitution as part of the government’s
efforts to achieve universal health coverage using financial risk protection approaches. 146
There are three key programmes of NHIS – FSSHIP, Informal Sector Social Health Insurance
Programme (ISSHIP), and BHCPF-funded Vulnerable Group Social Health Insurance
Programme (VGSHIP) 147 – of which FSSHIP is the most prominent and the first to be
implemented. 148 So far, FSSHIP, the major programme of the NHIS, cover less than 5 % of theentire population.149 This has been partly attributed to a slow uptake by state governments
because they feel excluded from the scheme, particularly during the design stage. 150
FSSHIP covers employees of federal, state and local governments, as well as private
institutions employing at least 10 individuals. 151 However, the private sector‘s employers are
not obliged to enrol their employees. This has been suggested as one of the reasons for thescheme poor coverage. 152 The federal government is expected to pay an equivalent of 3.25 %while the employee pays 1.75 %, representing 5 % of the employee’s consolidated salary. For
the states, local governments and employers in the organised private sector, the employer
contributes 10 % while the employee pays 5 %, summing up to 15 % of the employee’s basic
salary.153

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
145
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, January 2019, url,
pp. 55-79
146
Nigeria, National Health Insurance Scheme Decree No. 35 of 1999, Laws of the Federation of Nigeria, August
2011, url, pp. 3-4
147
Nigeria, NHIS, Programmes, n.d., url
148
Onoka, C.A. et al., Promoting universal financial protection: constraints and enabling factors in scaling-up
coverage with social health insurance in Nigeria, 2013, url, p. 2
149
Alawode, G.O. and Adewole, D.A., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers, January 2021, url, p. 1
150
Onoka, C.A. et al., Promoting universal financial protection: Constraints and enabling factors in scaling-up
coverage with social health insurance in Nigeria, 2013, url, pp. 2-3
151
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 12-14
152
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
153
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 12-14
144

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employing 10 or less people, artisans, voluntary participants, rural dwellers, and others notcovered under the Formal Sector or the Vulnerable Group. 154 Contributions are to be
actuarially determined at a flat rate fee per household/individual household member ormember of an occupation-based group and paid in cash monthly or seasonally in advance. 155
This sector has received less focus and gained less traction as compared to its formal sector
counterpart. 156 No information was found on the actual coverage of this particular programme.
A component of the VGSHIP focused on the indigents, pregnant women and children, iscurrently being implemented with funding from the BHCPF. 157 This requires individuals toregister with a BHCPF-designated PHC in their ward to be able to access services at no costto them. No assessment has been done for this intervention given that it is still at the early
implementation stage. 158

3.4 Community-based health insurance (CBHI) schemes
NHIS expanded its health insurance programme to include the CBHI programme targeted at
65 % of Nigeria’s population which constitutes the informal sectors – who are mostly rural
dwellers. 159 According to the NHIS agency, CBHI targets ‘cohesive groups’ of households orprofessional bodies seeking a collective pool of health risks to minimise individual spendingon health. Members are expected to participate in management and coordination of thegroup. It is required that participating communities, households or professional groups must
enrol at least 50 % of its members or a minimum of 1 000 members. Individual contributions
will be the actuarially determined rate for all and paid in cash periodically. The benefit
package will include pre- and post-natal care, normal delivery, child welfare services(including immunisation), family planning and health education services. 160 A 2014 publication
reported that poverty in rural areas and the inability to impose sanctions may havecontributed to the programme’s poor performance. 161

3.5 Private health insurance schemes
There is limited research on private health insurance schemes in Nigeria. Available evidence
suggests that private health insurance commenced in 1998 and, in 2005, there were over 13
health maintenance organisations providing private health insurance services in Nigeria:162••

Total Health Trust Ltd
Hygeia Health Maintenance Ltd

Nigeria, NHIS, Operational Guidelines, October 2012, url, p. 36
Nigeria, NHIS, Operational Guidelines, October 2012, url, p. 39
156
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
157
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
158
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
159
Shittu, A.K. and Afolabi, O.S., Community Based Health Insurance Scheme and State-Local Relations in Ruraland Semi-Urban Areas of Lagos State, Nigeria, 2020, url, p. 21
160
Nigeria, NHIS, Community-Based Social Health Insurance Programme; n.d., url
161
Odeyemi, I.A.O., Community-based health insurance programmes and the national health insurance scheme of
Nigeria: challenges to uptake and integration, 2014, url, pp. 3, 11
162
Awosika, L., Health insurance and managed care in Nigeria, December 2005, url, pp. 42, 47
154

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Healthcare International Ltd
Southern Rose Nig Ltd
Clearline International Ltd
Premium Health TrustMultishield Ltd
Managed Health Services Ltd
First Health Ltd
Expat care HMO
Royal HMO
Rosberger Nig
United Healthcare International Ltd
Premier Medicaid Nig. Ltd.

3.6 Other social security plans
Over the years, the federal government has developed and refined several social security
schemes to improve the welfare of its citizens. However, interventions covering family
allowance and unemployment benefits are unavailable in the country. 163 Specific social
security plans available in Nigeria encompass occupational disease and work injury, old age
pensions and allocations for disabled persons, minimum wage, and other poverty alleviation
measures. 164

3.6.1 Occupational diseases and work injury
The Employee Compensation Act (ECA) was signed into law in 2010 and repealed theWorkmen compensation scheme (1987-2011). Unlike its predecessor, ECA contains
comprehensive provisions ensuring employees are compensated for accidents at workplaceor outside workplace. It covers medical treatment in case of accident, rehabilitation, andpayment of compensation for disabilities and death. The mandate also covers treatment andpayment of compensation to employees who suffer from occupational diseases contracted in
the course of employment. Within this policy, employers are to contribute 1 % of their payroll
costs to the Nigeria Social Insurance Trust Fund (NSITF) with a view to ensure proper use of
the funds. The funds enable NSITF to handle the medical treatment for occupational diseaseor work injury of employee; and in the case of death, it ensures employee dependants arecompensated. 165

3.6.2 Old age pensions and allocations for disabled persons (andsurvivors)
The Pension Reform Act (PRA) was enacted in 2004 to improve on NSITF and public sector
pension regimes. Under PRA, the custody of pension funds is transferred from NSITF toprivate sector companies - Pension Fund Custodians (PFCs). 166 The employee contribution topension is a minimum of 18 % (a minimum of 8 % by the employee and a minimum of 10 % by
the employer). 167

EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
164
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
165
Gbenga Biobaku and Co., The New Employees’ Compensation Act, n.d., url, pp. 1-2
166
Nigeria, National Assembly, Pension Reform Act 2004, 2004, url, pp. 5, 19
167
Nigeria, National Assembly, Pension Reform Act, 2014, url, p. 8
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3.6.3 Minimum wage
The minimum wage in Nigeria is based on monthly income with an average working period of
40 hours per week and is 30 000 Nigerian naira (NGN) (equivalent to USD 73.1). 168 However,this applies mostly to government employees and excludes the majority in the informal
sector. 169

3.6.4 Poverty alleviation measures
The following are some of the poverty alleviation measures that have been put in place by theFederal Government of Nigeria although there’s paucity of evaluation studies on theireffectiveness:•••

N-POWER Nigeria: this is an initiative that was set up by the Nigerian President,
Muhammadu Buhari on the 8th of June 2016 in order to address the issues of
unemployment among the youthful population through building their capacity on
various areas. It was designed as a component of the National Social Investment
Programme to create a platform for human capital development. 170 It has beenreported that an estimated 500 000 youths have benefited from this initiative until
December 2020. 171
Graduate Internship Scheme: this scheme was established to enable eligible
graduates in Nigeria to become interns in reputable private and public firms. The
project implementation unit is domiciled within the Federal Ministry of Finance. 172
Youth Entrepreneurship Support Programme: an intervention by Nigeria’s Bank ofIndustry (BOI), aimed at training the young aspiring entrepreneurs, aged 18-35 years,
and supporting them in order to access funds for the actualisation of their businessideas, as well as the expansion/modernisation of their existing businesses. 173

3.7 Out-of-pocket (OOP) health expenditure
According to the 2017 NHA, households are mainly responsible for funding healthcare;household expenditure was approximated at NGN 3.3 trillion (USD 8.1 million), equivalent to77.5 % of the current health expenditure. Below is a breakdown of sources of funding for
health.
Institutional Financing Sources (FS.RI)
Households
Corporations
Non-profit institutions
Donors (external)
Federal governmentState government
Local government

Amount (Billions)
3 332.3
28.5
2.9
320.5
264.7
295.5
52.8

Percentage
77.5 %
0.7 %
0.1 %
7.5 %
6.2 %
6.9 %
1.2 %

Wage Indicator, Minimum Wage – Nigeria, 2022, url
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
170
Opera News, N-Power: Less than 9% of the 5 million Nigerians who applied will benefit from the scheme, n.d.,url
171
Premium Times, FG increases number of N-Power beneficiaries to one million - Official, December 2020, url
172
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
173
Bank of Industry, Youth Entrepreneurship Support Programme (YES-Programme), 2020, url
168

169

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Institutional Financing Sources (FS.RI)
Total

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Amount (Billions)
4 297.1

Table 6: Institutional sources of health financing 174

Percentage
100.0 %

3.7.1 Cost of treatment
Consultation fee is dependent on the facility type visited. On an average, specialist
consultations are more expensive in private as compared to the public facilities. Also, the costof public outpatient and inpatient treatments varies by facility type.175
Cost of consultations

Specialist
Consultation

Public outpatient
treatment price(USD)
4.1 (3.9-4.3)

Public inpatient
treatment price(USD)
4.1 (3.9-4.3)

Private outpatient
treatment price(USD)
60.9 (59.9-61.9)

Private inpatient
treatment price(USD)
60.9 (59.9-61.9)

Table 7: Cost of consultation by facility type 176
In private facilities, specialist consultation costs more for both inpatient and outpatient carethan in public facilities. The total costs incurred by patients on admission can be calculated bysumming up all relevant services, including specialist consultation and bed rates; however,indirect costs, such as meals and transportation, are not included. 177

3.7.2 Cost of medication
The Nigerian government through the National Agency for Food and Drug Administration(NAFDAC) regulates and controls the manufacture, importation, exportation, distribution,
advertisement, sale and use of food, pharmaceuticals, and medical devices throughout the 36
states of the federation and FCT, through its officers within the 13 directorates of the agency.
This structure was established to regulate drug prices and quality. 178
Medications for prioritised diseases are provided for free in government-owned healthfacilities including anti-retrovirals, anti-TB medications, and multidrug-resistant TB. 179 Supply
chain challenges has led to informal pharmaceutical markets. Medication prices vary acrossthe northern and southern regions; these are higher towards the north due to the add-on costof distributing from the southern ports to the northern regions. 180

3.7.3 List of useful links
Institution
Budget Office of the Federation
Central Bank of Nigeria
Federal Inland Revenue Service
Federal Ministry of Health

Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
176
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
177
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
178
Nigeria, NAFDAC, NAFDAC Mandate, 2017, url
179
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
180
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
174

175

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Institution
Federal Ministry of Finance, Budget and National PlanningFederal Ministry of Works and Housing
Federal Road Safety Commission
National Agency for Food and Drug Administration
National Agency for the Control of AIDS
National Bureau of Statistics
National Health Insurance Scheme
National Insurance Commission
National Population Commission
National Primary Healthcare Development Agency
National Tuberculosis and Leprosy Control Programme
NCDC Microsite for COVID-19 updates
Nigeria Medical Directory
Office of the Account-General for the Federation
Office of the Auditor-General for the Federation
The Presidency, Federal Republic of Nigeria
USAID Nigeria Program

42

EUROPEAN UNION AGENCY FOR ASYLUMEUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

4 Cardiovascular diseases
4.1 General information
Cardiovascular diseases (CVDs) refer to conditions that alter the functionality of the heart andblood vessels, including the blood circulation; a few examples are strokes, coronary heartdiseases, hypertensive heart diseases, arrhythmias, heart failures, cardiomyopathies, valvular
heart diseases and congenital heart diseases. 181

4.1.1 Epidemiological context
According to Dalal et al., independent researchers funded by the Dean’s Office of the Harvard
School of Public Health to study emerging evidence on non-communicable diseases (NCDs),
sub-Saharan African (SSA) countries, including Nigeria, are undergoing changes in population
lifestyle and rapid urbanisation among others, which may have contributed to a rise in NCDs,
particularly CVDs. 182 According to the World Health Organisation (WHO) NCD country profiles
2018 report, NCDs were estimated to account for about 617 300 deaths (29 % of total deaths)
in Nigeria, out of which 11 % is attributed to CVDs. 183 Coronary heart disease, with a burden of
5.6 % of total deaths, is ranked as the second leading cause of death and first among
NCDs; 184 while stroke is the sixth major cause of death with a burden of 3.57 % of total
deaths. 185 Hypertension, a major risk factor for CVDs, has an estimated age adjusted death
rate of 13.66 per 100 000 population. 186 A systematic review of studies on the prevalence ofhypertension conducted by Adeloye et al. in 2014 found that approximately one-third ofurban-dwelling adults in Nigeria have arterial hypertension. 187 This was corroborated byfindings from a comparative analysis conducted in 2019, which estimated the prevalence ofarterial hypertension to be 27.5 % in urban Nigeria. 188

4.1.2 National policies and programmes for CVDs
In 2013, the Federal Ministry of Health (FMoH) articulated the country’s first strategy for thecontrol and prevention of NCDs in fulfilment of an earlier commitment made at the United
Nations (UN) General Assembly High-Level Meeting on NCDs in September 2011. 189 The policy
intention was to integrate the management of NCDs at all levels of government andhealthcare delivery system in Nigeria. However, this national effort lacked the whole-ofgovernment, whole-of-society and multi-sectoral approach required to address NCDs andtheir risk factors, some of which lie beyond the health sector. Lessons learnt from this effort
led to the galvanisation of broad stakeholder input in the most recent government policy

Boon, N. A. et al., Davidson’s Principles and Practice of Medicine, 19th ed. Edinburgh, Churchill Livingstone,
2002
182
Dalal, S. et al., Non-communicable diseases in sub-Saharan Africa: What we know now, International Journal of
Epidemiology, April 2011, url, p. 886
183
WHO, Noncommunicable Diseases (NCD) Country Profiles, 2018, url
184World Life Expectancy, Nigeria: coronary heart disease, 2018, url
185World Life Expectancy, Nigeria: stroke, 2018, url
186World Life Expectancy, Nigeria: hypertension, 2018, url
187
Adeloye, D. et al., An estimate of the prevalence of hypertension in Nigeria: a systematic review and metaanalysis, Journal of Hypertension, November 2014, url, p. 5
188
Okubadejo, N.U. et al., Prevalence of hypertension and blood pressure profile amongst urban-dwelling adults
in Nigeria: a comparative analysis based on recent guideline recommendations, Clinical Hypertension, 15 April
2019, url, p. 5
189
Nigeria, FMoH, National Policy and Strategic Plan of Action on Prevention and Control of Non-Communicable
Diseases (NCDs), May 2013, url, p. 2
181

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thrust – the National Multi-Sectoral Action Plan (NMSAP) for the Prevention and Control of
NCDs (2019-2025). 190 This policy emphasises the integration of CVD prevention, care andtreatment into basic primary healthcare (PHC) with referral to secondary and tertiary levels ofcare, as well as scaling up coverage of early detection, diagnosis and treatment of CVDs at
PHC level. This aligns with the 15 priority areas of the country’s Second National Strategic
Health Development Plan (NSHDP II). 191 As part of this, the NSHDP II Monitoring and
Evaluation Plan includes the CVD mortality among its key indicators for assessing the
trajectory of programme implementation. 192 Also, the screening and treatment of NCDs is
included in the Ward Minimum Health Care Package, which encompasses the services thatshould be accessible at primary healthcare centres (PHCCs). 193 Furthermore, the managementof hypertension is included among the basket of services to be financed by the Basic HealthCare Provision Fund, which represents a minimum of 1 % of the consolidated federal
government revenue earmarked for provision of health services at the PHC level, including
emergency health interventions. 194 The above policies suggest the presence of political will
and strategic direction; however, evaluation studies of these interventions detailing the reality
on the ground were not found. 195

4.1.3 Healthcare provisions for CVDs
Available CVD treatments at PHCCs include lifestyle modification consultations, risk factor
monitoring and pre-referral treatment, such as intravenous cannulation. Two treatment
guidelines, namely the National Standing Orders for Community Health Officers/Community
Health Extension Workers (CHEWs) and Junior Community Health Extension Workers(JCHEWs), encompassing pre-referral management protocols for CVDs, are available to guide
lower cadre health workers on early critical steps for managing CVDs before referral tosecondary facilities. However, studies have shown that these treatment protocols areunderutilised for various reasons, including high patient load and limited time available foroutpatient consultations. 196 In 2008, the FMoH introduced the National Standard Treatment
Guidelines (NSTG) to guide physicians at the secondary and tertiary facility levels on
standardised approaches for managing different ailments, including CVDs; however, a recent
study in the south-southern part of the country has noted its low awareness and use among
doctors it was intended for. 197
While there are few dedicated advanced cardiovascular diagnostic and care centres in
Nigeria, of which none in northeast and northwest zones 198 (see table 1), a 2014 study showedthat no facilities exist for regular sustained coronary artery bypass grafting (CABG) and open
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019 – 2025), August 2019, url, p. 43
191
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018 – 2022, url, p. 74
192
Nigeria, FMoH, Monitoring and Evaluation Plan for the Second National Strategic Health Development Plan
(2018 – 2022), url, p. 8
193
Nigeria, NPHCDA, Minimum Standards for Primary Health Care in Nigeria, n.d, url, p. 4
194
Nigeria, FMoH, Guidelines for the Administration, Disbursement, Monitoring and Fund Management of the
Basic Healthcare Provision Fund, August 2016, url, pp. 40-42
195
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
196
Ibrahim, D.O., Assessment of the Use of National Standing Orders in the Treatment of Minor Ailments among
Community Health Practitioners in Ibadan Municipality, October 2016, International Journal of Scientific andResearch Publications, url, pp. 51-53
197
Ayinbuomwan, A.S. and Isah, A.O., Standard Treatment Guidelines: Perception and Utilization in a Tertiary
Health Care Facility in South-South, Nigeria, Annals of African Medicine, March 2019, url, p. 48-50
198
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
190

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heart surgery programmes; this poses a threat to clinical outcomes for patients with ischaemic
heart diseases and significant coronary stenoses. 199 In a case report, an author identified 13
coronary artery disease (CAD) cases out of 747 autopsies conducted in south-south Nigeria.
Because of a paucity of diagnostic and therapeutic facilities for coronary angiography in
Nigeria to confirm the diagnosis of CAD and offer appropriate interventional therapy, all thesepatients were missed and treated for other co-existing conditions. 200
S.
No.

Geopolitical
zone

State

Facility name1
2
3

Southwest

Lagos

University Teaching Hospital
Euracare Nigeria
Reddington Multi-Specialist
Hospital
Lagoon Hospitals
Alpine HospitalFirst Cardiology Consultants
University College Hospital Ibadan
Babcock University Teaching
Hospital
Bayelsa Diagnostic Centre
University of Nigeria, Nsukka
Turkish Nizamiye Hospital

4
5
6
7
8

Ibadan
Ogun

9
10
11

South-south
Southeast
North central

1213Northeast
Northwest

Bayelsa
Enugu
Federal Capital
Territory (FCT)
Not available
Not available

Facility type
PublicX

X
X
X

Private
X
X
X
X
X
X

X

Table 8: Regional/state distribution of advanced cardiovascular diagnostic and care centres in
Nigeria 201

4.2 Access to treatment
Despite the high burden of hypertension, a review of studies in 2012 on this disease area
revealed that the awareness (14-30 %), treatment (<20 %) and control (9 %) rates are low. 202 A
representative sample of health centres (n = 62) was reviewed in 2019 with an adaptation of
the WHO Service Availability and Readiness Assessment (SARA) tool to assess the diagnosis,
treatment and management of NCDs, specifically hypertension and diabetes mellitus. 203 This
found that few PHCCs had guidelines (13 %), treatment algorithms (5 %) or informationmaterials (2 %) for hypertension diagnosis or management within the clinic on the day ofassessment. More than half had capacity for dispensing initial or follow-up (57 %) antihypertensive medications and for providing long-term continued care (60 %) for patients withhypertension. All assessed PHCCs depended on paper-based records, and very few had afunctional computer (17 %) or access to the Internet or e-mail (8 %). 204

Johnson, A. et al., A Cross-sectional study of stand-alone Percutaneous Coronary Intervention in a Nigerian
Cardiac Catheterization Laboratory, BMC Cardiovascular Disorders, January 2014, url, p. 4
200
Akintunde, A.A. and Olafiranye, O., Triple vessel coronary artery disease in a rural Nigerian: A reflection of poor
diagnostic infrastructure or rarity in prevalence? A call for action, Journal of Medical Research, 2019, url,
pp. 109-111
201
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
202
Ogah, O. S. et al., Blood pressure, prevalence of hypertension and hypertension related complications in
Nigerian Africans: a review, December 2012, url, pp. 330, 332
203
Orji, I. A. et al., Capacity and site readiness for hypertension control program implementation in the Federal
Capital Territory of Nigeria: a cross-sectional study, April 2021, url, pp. 2-3
204Orji, I. A. et al., Capacity and site readiness for hypertension control program implementation in the Federal
Capital Territory of Nigeria: a cross-sectional study, April 2021, url, pp. 4-8
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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

To promote access, the Government of Nigeria provisioned for preventive and curative CVD
treatment and care in the benefit packages designed to cover different segments of thesociety within the formal and informal sectors, as well as the vulnerable groups (see table9). 205 The country has three levels of care, and the patient’s first port of entry into the healthsystem is through the PHCC with referral to higher levels where necessary; hence, available
insurance programmes reflect this reality and cover for referrals to higher levels of care –secondary and tertiary facilities. 206 However, 60-90 % of patients are reported to self-refer toreferral levels of care above PHCCs. This is due to various reasons ranging from patient
perception that they are more likely to see doctors at the secondary facilities to distrust of theoperational capacity of PHCCs in terms of equipment, drugs and laboratory capacity.207 This
overburdens the higher levels of care with minor ailments, which could be managed at the
primary facilities, and impacts negatively on efficiency in patient management – evidenced byprolonged waiting times in most facilities. 208
Low community awareness of the diseases and their related risk factors, lack of affordable
transport, lack of proximity to health facilities especially for individuals dwelling in hard-toreach areas and high cost of care, within the context of a poor health insurance system, areamong the barriers to accessing care for cardiovascular conditions. 209 CVD treatment anddrugs are less accessible in the northern part of the country and in the rural areas comparedto the southern and urban regions. 210 The Government of Nigeria, through the enactment of
the National Health Act of 2014, established the Basic Health Care Provision Fund (BHCPF) 211
to provide more funding for healthcare to cater for the most vulnerable groups in thesociety. 212 Although the programme formally commenced in 2018, some commentators haveargued that it is still too early to measure progress. 213

4.3 Insurance and national programmes
The National Health Insurance Scheme (NHIS) was launched in 2005 and provides healthinsurance coverage for Nigerians through three major programmes (see table 9). 214 Unlike

Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 35-36, 42-44
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the Operations of the NHIS Formal Sector
Programmes, October 2020, url, pp. 7-8
207
Koce, F. et al., Understanding healthcare self-referral in Nigeria from the service users’ perspective: aqualitative study of Niger state, April 2019, url, pp. 1-2
208
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
209
Thaddeus, S., and Maine, D., Too Far to Walk: Maternal Mortality in Context, 1994, url, pp. 1091-1108
210
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
211
The BHCPF utilizes two approaches to improve service delivery in at least one PHCC per ward in Nigeria: 1)
through direct financial investments that funds critical upgrade for PHC infrastructure, improving availability ofskilled staff and assuring stock of medicines and health commodities; and 2) through the purchase of a Basic
Minimum Package of Health Services (BMPHS) from PHC providers at no cost to Nigerians.
212
Nigeria, National Health Act, October 2014, url
213
Results for Development (R4D), Preliminary Learnings from Nigeria’s Basic Health Care Provision Fund,
December 2020, url
214
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
205

206

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

programmes on tuberculosis, human immunodeficiency virus (HIV) and malaria, there are no
specific government-driven financial support programmes for the treatment of CVDs. 215
Programme

Focus

Requirements

Scope ofcoverage

Formalsector social
healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised
private sector or
willing to makevoluntary
individual/family/groupcontributions

1. Public/federal tier government pays
3.25 % and employee
pays 1.75 % of
employee's basic salary
2. Armed forces government pays entire
5 % of employee's
basic salary
3. Private/othergovernment tiers employer pays 10 %and employee pays
5 % of employee's
basic salary

Coverhealthcare
benefits for theemployee, aspouse andfour biologicalchildren below
the age of 18
years

Informalsector social
healthinsurance
programme

For individuals in theinformal sector. It
covers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers, and others
not covered under theformal sector or thevulnerable group

For theregisteredindividual alone

Vulnerable
group

For indigents and thevulnerable (children
under five, physicallychallenged people,
prison inmates,
pregnant women,orphans and internallydisplaced people)

Community-based
health insurance
scheme - actuariallydetermined flat rate fee
perhousehold/individual
household member ormember of an
occupation-based
group and paid in cash
monthly or seasonallyin advance
Register with a PHCC
under the Basic HealthCare Provision Fund
Programme

For theregisteredindividual alone

Cardiovasculardisease (CVD)
services covered1.
Outpatient/preventive
care (such as risk
factor monitoring andprescriptions, e.g.
diuretics)
2. Admission for up to
three weeks
3. Consultation withspecialists(cardiologists/cardiac
surgeons)
4. Prescribed drugs,
pharmaceutical careand diagnostic tests
ascontained in the NHIS
Drugs List and NHIS
Diagnostic Test Lists
As in the public sector

As in the public sector

Table 9: Health insurance programmes in Nigeria 216
There exist varying degrees of insurance coverage for certain CVD services; for example,
high-technology investigations, such as computed tomography scan and medical resonanceimaging, are partially excluded (health maintenance organisation would pay 50 % of cost)
while management of cardiovascular congenital abnormalities requiring advanced surgicalprocedures (e.g. tetralogy of Fallot, atrial septal defect and ventricular septal defect) is totally
excluded. 217

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
216
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
217
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 24-25
215

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

It is important to note that although health insurance is available in-country, households
provide 77.5 % of the current health expenditure while the federal government and donors
contribute 6.2 % and 7.5 %, respectively. 218 This implies that out-of-pocket expenditure on
health remains very high and would impact the economic status of citizens. 219

4.4 Cost of medication
The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 220
The National Agency for Food and Drug Administration (NAFDAC) maintains a database forregistered medications. 221
The prices of medications were collected from six private pharmacies across the country –four in the south and two in the northern regions. 222 Medicines that are only available in theinformal market were not listed. See more details of medication cost in the methodology
section of the general country report.
Generic nameAnti-hypertension
Amlodipine
Amlodipine +valsartan +hydrochlorothiazide
Atenolol
Bisoprolol
Bumetanide
Candesartan
Carvedilol
Doxazosin
Enalapril
Eplerenone
Furosemide
Hydrochlorothiazide
Irbesartan
Lercanidipine
Lisinopril
Lisinopril +hydrochlorothiazide(combination)
Losartan
Metoprolol
Nifedipine
Olmesartan
Perindopril
Propranolol
Spironolactone
Telmisartan

Brand name ®

DosageForm

Number ofunits in thecontainer

Price per box (UnitedStates Dollar (USD))

Norvasc®
Exforge®

10 mg
10/160/25
mg

TabletTablet100
2816.5 (15.0-18.0)
24.9 (23.8-26)

Ternomin®
Concor®
Bumetanide®
Atacand®
Carvedilol
Doxazosin
Enaladex®
Inspra®
Bristol®
Hydrochlorothiazide
Avapro®
Lercanidipine
Lisinopril
Zestoretic®

50 mg
5 mg
5 mg
16 mg
12.5 mg
2 mg
5 mg
50 mg
40 mg
25 mg
300 mg
20 mg
10 mg
10
mg/12.5mg
50 mg
100 mg
20 mg
40 mg
2 mg
40 mg
40 mg
80 mg

TabletTabletTabletTabletTabletTabletTabletTabletTabletTabletTabletTabletTabletTablet

28
28
28
28
28
28
28
28
28
28
30
28
28
28

1.7 (1.4-2.0)
6.1 (5.2-7.0)
28.4 (26.0-30.8)
33.4 (32-34.8)
2.4 (2.2-2.6)
1.7 (1.0-2.4)
2.9 (2.0-3.8)
121.8 (120-123.6)
3.4 (2.8-4.0)
4.8 (4.5-5.1)
14.6 (13.9-15.3)
7.4 (7.0-7.8)
2.1 (1.7-2.5)
4.3 (3.8-4.8)

TabletTabletTabletTabletTabletTabletTabletTablet

28
30
50
10
30
50
50
28

3.3 (2.9-3.7)
7.2 (6.5-7.9)
2.7 (2.0-3.4)
2.9 (2.5-3.3)
9.0 (7.0-11.0)
6.1 (5.9-6.3)
6.1 (5.8-6.4)
8.5 (8.0-9.0)

Losartan
Betaloc®
Cardovasc Retard®
Orion®
Perindopril®
Inderal®
Aldactonee®
Micardis®

Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
220
Nigeria, FMoH, Nigeria Essential Medicines List, 7th edition, 2020, url
221
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, url
222
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
218

219

48

EUROPEAN UNION AGENCY FOR ASYLUMGeneric nameBrand name ®

Torasemide
Duretor-20®
Valsartan
Diovan®
Antiplatelet aggregation
Ticagrelor
Brilinta®

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

DosageForm

Price per box (UnitedStates Dollar (USD))

TabletTabletNumber ofunits in thecontainer
10
28

20 mg
80 mg
90 mg

Tablet30

85.3 (84.3-86.3)

Table 10: Details of medication available in the formal market 223

6.6 (6.0-7.2)
8.5 (8.2-8.8)

4.5 Cost of treatment
There are no specific government-driven financial support programmes for the treatment of
CVDs. 224 About 95 % of the population are yet to benefit from the country’s NHIS; hence, outof-pocket payment at the point of care is the experience for most individuals. 225 A 2014 study
to report the costs of CVDs in Nigeria based on prospectively collected operational data
found that the costs of CVD prevention care were USD 144 (range 130-158) per patient per
year; direct and indirect costs for outpatient care were USD 82 and 62, respectively, while thecost drivers were drugs (USD 39) and diagnostic tests (USD 36). 226 This is beyond the reach of
40 % of the total population, or almost 83 million people, who live below the country’s poverty
line of NGN 137 430 (USD 381.75) per year. 227
For this report, the local consultant gathered information on the costs of public outpatient andinpatient treatments, which were obtained from eight facilities – five privately owned andthree government-owned centres spread across the north central, south-south andsouthwestern regions of the country. In private facilities, a specialist consultation costs less for
inpatient care than outpatient care; however, in the long run and with multiple consultations,
inpatient care is more expensive. The total costs incurred by patients can be calculated bysumming up all relevant services; however, indirect costs, such as bed rates, meals andtransportation, were not included. 228

Specialist
Consultation by a
cardiologist
Consultation by a cardiac
surgeonPublic outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

36.5 (35.0-38.0)

36.5 (36.0-37.0)

73.0 (72.0-74.0)

48.8 (48.0-49.6)

36.5 (35.0-38.0)

36.5 (36.0-37.0)

85.3 (85.0-85.6)

48.8 (48.0-49.6)

Table 11: Treatment cost by facility type 229
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
224
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
225
Alawode, G.O., and Adewole, A.D., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers, January 2021, url, p. 7
226
Hendriks, M.E. et al., Costs of cardiovascular disease prevention care and scenarios for cost saving: A microcosting study from rural Nigeria, November 2014, url, pp. 4-5
227
Nigeria, NBS, 2019 Poverty and Inequality in Nigeria: Executive summary, May 2020, url, p. 5
228
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
229
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
223

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

Public treatment price (USD)
Laboratory researchLaboratory research of blood; INR,
e.g. in case of acenocoumarol
24.3 (24.0-24.6)
anticlotting
Laboratory research for
cardiac biomarker; creatine
29.2 (29.0-29.4)
kinase MB (CK-MB)
Laboratory research for29.2 (29.0-29.4)
cardiac biomarker; troponin
Diagnostic imaging
Angiography
Not available(= arteriography)
Cardiac stress test
Not available
Electrocardiogram (ECG;
12.1 (11.9-12.3)
cardiology)
Holter monitoring/ambulatory ECG
60.9 (60.0-61.8)
device (cardiology)
Ultrasound of the heart (=echocardiography =36.5 (36.2-36.8)
echocardiogram = transthoracic
echocardiogram (TTE))
Treatment
Clinical admittance in cardiology
5.0 (4.5-5.5)
department (daily rates)
Clinical admittance in cardiac
5 (4.5-5.5)
surgery department (daily rates)
Intervention possibilities in case of (high risk of) myocardial infarction
Cardiac surgery; cardiac
Not available
catheterisation
Cardiac surgery; CABG; bypass
Not available
Cardiac surgery; percutaneoustransluminal coronary angioplasty
Not available(PTCA)/percutaneous coronary
intervention (PCI); coronary
angioplasty, including follow-up
Intervention possibilities in case of severe heart rhythm disorders
Cardiology, placement of
1 583.5 (1 580.0-1 587.0)
pacemaker
Cardiology, maintenance and1 583.5 (1 580.0-1 587.0)
follow-up of pacemaker
Cardiology, placement of
implantable cardioverter1 583.5 (1 580.0-1 587.0)
defibrillator (ICD)
Cardiology, follow-up of ICD by
243.6 (240.0-247.2)
cardiologist

Private treatment price (USD)
38.4 (38.0-38.8)
102.4 (100.0-104.8)
102.4 (100.0-104.8)
243.8 (241.3-246.3)
63.9 (63.2-64.6)
25.6 (25.2-26.0)
63.9 (63.0-64.8)
51.2 (51.0-51.4)

25.6 (25.2-26.0)
187.7 (185.2-190.2)
3 412.6 (3 410.1-3 415.1)
13 406.5 (13 400.0-13 413.0)
6 093.8 (6 087.0-6 100.0)

1 948.9 (1 935.0-1 962.8)
1 948.9 (1 935.0-1 962.8)
2 192.6 (2 190.0-2 195.2)
365.4 (360.0-370.8)

Table 12: Cost of laboratory investigations by facility type 230

internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
230
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

4.6 NGOs
There is a substantial number of local and international NGOs in Nigeria focused on healthsystem strengthening activities, more in the north than the southern region, and the regional
mismatch is largely attributed to varying health indices across the country.231 However, themajority of the NGOs do not focus on CVDs, and for those that do, their actual reach andimpact in terms of assisted people with CVDs were not found.232
Examples of current programmes funded by international donor programmes on CVD include:
1) Resolve to Save Lives, a five-year campaign funded by Bloomberg Philanthropies, the Chan
Zuckerberg Initiative and the Bill & Melinda Gates Foundation. Resolve aims at saving 100
million lives by implementing proven solutions to prevent heart disease and stroke, theworld’s leading cause of death. 233 2) Save-A-Heart Nigeria project is an international medical
humanitarian organisation created by “TEAM NIGERIA”: volunteers from the Cardiothoracic
Surgery Unit of the Royal Victoria Hospital in Belfast, Northern Ireland. Their aim is to support
the development of an affordable and sustainable open-heart surgery programme in
Nigeria. 234
Others include the Rotary Club of Nigeria and Voom Foundation. 235 The Rotary Club is a 110year-old institution with over 1.2 million members across 145 countries, including Nigeria; they
actively support efforts at halting disease transmission, providing clean water, sanitation andhygiene, among other interests. 236 The club has helped to provide access to treatment forchildren living with cardiovascular conditions in the southern part of the country. 237
The Voom Foundation is an international medical humanitarian organisation composed ofvolunteer health professionals of all cadres with a mission to deliver high-quality andsustainable health programmes to the underserved in Nigeria. Since 2013, the foundation has
collaborated with three health facilities to deliver the open-heart programme in Nigeria, as
well as training for local staff to support a sustainable open-heart programme in Nigeria;
however, their medical missions were temporarily suspended due to COVID-19 and travel
restrictions, including the cardiac programme. 238

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
232
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
233
Resolve to Save Lives, Strengthening outbreak response in Nigeria, n.d, url; Resolve to Save Lives, About, n.d.,url
234
Save-A-Heart Nigeria Project, n.d, url
235
Ike, S.O. et al., Cardiovascular diseases in Nigeria: What has happened in the past 20 years? June 2020, url,
p. 24
236
Rotary, Who we are, n.d., url
237
Vanguard, Rotary commences treatment of children with heart diseases, July 2017, url
238
Voom Foundation, About us, n.d, url
23151

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

5 Diabetes mellitus
5.1 General information
Diabetes mellitus (DM) is a metabolic condition characterised by elevated blood sugar levels
accompanied by disturbances in carbohydrate, protein, and fat metabolism resulting fromdefects in insulin production, insulin action or both. 239 Gestational, type 1 and type 2 are thethree most frequently recognised types of DM in the Nigerian setting; of the three types, type
2 is the most commonly documented in endocrine clinics. 240

5.1.1 Epidemiological context
There has been no national health (diabetes) survey since 1992 when a prevalence of 2.2 %for diabetes was reported; hence, there is limited epidemiological data on diabetes althougha 2018 meta-analysis of previously available studies estimated the pooled prevalence to be
5.77 % suggesting that 1 out of every 17 adults in Nigeria is living with the disease. 241
According to the World Health Organisation (WHO) 2016 Country Profiles Report, diabetes
contributed to an estimated 2 % of total mortality in all ages with a combined type 1 and type
2 prevalence of 4.3 %. 242 Of note is that the mortality estimates have a high degree of
uncertainty as they are not based on Nigeria’s epidemiological data on DM, which are very
limited, but rather on a combination of country life tables, cause of death models, regionalcause of death patterns, and the WHO and the Joint United Nations Programme on HIV and
AIDS (UNAIDS) programme estimates for some major causes of death (not including noncommunicable diseases (NCDs)). 243
A systematic review of DM conducted in 2016 estimated the age-adjusted prevalence rates oftype 2 DM in Nigeria among people aged 20-79 years to be 5.7 % accounting for over 4.7
million cases in 2015. 244 However, the studies reviewed may not be representative of theentire country given that the selected studies were mostly from the southern geopoliticalzone of Nigeria. 245 The highest combined type 1 and type 2 prevalence was observed in thesouth-south region of the country at 8.5 %. 246
The burden of undiagnosed DM in Nigeria is very high. 247 In 2019, it was estimated that there
were 1 317 000 undiagnosed cases of diabetes with 63 957 diabetes-related deaths. 248

WHO, Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO
consultation. Part 1: Diagnosis and classification of diabetes mellitus, 1999, url, p. 2
240
Ogbera, A.O. and Ekpebegh, C., Diabetes mellitus in Nigeria: The past, present and future, December 2014, url,
p. 906
241
Uloko, A.E. et al., Prevalence and Risk Factors for Diabetes Mellitus in Nigeria: A Systematic Review and MetaAnalysis, May 2018, url, pp. 1307, 1311
242
WHO, Diabetes Country Profiles 2016, Nigeria, April 2016, url
243
WHO, Diabetes Country Profiles 2016: Explanatory notes, April 2016, url, pp. 1-2
244
Adeloye, D. et al., Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in
Nigeria: a systematic review and meta-analysis, May 2017, url, p. 12
245
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
246
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019 – 2025), August 2019, url, p. 28
247
Enang, O.E. et al., Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents
of Calabar, Nigeria, June 2014, url, p. 1
248
IDF, International Diabetes Federation, IDF Diabetes Atlas 9th edition, 2019, url, pp. 136-137
239

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

5.1.2 National policies and programmes for DM
The Second National Strategic Health Development Plan 2018-2022 and the National MultiSectoral Action Plan for the Prevention and Control of Non-Communicable Diseases 20192025 include the following within the Essential Package of Services to be provided at alllevels: screening for diabetes (routine sugar testing) and risk factors; counselling and support
services; diagnosis and management of diabetes; management of diabetic complications andrehabilitation. 249 However, care in primary healthcare centres (PHCCs) is mostly limited tourine testing for glucose and very few have blood glucose meters. This has been attributed toa shortage of personnel skilled in the management of DM, as well as to a paucity of relevant
infrastructure and equipment for healthcare delivery. 250

5.1.3 Healthcare provisions for DM
There is no national institute specialised in treating DM; rather, screening and risk monitoring
are offered at the primary healthcare (PHC) level – the first port of entry into the country’s
health system – while treatment and advanced care are provided at the secondary andtertiary facilities. The patients diagnosed with DM at PHCCs are rarely treated at this level, but
are rather referred to secondary facilities because PHCCs have often community healthextension workers (CHEWs) and nurses with little or no experience in diabetes management.
At the secondary facility level, individuals with DM are managed by doctors without therequired subspeciality in diabetes while other relevant healthcare workers, such as
chiropodists, diabetes educators and dietitians, are scarce. 251 Specialised services, such as
consultations with diabetologists/endocrinologists or specialised surgeries, are provided at
the tertiary level – the teaching hospitals – distributed across the six regions, which servealso as sites for internships for newly graduated doctors (see table 1 below). 252
S.
No.

Geopoliticalzone

Facility name1

Southeast

Facility type
PublicAbia State University Teaching Hospital, Aba

X

2

Nnamdi Azikiwe University Teaching Hospital, Nnewi

X

3

Ebonyi State University Teaching Hospital, Abakiliki

X

4

University of Nigeria Teaching Hospital, Enugu

X

5

Imo State University Teaching Hospital, Orlu

X

6

Anambra State University Teaching Hospital, Amaku
Awka

X

7

Madonna University Teaching Hospital, Elele

8

Federal University Teaching Hospital, Abakiliki

9South-south

PrivateX
X

University of Uyo Teaching Hospital, Uyo

X

10

University of Calabar Teaching Hospital, Calabar

X

11

University of Benin Teaching Hospital, Benin City

X

12

Delta State University Teaching Hospital, OgharaX

13

Niger Delta University Teaching Hospital, Okolobiri

X

14

Igbinedion University Teaching Hospital, Okada

X

Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018 – 2022, url, pp.73-74;
Nigeria, Federal Ministry of Health, National Multi-Sectoral Action Plan for the Prevention and Control of NonCommunicable Diseases (2019 – 2025), August 2019, url, pp. 56-57
250
Fasanmade, O.A. and Dagogo-Jack, S., Diabetes Care in Nigeria; November-December 2015, url, p. 823
251
Fasanmade, O.A. and Dagogo-Jack, S., Diabetes Care in Nigeria, November-December 2015, url, pp. 822-823
252
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
249

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

S.
No.

Geopoliticalzone

Facility name15

Southwest

Lagos University Teaching Hospital, Idi-Araba

X

16

Olabisi Onabanjo (Ogun state) University Teaching
Hospital, Sagamu

X

17

LAUTECH University Teaching Hospital,
Osogbo/Ogbomosho

X

18

OAU Teaching Hospital Complex, IIe-ife

X

19

University College Hospital, Ibadan

X

20

Babcock University Teaching Hospital, Ilishan-Remo

21

University Teaching Hospital, Ado-ekitiX

22

Lagos State University Teaching Hospital, Ikeja

X

Federal Teaching Hospital, Ido-Ekiti

X

University of Ilorin Teaching Hospital, Ilorin

X

Jos University Teaching Hospital, Lamingo Jos
University of Abuja Teaching Hospital, Gwagwalada

X
X

Benue State University Teaching Hospital, Makurdi

X

23
24
25
26

North
central27
28
29

Facility type
PublicX

Bingham University Teaching Hospital, Jos

X

University of Maiduguri Teaching Hospital, Maiduguri

X30

Abubakar Tafawa Belewa University Teaching Hospital,
BauchiX

31

Federal University Teaching Hospital, Gombe

X

32

Northeast

Northwest

PrivateAminu Kano Teaching Hospital, Kano

X

33

Ahmadu Bello University Teaching Hospital, Zaria

X

34

Usmanu Danfodio University Teaching Hospital, Sokoto

X

Table 13: Regional distribution of tertiary facilities with specialised services for DM in
Nigeria 253

5.2 Access to treatment
Broadly, poverty has been identified as one of the major factors that impacts on an
individual’s willingness to seek healthcare. 254 This is reflected in the Nigerian context where
over 40 % of the population live below the poverty line. 255 In 2018, a descriptive crosssectional study conducted amongst civil servants in the southwestern region in order to
identify factors affecting health-seeking behaviour (HSB) found that respondents’characteristics, such as completing tertiary education, possessing lower household sizes,
belonging to higher socio-economic status quartile and participation in the National Health
Insurance Scheme (NHIS), were important drivers for the respondents’ decision to seek
care. 256 Also, low community awareness of the disease and its related risk factors, lack ofaffordable transport, lack of proximity to health facilities especially for individuals dwelling in
hard-to-reach areas and high cost of care within the context of a poor health insurance
system are amongst the barriers to accessing care. 257

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
254
Adler, N.E. et al., Socioeconomic status and health. The challenge of the gradient, January 1994, url
255
Nigeria, NBS, 2019 Poverty and Inequality in Nigeria: Executive summary, May 2020, url, p. 5
256
Latunji, O.O. and Akinyemi, O.O., Factors Influencing Health-Seeking Behaviour Among Civil Servants In
Ibadan, Nigeria, June 2018, url, p. 59
257
Thaddeus, S., and Maine, D., Too Far to Walk: Maternal Mortality in Context, 1994, url, pp. 1091-1108
253

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Data from 2016 suggest that essential medicines for DM, including insulin, and basic
equipment, such as tuning forks, were unavailable in most primary care facilities, which aremostly based in rural areas (see table 14). 258
Medicines in primary care facilities
Insulin
Metformin
Sulphonylurea
Procedures
Retinal photocoagulation
Renal replacement therapy by dialysis
Renal replacement therapy bytransplantation

Basic technologies in primary carefacilities
Blood glucose measurement
Oral glucose tolerance test
A haemoglobin A1c (HbA1c) test
Dilated fundus examination
Foot vibration perception by tuning fork
Foot vascular status by Doppler
Urine strips for glucose and ketone
measurement

○
●
●
○
○
○

●
●
○
○
○
○
●

Table 14: Availability of medicines, basic technologies and procedures in the public healthsector 259○ = not generally available● = generally available
In secondary and tertiary facilities, nurses are trained to provide basic care to patients, but not
specifically for DM management. Nurses are responsible for bedside urine tests, point-of-careblood glucose determinations, basic nutritional advice, education for insulin self-injection, andinsulin administration for patients with cognitive dysfunction or who are otherwise unable toself-inject. The physician/patient ratio in Nigeria is suboptimal. Hence, in both secondary andtertiary facilities, DM clinics are overstretched with about 5 to 10 doctors seeing 100 to 200
DM patients in very few hours (most clinics run once a week from 8 or 9 AM to 1 to 2 PM).260

5.3 Insurance and national programmes
The NHIS was launched in 2005 and provides health insurance coverage for Nigerians
through three major programmes (see table 15). 261
Programme

Focus

Requirements

Formal sectorsocial healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised private
sector or willing to makevoluntary
individual/family/groupcontributions

1. Public/federal tier Government pays
3.25 % andemployee pays
1.75 % of employee's
basic salary
2. Armed forces Government pays
entire 5 % of
employee's basic
salary3. Private/othergovernment tiers Employer pays 10 %and employee pays
5 % of employee's
basic salary

Scope ofcoverage
Coverhealthcare
benefits for theemployee, aspouse andfour biologicalchildren below
the age of 18
years

DM services covered
1. Outpatient/preventive
care (risk factor
monitoring,prescriptions, etc.)
2. Admission for up to
three weeks
3. Consultation withspecialists(diabetologists/internists)
4. Prescribed drugs,
pharmaceutical care anddiagnostic tests as
contained in the NHIS
Drugs List and NHIS
Diagnostic Test Lists

WHO, Diabetes Country Profiles 2016, Nigeria, April 2016, urlWHO, Diabetes Country Profiles 2016, Nigeria, April 2016, url
260
Fasanmade, O. A. and Dagogo-Jack, S., Diabetes Care in Nigeria, November-December 2015, url, p. 824
261
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
258

259

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Informal sectorsocial healthinsurance
programme

For individuals in theinformal sector. It covers
employees ofcompanies employing 10
or less people, artisans,voluntary participants,rural dwellers andothers not covered
under the formal sector
or the vulnerable group

Vulnerable
group

For indigents and thevulnerable (children
under five, physicallychallenged people,
prison inmates,
pregnant women,orphans and internallydisplaced people)

Community-based
health insurance
scheme - Actuariallydetermined flat rate
fee perhousehold/individual
household member
or member of an
occupation-based
group and paid in
cash monthly orseasonally inadvance
Register with a PHCC
under the Basic
Health Care
Provision Fund
Programme

Scope ofcoverage
For theregisteredindividualalone

DM services covered

For theregisteredindividualalone

As in the public sector

As in the public sector

Table 15: Health insurance programmes in Nigeria 262
There exist varying degrees of insurance coverage for certain DM services; for example, hightechnology investigations, such as computed tomography scan and medical resonanceimaging, are partially excluded (health maintenance organisation would pay 50 % of cost
while provision of contact lens from ophthalmological complications arising from DM is totally
excluded). 263

5.4 Cost of medication
The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 264
The National Agency for Food and Drug Administration (NAFDAC) maintains a database forregistered medications. 265
The prices of medications were collected from six private pharmacies across the country –four in the south and two in the northern regions. 266 Medicines that are only available in theinformal market were not listed.
Generic nameBrand name

DosageForm

Acarbose
Canagliflozin

Precose®
Invokana®

25 mg
100 mgTabletTabletNumberof unitsin thecontainer
10
30

Price per box(USD)
35.3 (35.0-35.6)
54.8 (52.0-57.6)

Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
263
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp.24-25
264
Nigeria, FMoH, Nigeria Essential Medicines List, 7th edition, 2020, url
265
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, n.d., url
266
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
262

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Generic nameBrand name

DosageForm

Numberof unitsin thecontainer
30
90
30
28
28
1

Price per box(USD)

Dapagliflozin
Empagliflozin
Glibenclamide
Gliclazide
Glimepiride
Glucagon

Farxiga®
Glyxambi®
Dionil®
Diamicron®
Amaryl®
Glucagon

10 mg
25 mg
5 mg
60 mg
2 mg
1 mg

Insulin, premixed:
aspart (rapid
acting) and aspart
protamine(intermediate
acting) like
Novomix®
Insulin, premixed:
combination oflispro (rapid
acting) and insulin
lispro protamine(intermediate
acting)Insulin, premixed:
combination ofregular (shortacting) and insulin
isophane(intermediate
acting) like
®Mixtard
Insulin:combination of
insulin degludec(extra long acting)and insulin aspart(rapid acting)
Insulin:intermediate
acting [12-24
hours]; insulin
NPH/isophanelike ®Insulatard
Insulin: longacting [24 hours];
insulin glargine
like ®Lantus
Insulin: rapid
acting[2-5 hours];
insulin aspart like
®Novorapid
Insulin: rapid
acting [2-5 hours];
insulin lispro
Linagliptin
Liraglutide
Metformin
Sitagliptin
Tolbutamide
Vildagliptin

Novomix 30®

100 iu/ml

TabletTabletTabletTabletTabletInjectionpen
Injectionpen1

11.1 (11.0-11.2)

Humalog®

75/25 mg

Injectionpen

1

193 (190.0-196.0)

Mixtard® 30 HM

100 iu/ml

Injection

1

8.5 (8.2-8.8)

Tresiba®

70/30 mgVial

1

57.3 (57.0-57.6)

Insulatard®

100 iu/ml

Vial

1

10.5 (10.0-11.0)

Lantus®

100 iu/ml

Injectionpen1

12.1 (11.8-12.4)

Novorapid®

100 iu/ml

Injectionpen

1

12.3 (12.0-12.6)

Actrapid®

100 iu/ml

Vial1

12.2 (11.9-12.5)

Trajenta®
Victoza®
Panfor®
Janumet®
Tolbutamide®
Galvus®

5 mg
6 mg/ml
100 mg
100 mg
500 mg
50 mg

TabletInjection
TabletTabletTabletTablet

28
1
100
56
28
28

81.7 (80.0-83.4)
101.2 (100.0-102.4)
11.7 (10.9-12.5)
14.7 (14.5-14.9)
4.1 (4.0-4.2)
16.1 (15.9-16.3)

57

116.0 (114.0-118.0)
167.5 (165.0-170.0)
4.7 (4.5-4.9)
25.6 (25.2-26.0)
7.4 (7.2-7.6)
102.9 (100.8-105.0)

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUMTable 16: Details of medication available in the formal market 267

5.5 Cost of treatment
There are no government-driven financial support programmes specifically for the treatmentof DM. 268 About 95 % of the population are yet to benefit from the country’s NHIS; hence, outof-pocket payment at the point of care is the experience of most individuals. 269
The cost of public outpatient and inpatient treatments was obtained from eight facilities – five
privately-owned and three government-owned centres spread across the north central, southsouth and southwestern regions of the country. 270 In private facilities, a specialist consultation
costs less for inpatient care than outpatient care; however, in the long run and with multiple
consultations, inpatient care is more expensive. The total costs incurred by patients can becalculated by summing up all relevant services; however, indirect costs, such as bed rates,
meals and transportation, were not included. 271

Specialist
Consultation by aninternal specialist(internist)
Consultation by an
endocrinologist
Consultation by anophthalmologist
Consultation by aneurologist
Consultation by ageneral practitioner
Consultation by
vascular surgeon(e.g. for diabetic
foot)Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

41.4 (40.0-42.8)

41.4 (40.0-42.8)

60.9 (60.0-61.8)

48.8 (48.0-49.6)

41.4 (40.0-42.8)

41.4 (40.0-42.8)

60.9 (60.0-61.8)

48.8 (48.0-49.6)

41.4 (40.0-42.8)

36.6 (36.0-37.2)

60.9 (60.0-61.8)

60.9 (60.0-61.8)

41.4 (40.0-42.8)

36.6 (36.0-37.2)

85.3 (85.0-85.6)

48.8 (48.5-49.1)

41.4 (40.0-42.8)

24.4 (23.4-25.4)

60.9 (60.0-61.8)

48.8 (48.5-49.1)

41.4 (40.0-42.8)

73.1 (72.9-73.3)

85.3 (85.0-85.6)

48.8 (48.5-49.1)

Table 17: Treatment cost by facility type 272

Laboratory research

Public treatment pricePrivate treatment price

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
268
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021.
269
Alawode, G.O. and Adewole, D.A., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers, January 2021, url, p. 7
270
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021.
271
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021.
272
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
267

58

EUROPEAN UNION AGENCY FOR ASYLUMBlood glucose (including
HbA1C/glyc.Hb)
Renal/kidney function(creatinine, urea,
proteinuria, sodium,
potassium levels)
Laboratory research of
thyroid function (TSH, T4,
T3)
Devices
Blood glucose meter for
self-use by patient
Blood glucose self-test
strips for use by patient
Treatment
Clinical admittance ininternal or endocrinology
department (daily rates)
Laser treatment of diabetic
retinopathy
Ophthalmology: Intravitreal
injections with medication(per shot)

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Public treatment price36.6 (36.0-37.2)

Private treatment price30.7 (30.0-31.4)

85.3 (85.0-85.6)

25.6 (25.0-26.2)

122.0 (120.0-124.0)

255.9 (254.0-257.8)

Not provided to patient29.3 (25.5-33.1)

Not provided to patient19.5 (19.0-20.0)

6.0 (5.0-7.0)

187.7 (185.0-190.4)

267.9 (265.0-270.8)

365.6 (363.0-368.2)

414.2 (410.0-418.4)

487.5 (486.0-489.0)

Table 18: Cost of laboratory investigations by facility type 273

5.6 NGOs
There are a significant number of local and international non-profit organisations in Nigeria;
they are more in the north than the south and the regional discrepancies are largely attributed
to the poor health indices in the northern part of the country. However, the majority of theNGOs do not focus on DM, and for those that do, their actual reach and impact in terms ofassisted people with DM were not found.274
The World Diabetes Foundation (WDF) has supported several health systems strengthening
projects across Nigeria focusing on research, improving access to diabetic care and creatingawareness on DM, including its risk factors. 275 These programmes have varied from one to
five years of implementation. 276
Other examples of NGOs working on diabetes management include:••

Diabetes Association of Nigeria (DAN), a national body for diabetes with overall goalof providing a platform to address the concerns of DM patients in Nigeria throughawareness creation and advocacy to help elevate the management of DM in the
public agenda.
Strategies for Improving Diabetes Care in Nigeria (SIDCAIN) study group, a bodyformed by physicians from three tertiary hospitals in southwestern Nigeria with thegoal of improving care for diabetes and hypertension. So far, this group has set up

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
274
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
275
WDF, Strategies for improving diabetes care WDF08-321, n.d., url; WDF, Strengthening diabetes care in Lagos
state through 35 diabetes clinics, Nigeria, WDF16-1433, n.d., url; WDF, Diabetes awareness and care project inNigeria, WDF17-1474, n.d., url
276
WDF, Diabetes Prevention Project - WDF16-1354, n.d., url; WDF, Gestational Diabetes Program in Niger-Delta WDF16-1347, n.d., url
273

59MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

•
•

277

EUROPEAN UNION AGENCY FOR ASYLUM

several primary and secondary centres for NCD screening and care in some states inthe southwest Nigeria region. Also, SIDCAIN has rolled out treatment guidelines,
educational material and patient support programmes.
Sonny Kuku Foundation (SKF), a centre set up in Lagos State, southwestern Nigeria, toprovide support for patients with DM and other conditions.
The Lee Maeba Foundation and its Diabetes Centre of Excellence, a charitableorganisation set up in Rivers State, the southern part of the country, to provide
diabetes support services, including care, counselling, nutrition and cooking classes,
and free supplies and consultation to diabetes patients and their families. 277

Fasanmade, O. A. and Dagogo-Jack, S., Diabetes Care in Nigeria, November-December 2015, url, pp. 825-826

60

EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

6 Topical Report: Hepatitis
6.1 General information
Hepatitis is an inflammation of the liver which can be self-limiting or can lead to numerous
health conditions, such as liver fibrosis (scarring), cirrhosis or liver cancer. The most common
causes of hepatitis in the world include infections, toxic substances (e.g. alcohol and certain
drugs), autoimmune diseases and hepatitis viruses (mainly types A, B, C, D, and E). Hepatitis
virus type B and C are the most common causes of chronic liver diseases, including livercirrhosis and cancer. 278

6.1.1 Epidemiological context
Nigeria is among the countries with the highest burden of viral hepatitis. 279 According to the2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) report, 280 the hepatitis B virus(HBV) and hepatitis C virus (HCV) prevalence among individuals aged 15 to 64 years stands at
8.1 % (10.3 % in men and 5.8 % in women) and 1.1 % (1.3 % in men and 1.0 % in women),
respectively. 281 Thus, an estimated 20 million Nigerians are living with hepatitis B or hepatitis
C. 282 For HBV, its prevalence peaked at people aged 35 to 39 years (10.2 %) and was lowest
for people aged 55 to 59 years (2.5 %) while HCV prevalence peaked at aged 50 to 54 years(3.3 %) and was lowest at aged 15 to 19 years (0.4 %). HBV and HCV prevalence amongst
pregnant women stood at 5.9 % and 0.6 %, respectively. A disparity was noted amongst theurban and rural populations; prevalence was found to be higher in rural areas (HBV - 8.5 %;HCV - 1.8 %) than amongst urban dwellers (HBV – 7.6 %; HCV – 0.4 %). 283
In 2019, it is estimated that there were approximately 20 245 HBV and 2 965 HCV related
deaths. 284 The key transmission routes for HBV include: from mother to child at birth,needlestick injury, tattooing, piercing and exposure to infected blood and body fluids – saliva,
menstrual, vaginal and seminal fluids. 285 The HCV transmission route is similar to HBV’s
except that sexual transmission, a risk factor, is less common and the HCV is not spread via
breast milk, food, water or casual contact – hugging, kissing, sharing food or drinks with acarrier. 286 Other risk factors for transmission specific to Nigeria include local circumcision,
local uvulectomy, scarification, tribal marks, surgical procedures, body piercing, home birthand receipt of blood transfusions. 287

6.1.2 Strategies and policies for hepatitis
WHO, Hepatitis, September 2019, url
Nigeria, FMoH, National AIDS/STIs Control Program, National Guidelines for the Prevention, Care andTreatment of Viral Hepatitis B & C in Nigeria, 2016, url, p. 10
280
The NAIIS survey was a national house-hold based Survey, with a sample size of 83 909 households and383 574 individuals across 36 States and the FCT. Through this survey, the HIV incidence and prevalence aswell as the viral load suppression and risk behaviours were determined. For the first time, there were estimatesof national HIV incidence and viral load suppression as well as estimates of the prevalence of hepatitis B and C
virus infections. Source: Nigeria, FMoH, NAIIS, 2018 Technical Report, October 2019, url, p. 11
281
Nigeria, FMoH, NAIIS, 2018 Technical Report, October 2019, url, p. 128
282
Nigeria, FMoH, National AIDS/STIs Control Program, National Guidelines for the Prevention, Care andTreatment of Viral Hepatitis B & C in Nigeria, 2016, url, p. 4
283
Nigeria, FMoH, NAIIS, 2018 Technical Report, October 2019, url, pp. 128-134
284
Coalition for Global Hepatitis Elimination, Nigeria, 2019, url
285
Berinyuy, B.E. et al., Prevalence of Hepatitis B Virus in Nigeria: Review Update, November 2019, url, p. 2
286
WHO, Hepatitis C, July 2021, url
287
Nigeria, FMoH, National AIDS/STIs Control Program, National Guidelines for the Prevention, Care andTreatment Of Viral Hepatitis B & C in Nigeria, 2016, url, p. 16
278

279

[M

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

In 2016, the FMoH articulated the first national guidelines for the prevention, treatment andcare of viral hepatitis in Nigeria that encompasses recommended strategies for effective
programme management of viral hepatitis, including health system strengthening,
decentralisation of services, task shifting, logistics management, monitoring and evaluation,and operational research for the control of viral hepatitis in Nigeria. 288 Also, it provides thetreatment protocols to be used by healthcare workers, for screening, treatment and care ofpeople with HBV and HCV infections. 289 Within the Second National Strategic Health
Development Plan 2018-2022 (NSHDP II), the immunisation of infants and high-risk groups(health workers, commercial sex workers and their clients, injection drug users, men who
have sex with men, all antenatal care hepatitis negative clients of traditional birth attendants,
barbers etc.), as well as screening and diagnosis of chronic hepatitis infection werehighlighted as services to be provided at the primary healthcare centre (PHCC) level withreferral to secondary and tertiary facilities for the management of confirmed cases. 290
Screening of hepatitis in pregnant women is included amongst the basket of services to befinanced by the Basic Health Care Provision Fund (BHCPF) 291 – which includes contributions
from grants by international donor partners; funds from any other source; and a minimum of
1% of the consolidated federal government revenue earmarked for provision of healthservices at the PHC level, including emergency health interventions. 292
The NSHDP II includes as part of its key objectives the reduction of the high incidence,
morbidity and mortality caused by viral hepatitis; relevant indicators to track progress arelisted within its monitoring and evaluation plan. 293 By 2022, Nigeria aims to achieve a 50 %reduction in hepatitis B prevalence per 100 000 population. 294 The above policies may
suggest the presence of political will and strategic direction; however, information on
evaluation of these interventions detailing the reality on the ground was not found. 295

6.1.3 Healthcare provisions for hepatitis
The available services for managing hepatitis at PHCCs, as listed within the Ward Minimum
Health Care Package, include lifestyle modification consults and counselling, screening andpre-referral treatment when required. 296 In 2008, the FMoH introduced the Standard
Treatment Guidelines (STG) to guide physicians at the secondary and tertiary facility level on
standardised approaches for managing different ailments, including hepatitis infections. 297
However, a recent study in the south-south geopolitical zone of the country has noted its low
awareness and use amongst doctors for which it was intended for. 298

Nigeria, FMoH, National Guidelines for the Prevention, Care and Treatment Of Viral Hepatitis B & C in Nigeria,
2016, url, p. 11
289
Nigeria, FMoH, National Guidelines for the Prevention, Care and Treatment Of Viral Hepatitis B & C in Nigeria,
2016, url, p. 19-54
290
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018 – 2022, url, p. 66
291
Olakunde B.O. et al., Antenatal hepatitis B screening in Nigeria: a comparative analysis with syphilis and HIV,
August 2021, url
292
Nigeria, FMoH, National Health Insurance Scheme (NHIS) and the National Primary Care Development Agency(NPHCDA), Basic Healthcare Provision Fund, Guidelines for the Administration, Disbursement, Monitoring andFund Management of the Basic Healthcare Provision Fund, August 2016, url, p. 15
293
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018 – 2022, url, p. 65
294
Nigeria, FGoN, Monitoring And Evaluation Plan for the Second National Strategic Health Development Plan
(2018 – 2022), url, p. 16
295
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
296 Nigeria, NPHCDA, Ward Health System, 2018, n.d, p. 24
297
Nigeria, FMoH, Standard Treatment Guidelines, 2008, url
298
Ayinbuomwan, A.S. and Isah, A.O., Standard Treatment Guidelines: Perception and Utilization in a Tertiary
Health Care Facility in South-South, Nigeria, March 2019, url, p. 10288

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There is no dedicated national institute specialised in treating hepatitis; rather internal
medicine departments within tertiary facilities are responsible for treating cases (see list of
tertiary centres in table 13). 299

6.2 Access to treatment
Although guidelines and strategic directions have been developed to guide Nigeria’s
response to viral hepatitis, barriers to access services still exist. A study conducted insoutheastern Nigeria on the uptake of hepatitis vaccination and its determinants amongst
health workers found that vaccination cost (10.8 %), lack of knowledge where to receive thevaccine (47.5 %), individual belief that they could not be infected (6.6 %) and other reasons(51.1 %), such as a long vaccination schedule and lack of time were reasons for poor uptake. 300
More importantly, the allocation of healthcare resources is skewed towards secondary andtertiary facilities that are largely sited in urban regions; hence, care is not easily accessible torural dwellers. 301
For some individuals that are able to reach healthcare facilities, financial barriers mitigate
against access to screening and treatment for hepatitis. 302 Although the government
established the National Health Insurance Scheme (NHIS) to prevent individuals fromcatastrophic expenditure on health, only a minority of Nigerians (approximately 5 %) arecovered and the rest pay out of pocket at the point of care. 303 Also, primary healthcare
workers are not adequately trained and equipped to diagnose and treat patients with chronic
hepatitis B and hepatitis C. 304

6.3 Insurance and national programmes
The NHIS was launched in 2005 and provides health insurance coverage for Nigerians
through three major programmes (see table 19). 305
Programme

Focus

Requirements

Formalsector social
healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised
private sector or willingto make voluntaryindividual/family/groupcontributions

1. Public/federal tier Government pays
3.25 % andemployee pays 1.75
% of employee's
basic salary
2. Armed forces Government pays
entire 5 % of

Scope ofcoverage
Coverhealthcare
benefits
for theemployee,a spouse
and 4
biologicalchildrenbelow theHepatitis services covered
1. Outpatient/preventive care(vaccination, screening andtreatment)
2. Admission for up to threeweeks
3. Consultation with specialists(internists/gastroenterologists)
4. Prescribed drugs,
pharmaceutical care anddiagnostic tests as contained in

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
300
Omotowo, I.B. et al., Uptake of hepatitis B vaccination and its determinants among health care workers in a
tertiary health facility in Enugu, South-East, Nigeria, June 2018, url, pp. 3-4
301
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
302
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
303
Alawode, G.O. and Adewole, D.A., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers, January 2021, url, p. 1
304
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
305
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5299

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Programme

Focus

Informalsector social
healthinsurance
programme

For individuals in theinformal sector; itcovers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers and others
not covered under theformal sector or thevulnerable group

Vulnerable
group

For indigents and thevulnerable (children
under-5, physicallychallenged people,
prison inmates,
pregnant women,orphans and internallydisplaced people)

Requirements
employee's basic
salary3. Private/othergovernment tiers Employer pays 10 %and employee pays
5 % of employee's
basic salaryCommunity-based
health insurance
scheme - Actuariallydetermined flat rate
fee perhousehold/individual
household member
or member of an
occupation-based
group and paid in
cash monthly orseasonally inadvance
Register with a
PHCC under the
Basic Health Care
Provision Fund
Programme

EUROPEAN UNION AGENCY FOR ASYLUM

Scope ofcoverage
age of 18
years

Hepatitis services covered

For theregisteredindividualalone

As in public sector

For theregisteredindividualalone

As in public sector

the NHIS Drugs List and NHIS
Diagnostic Test Lists

Table 19: Health insurance programmes in Nigeria 306
There exist varying degrees of insurance coverage for certain hepatitis services; for example,
high-technology investigations, such as computed tomography scan and magnetic resonanceimaging, are partially excluded (health maintenance organisation would pay 50 % of cost). 307
The Clinton Health Access Initiative (CHAI), through its access programme, has subsidised
costs of HCV diagnostics in health centres in three states in Nigeria – Lagos, Abuja andKwara. In addition, CHAI has partnered with the state government to provide affordable HCV
ribonucleic acid (RNA) test at USD 35 per person for residents of Nasarawa state in the northcentral region of Nigeria. 308

6.4 Cost of medication
Antiviral medications are helpful in lowering the impact of infection on patients, but do notprovide cure. Individuals infected with hepatitis may require life-long treatment. 309 There ispoor adherence to treatment due to high cost of medications, as well as unavailability of key
medications. 310

Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
307
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp.24-25
308
Hepatitis B Foundation, The Journey to Hepatitis Elimination in Nigeria, January 2020, url
309
WHO, Guidelines on hepatitis B and C testing, February 2017, url, p. 24
310
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
306

64EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 311
The National Agency for Food and Drug Administration (NAFDAC) maintains a database forregistered medications. 312
The prices of medications were collected from six private pharmacies across the country –four in the south and two in the northern regions. 313 Medicines which are only available in theinformal market have been excluded. See more details of medication cost in the methodology
section of the introduction.
Generic Name

Brand name Dosage

Hepatitis B medication
Entecavir
Vega®
1 mg
Hepatitis C medication
Daclatasvir
Mylan®
60 mg
Ledipasvir + sofosbuvir
Apraser®
90/40 mg(combination)
Ribavirin
Okychris®
400 mgSofosbuvir
Mylan®
400 mgsofosbuvir + velpatasvir
Epclusa®
400/100 mg(combination; e.g. Epclusa®)
Both hepatitis B and C (classic medication)
Peg interferon alfa 2a
Pegasys
180 mcg
PFs®
Interferon alfa 2a
Pegasy PFs 180 mcg

Form

Number ofunits in thecontainer

Price per box (USD)

tablet30

7.5 (7.0-8.0)

tablettablet60
60

132.0 (130.0-134.0)
292.5 (290.0-295.0)

tablettablettablet4230
30

51.2 (50.0-52.4)
142.6 (140.0-145.2)
325.4 (323.5-327.3)

vial

0.5 ml97.5 (96.5-98.5)vial

0.5 ml97.5 (96.5-98.5)

Table 18: Details of medication available in the formal market in Nigeria 314

6.5 Cost of treatment
The cost of outpatient and inpatient treatments are higher in private facilities as compared tothe public ones irrespective of the geographical region. Public facilities provide cheaper
consultation and laboratory services but with longer waiting times. 315
The cost of public outpatient and inpatient treatments was obtained from eight facilities – five
privately owned and three government-owned centres spread across the northcentral, southsouth and southwestern regions of the country. The values indicated in each cell is theaverage sum of the values collated from the visited facilities. The total direct costs incurred bypatients can be approximated by summing all relevant services; indirect costs such as travel
and lost wages were not included. All medications incur supplementary charges. Of note,
inpatient costs are not inclusive of food. 316

Nigeria, FMoH, Nigeria Essential Medicines List, 7th edition, 2020, url
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, n.d., url
313
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
314
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
315
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
316
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
311

312

65

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIASpecialist
Consultation byinternist (orinfectiologist)
Consultation by agastroenterologist

EUROPEAN UNION AGENCY FOR ASYLUM

Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

41.4 (40.8-42.0)

41.4 (40.8-42.0)

60.9 (60.5-61.3)

48.7 (48.5-48.9)

41.4 (40.8-42.0)

41.4 (40.8-42.0)

60.9 (60.5-61.3)

48.7 (48.5-48.9)

Table 19: Treatment cost by facility type 317
Public treatment price (USD)
Laboratory tests for hepatitis B and hepatitis C
Laboratory research of hepatitis B
17.9 (17.5-18.3)
antibodies; HBsAb, HBeAb, HBcAb
Laboratory research of hepatitis B
121.8 (120.5-123.1)
antigens; HBsAg, HBeAg
Laboratory research of HBV DNA
85.3 (84.8-85.8)
testing in case of Hepatitis B
Laboratory research of HCV RNA
85.3 (84.8-85.8)
test [Hepatitis C]
Laboratory research of liver function
12.2 (12.0-12.4)(PT, albumin, bilirubin,transaminases: ASAT(=SGOT),
ALAT(=SGPT) etc.)
Diagnostics for hepatitis
Diagnostic imaging by means of
10.9 (10.5-11.4)
ultrasound (of the liver)Diagnostic research, in the form of
36.6 (36.0-37.2)
liver biopsy
Diagnostic research: transient73.1 (73.0-73.2)
elastography; test for liver fibrosis(eg fibroscan)
Treatment
Clinical admittance on internal/60.9 (59.5-62.3)
infectious disease department (dailyrate)

Private treatment price (USD)
48.7 (48.5-48.9)
17.9 (16.8-19.0)
153.6 (152.5-154.7)
204.8 (203.2-206.4)
20.5 (20.0-21.0)

25.6 (24.5-26.7)
Not available
Not Available

187.6 (186.0-189.2)

Table 20: Cost of laboratory investigations by facility type 318

6.6 NGOs
The following NGOs working in the field of hepatitis are present in the country:•

CHAI has worked in several countries since 2016 including Nigeria with the aim toincrease the access to HCV testing and treatment. CHAI provides assistance tonational bodies to update clinical guidelines and the national strategic plan for viral
hepatitis. Further CHAI supported the Nasarawa state government to create a fiveyear elimination costing plan. 319

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
318
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
319
CHAI, Annual Report 2020, 2021, url, p. 59, 62
317

66

EUROPEAN UNION AGENCY FOR ASYLUM•MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAThe Yakubu Gowon Centre works with the Taraba state government with the aim toprovide affordable diagnostics and treatment on HCV for individuals residing in thestate. 320

June 2021

320

Hepatitis B Foundation, The Journey to Hepatitis Elimination in Nigeria, January 2020, url

67[Month] 2020

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

7 HIV/AIDS
7.1 General information
Human immunodeficiency virus (HIV) is an infection that targets and weakens the body’s
immune system. HIV destroys the white blood cells known as cluster of differentiation 4 (CD4)cells, thus making the organism susceptible to opportunistic infections such as tuberculosis(TB) and fungal infections, severe bacterial infections, and some cancers. 321 Following the
progressive deterioration of the immune system, acquired immunodeficiency syndrome(AIDS) is the final stage of HIV infection, characterised by the occurrence of opportunistic
infections or cancers. 322

7.1.1 Epidemiological context
There has been a decline in the estimated deaths from HIV/AIDS in Nigeria from 70 000 in2009 to 51 000 in 2019. 323 Although, it still remains the fifth leading cause of death inNigeria. 324 According to the 2020 Joint United Nations Programme on HIV/AIDS (UNAIDS)
report, there are approximately 1.7 million people living with HIV/AIDS (PLWHA) representing
less than 1 % of Nigeria’s population. 325 The 2018 Nigeria HIV/AIDS Indicator and Impact
Survey (NAIIS) estimated the HIV prevalence among the working-age population (15-64 years)
to be 1.4 %. This was lower among men (1.0 %) than women (1.8 %) and lower in urban (1.3 %)areas than in rural (1.5 %) areas. 326 In 2018, the annual HIV incidence among the working age
population stood at 0.08 % (women 0.12 %, men 0.05 %) corresponding to 8 new infections
per 10 000 persons per year and peaked at 0.22 % among women aged 25-34 years and at
0.10 % among men in the same age group. 327 Regional variation in HIV prevalence exists; thesouth-south zone has the highest regional prevalence (3.1 %) among adults aged 15-49 years
as compared to the north-central, south-east, south-west, north-east and north-west zones,
which stands at 2.0 %, 1.9 %, 1.1 %, 1.1 % and 0.6 %, respectively. 328
PLWHA are at risk of contracting other diseases, such as TB, hepatitis B virus (HBV) andhepatitis C virus (HCV). In 2018 the overall prevalence of HBV and HCV infections among HIVpositive adults aged 15-64 years was 8.9 % (13.3 % in men and 6.5% in women) and 1.1 %(0.8 % in men and 1.2 % in women) respectively. 329 According to the 2018 NAIIS, about 9.9 %of adult PLWHA had ever visited a clinic for TB evaluation of which 40.4 % were diagnosed
with TB.330

7.1.2 Strategies and policies for HIV/AIDS
Nigeria has demonstrated strong political will in the fight against HIV/AIDS. In December
2016, the FMoH revised its guidelines to a ‘test and treat approach’ expanding antiretroviralWHO, HIV/AIDS, n.d., urlWHO, HIV/AIDS, July 2021, url
323
UNAIDS, Nigeria Fact Sheet, 2019, url, accessed 7 June 2021
324
Institute for Health Metrics and Evaluation, Nigeria Dashboard, 2019, url
325
UNAIDS, Nigeria Fact Sheet, 2019, url, accessed 7 June 2021
326
Nigeria, FMoH, NAIIS 2018: Technical Report, October 2019, url, p. 47
327
Nigeria, FMoH, NAIIS 2018: Technical Report, October 2019, url, p. 45
328
UNAIDS, Press release: New survey results indicate that Nigeria has an HIV prevalence of 1.4%, March 2019, url
329
Nigeria, FMoH, NAIIS 2018: Technical Report, October 2019, url, pp. 128-132
330
Nigeria, FMoH, NAIIS 2018: Technical Report, October 2019, url, p. 13
321

322

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

therapy (ART) eligibility to all confirmed cases irrespective of WHO clinical stage and CD4+
cell count, and recommended initiation of ART once patients are willing and ready to startART for life. 331 Subsequently, the country adopted the National HIV and AIDS Strategic Plan
2017-2021 and the Revised National HIV and AIDS Strategic Framework 2019-2021 to guidethe country’s future response to HIV. 332 Nigeria aims to reduce the incidence of HIV infections
by 70 % by 2022.333
Voluntary counselling and prevention of mother-to-child transmission of HIV/AIDS at the
primary healthcare level and treatment of co-morbid conditions, such as diarrhoea andpneumonia, are included amongst the basket of services to be financed by the Basic
Healthcare Provision Fund – which represents a minimum of 1 % of the consolidated federal
government revenue earmarked for provision of health services at the primary healthcare(PHC) level, including emergency health interventions. 334

7.1.3 Healthcare provisions for HIV/AIDS
Available services for managing HIV at primary healthcare centres (PHCCs), as listed within
the Ward Minimum Health Care Package, include voluntary counselling, screening, andtreatment (including for opportunistic infections). 335 Due to healthcare worker shortages
especially in rural communities, the FMoH articulated a systematic approach for ART
decentralisation within the task shifting and task sharing policy. The implementation ofdecentralised ART services includes shifting and sharing HIV management tasks fromphysicians to non-physicians, from nurses to community health extension workers (CHEWs)
and subsequently to trained peer educators, patients, and communities. 336

7.2 Access to treatment
Despite the National effort at eliminating HIV/AIDS, UNAIDS estimates that the coverage of
HIV/AIDS services is sub-optimal. Approximately 65 % of adults and children living with HIV
receive ART, leaving about a 35 % coverage gap. This varies across different segments of the
population with the highest coverage in women above age 15 at 80 %, and lowest in children
between the age 0 and 14 at 36 %. 337 Information on the treatment of opportunistic infections
and co-morbidities is very limited.
Factors that mitigate access to HIV/AIDS treatment in Nigeria are grouped into three
categories, namely: health systems related, patients-related and community-related. 338 The
health system related barriers encompasses high cost of ARTs, shortage of health manpower,
highly congested and dilapidated healthcare facilities and knowledge gap amongst healthworkers. The patient-related impediments to access include long distance to service delivery
points, extended waiting time, indirect costs and user fees, while the community-related

Nigeria, FMoH, National Guidelines for HIV Prevention, Treatment and Care, 2016, url, pp. 4-5, 197
Nigeria, NACA, National HIV and AIDS Strategic Plan 2017-2021, December 2017, url, p. 20; Nigeria, NACA,
Revised National HIV and AIDS Strategic Framework 2019-2021: Future Directions for the HIV/AIDS Response
in Nigeria, n.d., url, p. 16
333
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 65
334
Nigeria, FMoH, National Health Insurance Scheme (NHIS) and the National Primary Care Development Agency(NPHCDA), Basic Healthcare Provision Fund, Guidelines for the Administration, Disbursement, Monitoring andFund Management of the Basic Healthcare Provision Fund, August 2016, url, pp. 41-42
335
Nigeria, NPHCDA, Ward Health System, 2018, pp. 20-24
336
Nigeria, FMoH, Task-shifting and Task-sharing Policy for Essential Health Care Services in Nigeria, August
2014, url, pp.41-42
337
UNAIDS, Nigeria Fact Sheet, 2019, url
338
Jalal-Eddeen, A.S. and Adamu, H.I., Barriers to HIV/AIDS Treatment in Nigeria, January 2015, url, pp. 306-307
331

332

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barriers include stigma and discrimination against people living with HIV/AIDS, gender
discrimination against PLWHA and sociocultural misconceptions. 339

7.3 Insurance and national programmes
The National Health Insurance Scheme (NHIS) was launched in 2005 and provides healthinsurance coverage for Nigerians through three major programmes (see Table 21). 340
Programme

Focus

Requirements

Formal sectorsocial healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised private
sector or willing to makevoluntary
individual/family/groupcontributions

1. Public/federal tier:
Government pays
3.25 % and employee
pays 1.75 % of
employee's basic salary
2. Armed forces:
Government pays
entire 5 % of
employee's basic salary
3. Private/othergovernment tiers:
Employer pays 10 %and employee pays
5 % of employee's
basic salary

Informalsector social
healthinsurance
programme

For individuals in theinformal sector. It covers
employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers and others notcovered under theformal sector or thevulnerable group

Vulnerable
group

For indigents and thevulnerable (Children
under five, physicallychallenged persons,prison inmates,
pregnant women,orphans, and internallydisplaced persons)Community-based
health insurance
scheme - actuariallydetermined flat rate fee
perhousehold/individual
household member ormember of an
occupation-based
group and paid in cash
monthly or seasonallyin advance
Register with a PHCC
under the Basic
Healthcare Provision
Fund programme

Scope ofcoverage
Coverhealthcare
benefits for theemployee, aspouse and 4
biologicalchildren below
the age of 18
years

For theregisteredindividual alone

For theregisteredindividual alone

HIV/AIDS services
covered1.
Outpatient/preventive
care (voluntary
counselling,
screening andtreatment)
2. Admission for up to
three weeks for comorbidities
3. Consultation withspecialists(internists/HIV
specialists)
4. Prescribed drugs,
pharmaceutical careand diagnostic tests
as contained in the
NHIS drugs list and
NHIS diagnostic test
lists
As in public sector

As in public sector

Table 21: Health insurance programmes in Nigeria 341

Jalal-Eddeen, A.S. and Adamu, H.I., Barriers to HIV/AIDS Treatment in Nigeria, January 2015, url, p. 307
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p.5
341
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
339

340

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There exist varying degrees of insurance coverage for certain cross-cutting services, which
may be required in treatment of HIV-related complications, for example, high-technology
investigations, such as computed tomography (CT) scan and magnetic resonance imaging(MRI). These are partially excluded (health maintenance organisation would pay 50 % ofcost). 342

7.4 Cost of medication
The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 343
The National Agency for Food and Drug Administration (NAFDAC) maintains a database forregistered medications. 344
Antiretroviral medications for HIV are free of charge and available in most government-owned
health facilities but may not be free at privately owned pharmacies. 345
The prices of medications were collected from six private pharmacies across the country –four in the south and two in the northern regions. 346 Medicines that are only available in theinformal market have been excluded. See more details of medication cost in the methodology
section of the introduction.
Generic name

Brand
name

Single antiretrovirals/ARVs
Atazanavir
Mylan®
Darunavir
Prezista®
Dolutegravir
Aurobindo
Efavirenz
Hetero®
Lamivudine (bothKwality®
for hepatitis B andHIV)*
Nevirapine
Mylan®
Raltegravir*
Isentress®
Ritonavir*
Generic
Tenofovir
Mylan®
alafenamide (forboth hepatitis B
and HIV)*
Tenofovir
Kwality®
disoproxil (for both
hepatitis B andHIV)*
Zidovudine*
Aurobindo®
Combination with 2, 3 or 4 ARVs
Atripla®
Atripla®
(combination ofefavirenz/
emtricitabine/

DosageForm

Number ofunits in thecontainer

Price per box (USD)

300 mg
600 mg
50 mg
600 mg
150 mgtablettablettablettablettablet

60
60
30
30
30

87.8 (87.0-88.6)
124.3(123.0-125.6)
51.2 (50.0-52.4)
14.6 (14.0-15.2)
12.2 (11.9-12.5)

200 mg
400 mg
100 mg
300 mgtablettablettablettablet

60
60
30
30

29.3 (28.9-29.7)
270.5 (270.0-271.0)
7.3 (7.1-7.5)
87.7 (86.0-89.4)

300 mgtablet30

26.8 (26.2-27.4)

300 mgtablet60

29.3 (28.9-29.7)

200 mgtablet30

36.6 (36.2-37.0)

Nigeria, NHIS, Operational Guidelines, October 2012, url, pp.24-25
Nigeria, FMoH, Nigeria Essential Medicines List, 2020, url
344
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, n.d., url
345
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
346
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
342
343

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Generic name

Brand
name

DosageForm

EUROPEAN UNION AGENCY FOR ASYLUM

Number ofunits in thecontainer

Price per box (USD)

tenofovir
disoproxil)*
Combivir®
Combivir®
150/300 mg
tablet60
21.9 (21.3-22.5)(combination ofzidovudine/
lamivudine)*
Descovy®
truvada®
200/300 mg tablet
30
58.5 (57.8-59.2)(combination of
emtricitabine/
tenofovir
alafenamide)
Epzicom® Kivexa®
Epzicom®
300/600 mg tablet
30
19.5 (18.9-20.1)(combination of
abacavir andlamivudine)*
Kaletra®
Kaletra®
200/50 mg
tablet/87.8 (87.2 88.4)(combination oflopinavir/ritonavir)*
Truvada®
Truvada®
200/300 mg tablet
30
58.5 (57.6-59.4)(combination of
emtricitabine/
tenofovir
disoproxil)*
Medication for opportunistic infections (e.g. antibiotics, antivirals and antifungals)
Acyclovir*
Accord®
400 mgtablet28
24.3 (23.8-24.8)
Cefotaxim
Taxim®
1gvial
1
3.7 (3.5-3.9)
Ceftriaxone*
Rocephin®
1gvial
114.6 (14.2-15.0)
Doxycycline*
Hovid®
100 mgcapsule 100
29.3 (28.9-29.7)
Fluconazole*
Diflucan®
50 mg
capsule 3
9.8 (9.4 -10.2)
Itraconazole*
Sporanox®
100 mgcapsule 15
19.7 (18.9-20.5)
Nystatin*
Mycosop®
100 000syrup
30 ml
3.7 (2.9-4.5)
iu/ml

Table 82: Details of medication available in the formal market 347* Provided for free at public facilities.

7.5 Cost of treatment
In line with government policies, there should not be any user fees for HIV treatment services,
including monitoring and distribution of ARTs. However, it is not uncommon for patients to be
charged with consultation and testing fees prior to knowing their HIV status. Government
facilities provide HIV services for free. However, the long waiting time and the need for
privacy may inform patient decision to seek care in privately owned centres where user fees
are required. 348
The cost of inpatient and outpatient care is higher in private hospitals when compared to
public facilities. The increased price relates primarily to the cost of the room, consultations
and tests. The cost of public outpatient and inpatient treatment was obtained from eightfacilities – five privately owned and three government-owned centres distributed across thenorth-central, south-south and south-western regions of the country. The total direct costs
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
348
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
347

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

incurred by patients can be approximated by summing all relevant services; indirect costs,
such as travel and lost wages were not included. All medications incur supplementarycharges. It is to be noted that inpatient costs are not inclusive of food and lost daily wage. 349

Specialist
Consultation by internist(or infectiologist)
Consultation by HIV
specialist

Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Privateoutpatient
treatment price(USD)

Private inpatient
treatment price
(USD)

Free

Free

85.3 (84.8-85.8)

85.3 (84.8-85.8)

Free

Free

85.3 (84.8-85.8)

85.3 (84.8-85.8)

Table 23: Treatment cost by facility type 350
Public treatment price (USD)
Laboratory measurements
Viral load countFree
CD4 count
Free
Laboratory research:Free
resistance test for
antiretroviral drugs
Treatment
Clinical admittance on
60.9 (59.8-62.0)
internal/
infectious diseasedepartment (daily rate)

Private treatment price (USD)
134.1 (133.8-134.4)
48.8 (47.8-49.8)
901.6 (900.0-903.2)

187.7 (186.8-188.6)

Table 29: Cost of laboratory investigations by facility type 351

7.6 NGOs
Since 2003, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided overUSD 6 billion in Nigeria’s national HIV/AIDS response. This financial aid covers policy
development, human capacity development, HIV counselling and testing services, and healthsystem strengthening, including the provision of state-of-the art laboratories andpharmaceutical warehouses, to enhance Nigeria’s health systems to tackle HIV/AIDS, as wellas other diseases. 352 On 18 March 2021, PEPFAR launched three grants worth USD 900
million to support the fight against HIV, TB, and malaria, during the 2021-2023
implementation period. This will be jointly implemented by the National Agency for theControl of AIDS (NACA), Family Health International 360, the National Tuberculosis andLeprosy Control Programme, the Lagos State Ministry of Health, the Institute of Human
Virology, the National Malaria Elimination Programme, and Catholic Relief Services. 353

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
350
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
351
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
352
US Embassy and Consulate in Nigeria, PEPFAR, 2021, url
353
The Global Fund, Nigeria and Global Fund Launch New Grants to Fight HIV, TB and Malaria, March 2021, url
349

73MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

8 Psychiatry
8.1 General information
Psychiatry is a field of medicine that is concerned with the causes, prevention, diagnosis andtreatment of mental and behavioural disorders. 354 The focus here will be mood disorders,such as depression; anxiety disorders, such as post-traumatic stress disorders (PTSD);
psychotic disorders, such as schizophrenia and bipolar disorders; sleeping disorders; andaddiction problems, such as alcohol and opioid addiction.

8.1.1 Epidemiological context
There are limited reliable mental health prevalence data in Nigeria as the data are notroutinely collected and reported in health facilities. 355 The 2019 Global Burden of Disease
study estimated that 2.76 % of the entire Nigerian population suffers from depressive
disorders, which is equal to over 5.8 million people. This is lower than the projected global
prevalence, which stands at 3.76 %. 356 A 2020 study conducted in Southeast Nigeria foundthat the prevalence of mental illness may be considerably higher. According to this study,
70 % of respondents had depressive disorders. 357
Several studies have demonstrated the varying effect of mental health disorders on displaced
populations – including internally displaced, refugees and returnees – in Nigeria. 358 Since
2013, the Boko Haram insurgency, including farmer-herder clashes in Nigeria, has left almost
2 million people displaced and 10 million in need of life-saving services. 359

8.1.2 Strategies and policies for psychiatry
In 2013, the Federal Ministry of Health (FMoH) articulated the National Policy for Mental HealthService Delivery with the intention that mental, neurological and substance abuse (MNS) careshould be made available to all citizens within the national health system at the level ofprimary healthcare centre (PHCC) and in all communities. 360 Some commentators argue that
this policy is situated within the outdated Lunacy Act of 1958, 361 which is yet to be updated
after two failed attempts of revising it in 2003 and 2013. In 2009, the 2003 mental health bill
was withdrawn. A 2020 position paper suggested that a revision of the outdated law willallow for adequate allocation of resources to address Nigeria’s rising mental health needs. An
ongoing dialogue on revision of the Lunacy Act within the Senate led to a public hearing for
the Mental Health and Substance Abuse Bill, which was held on 19 February 2020. 362
Trivedi, J.K. and Goel, D., What psychiatry means to us, 2006, url, p. 168
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
356
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
357
Stanley, N. and Chinwe, E.S., Prevalence of Mental Disorders in Abakaliki, Ebonyi State, Southeastern Nigeria,
August 2020, url, p. 5
358
Morina, N. et al., Psychiatric Disorders in Refugees and Internally Displaced Persons After Forced
Displacement: A Systematic Review, September 2018, url, pp. 5-6; Amodu, O.C. et al., A Scoping Review of the
Health of Conflict-Induced Internally Displaced Women in Africa, February 2020, url, pp. 16-17
359
Kaiser, B.N. et al., Mental health and psychosocial support needs among people displaced by Boko Haram in
Nigeria, March 2020, url, p. 1
360
Nigeria, FMoH, National Policy For Mental Health Services Delivery, August 2013, url, p. 5
361
Ude, P.U., Policy Analysis on Nigerian Lunacy Act (1958): The Need for a New Legislation, 2015, url, p. 1
362
Ugochukwu, O. et al., The time is now: reforming Nigeria’s outdated mental health laws, August 2020, url, p. 1
354

355

74

EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAThe Second National Strategic Health Development Plan II (2018-2022) aims, as part of its key
objectives, to improve the mental health and psychosocial well-being of the Nigerian
populace by reducing the prevalence of serious, moderate and mild mental illnesses andsubstance abuse disorders. 363 The above policies may suggest the presence of political will
and strategic direction; however, information on evaluation of these interventions detailingthe reality on the ground was not found. 364

8.1.3 Healthcare provisions for psychiatry
Although the PHCCs are the first entry point for patients into Nigeria’s health system, the PHC
workers are too few and do not possess the requisite skills to counsel, detect, screen for andtreat mental disorders. 365 Hence, cases are referred to designated mental health facilities thatare faraway for most rural dwellers. Nigeria has designated facilities across the six
geopolitical zones for managing mental health disorders and they are as follows:
•

•
•
•
•
•
•
•
•
•

The Neuropsychiatric Hospital, Aro, Abeokuta: Government-owned psychiatry facility
located in the southwest geopolitical zone.
Yaba Psychiatric Hospital: Government-owned psychiatry facility located in thesouthwest geopolitical zone.
The Federal Neuropsychiatric Hospital, Kaduna: Government-owned psychiatry
facility located in the northwest geopolitical zone.
Federal Psychiatric Hospital, Calabar: Government-owned psychiatry facility locatedin the south-south geopolitical zone.
Federal Neuro-Psychiatric Hospital, Benin City: Government-owned psychiatry
facility which was set up in 1964 and situated in south-south geopolitical zone.
Federal Neuro-Psychiatric Hospital, Sokoto: Government-owned psychiatry facility
situated in the northwest geopolitical zone.
Federal Neuro-Psychiatric Hospital, Maiduguri: Government-owned psychiatry
facility located in the northeast geopolitical zone.
Federal Neuro-Psychiatric Hospital, Enugu: Government-owned psychiatry facility
located in the southeast geopolitical zone.
Tranquil and Quest: Privately owned psychiatry facility located in the southwest
geopolitical zone offering psychiatric evaluations, medication protocols, substanceabuse treatments, individual therapy, family therapy and group therapy.
Synapse Services: Privately owned psychiatry facility located in the north-central
geopolitical zone. 366

8.2 Access to treatment
A 2006 study reported that less than 10 % of individuals with severe or mild mental healthconditions had received care any time in the 12-month period during the study. 367 There arefewer than 300 psychiatrists for a population of more than 200 million people, skewed
towards the urban areas, and in view of poor knowledge of mental disorders at the primary

Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 72
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
365
Gureje, O. et l., Integrating mental health into primary care in Nigeria: report of a demonstration project using
the mental health gap action programme intervention guide, June 2015, url, p. 2
366
Nigeria, Public Health Nigeria, List of Psychiatric Hospitals in Nigeria, July 2020, url
367
Gureje, O. et al., Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Healthand Well-Being, 2006, url, p. 467
363

364

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

health care level, families in rural areas are left to cater to their affected family members. 368 In
contrast, as in 2015, there were about 46 472 psychiatrists in the USA for a population of 330
million. 369 Also, the figures for other mental health professionals are low, with total mental
healthcare workers at 0.9 per 100 000 population, further disaggregated into 0.70 nurses per
100 000 people; 0.02 psychologists per 100 000 individuals; 0.10 psychiatrists per 100 000
population; 0.04 social workers per 100 000 individuals; and 0.01 occupational therapists per
100 000 individuals. In addition, for inpatient care per 100 000 population, mental ward
hospital beds and general hospital psychiatric unit beds stand at 1.3 per 4.8 annual
admissions and 0.2 per 2.2 annual admissions, respectively. 370
At the community level, mental illnesses are not treated due to societal myths,
misconceptions and stigma associated with them. 371 In some rural communities, schizophrenia
and depression are not discussed rather attributed to the influence of witches or demonpossession while others believe that the mentally ill can “snap out of it” with sustained
effort. 372
Other challenges confronting access to mental healthcare in Nigeria include weak legislative
support to the review of existing laws, poor budgetary allocation (only 3.3 % of federal healthbudget goes to mental health, with 90 % of it spent on tertiary care), acute shortages ofskilled human resources at tertiary level and dearth of non-specialised skills at lower levels of
the health system to detect and manage mental health problems, failure to implement the
integration of mental health into primary healthcare and lack of mental health programmes
especially at lower levels of care. 373

8.3 Insurance and national programmes
The National Health Insurance Scheme (NHIS) was launched in 2005 and provides healthinsurance coverage for Nigerians through three major programmes (see Table 25). 374
Programme

Focus

Requirements

FormalSectorSocialHealthInsurance
Programme(FSSHIP)For individuals
employed within the
public/organised
private sector or willingto make voluntaryindividual/family/groupcontributions

1. Public/federal tier Government pays
3.25 % and employee
pays 1.75 % of
employee's basic
salary2. Armed forces Government pays
entire 5 % of
employee's basic
salary3. Private/othergovernment tiers -Scope ofcoverage
Coverhealthcare
benefits
for theemployee,aspouseand 4
biologicalchildrenbelow theage of 18
years

Psychiatry services covered
1. Outpatient care (risk factor
monitoring and prescriptions
for psychosomatic illnesses,
insomnia and other mental
health illnesses as may belisted from time to time by the
NHIS)
2. Admission for up to threeweeks
3. Consultation with specialists(psychiatrists/psychologists)
4. Prescribed drugs,
pharmaceutical care andObianuju, U. et al., The time is now: reforming Nigeria’s outdated mental health laws, August 2020, url, p.
e989; Onyemelukwe, C., Stigma and mental health in Nigeria: some suggestions for law reform, 2016, url, p. 64
369
Satiani, A. et al., Projected Workforce of Psychiatrists in the United States: A Population Analysis, June 2018,
url, p. 711
370
WHO, Nigeria, Mental Health Atlas country profile 2014, n.d., url
371
Onyemelukwe, C., Stigma and mental health in Nigeria: some suggestions for law reform, 2016, url, pp. 63-64
372
Soroye, M.O. et al., Community Psychiatry Care: An Urgent Need in Nigeria, May 2021, url, p. 1146
373
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 25
374
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
368

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EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Informal
SectorSocialHealthInsurance
Programme(ISSHIP)For individuals in theinformal sector. It
covers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers and others
not covered under theFormal Sector or the
Vulnerable Group

Vulnerable
Group

For indigents and thevulnerable (children
under five, physicallychallenged persons,prison inmates,
pregnant women,orphans and internallydisplaced persons)

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Requirements
Employer pays 10 %and employee pays
5 % of employee's
basic salaryCommunity-based
health insurance
scheme - actuariallydetermined flat rate
fee perhousehold/individual
household member
or member of an
occupation-based
group and paid in
cash monthly orseasonally in advance
Register with a PHCC
under the Basic
Healthcare Provision
Fund programme

Scope ofcoverage

Psychiatry services covered

For theregisteredindividualalone

As in public sector

For theregisteredindividualalone

As in public sector

diagnostic tests as containedin the NHIS drugs list and NHIS
diagnostic test lists

Table 25: Health insurance programmes in Nigeria 375
Mental health services for managing conditions, such as drug abuse and addiction, are totally
excluded from the benefit package of the NHIS. 376

8.4 Cost of medication
All the drugs listed in the table below are contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 377
The National Agency for Food and Drug Administration (NAFDAC) maintains a database forregistered medications. 378
The prices of medications were collected from six private pharmacies across the country –four in the south and two in the northern regions of the country. 379 Medicines which are only
available in the informal market have been excluded. Also, prices for numerous medications
have not been included because they are either not in NAFDAC’s list of approved drugs for
Nigeria or are available only in the informal market. 380 See more details of medication cost in
the methodology section of the introduction.

Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
376
Nigeria, NHIS, Operational Guidelines, October 2012, url, p.24
377
Nigeria, FMoH, Nigeria Essential Medicines List, 7th edition, 2020, url
378
Nigeria, NAFDAC, NADFDAC Green book: Registered Product Database Search, url
379
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
380
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
375

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Generic nameBrand name

DosageForm

Antidepressants
Amitriptyline
Teva
25 mg
tabletCitalopram
Teva
10 mg
tabletEscitalopram
Teva
10 mg
tabletFluoxetine
Flutex®
20 mg
capsuleImipramine
Spardysk®
25 mgtabletParoxetine
Seroxat®
20 mg
tabletSertraline
Zoloft®
50 mg
tabletMedication off-label use for PTSD
Alfuzosin (also with
Xatral XL®
10 mgtabletprostate complaints)
Lamotrigine (alsoTeva®
100 mgtabletantiepileptic)
Topiramate (alsoTopamax®
25 mg
tabletantiepileptic)
Antipsychotics; classic
Chlorpromazine
Obexol®
5 mgtabletFluphenazine
Modicat®
25 mg/ml
ampouleHaloperidol
Haldol®
5 mg/mlampouleAntipsychotics; modern atypical
Olanzapine
Olanza®
5 mg
tabletQuetiapine
Seroquel XR®
200 mgtabletRisperidone
Risperdal®
2 mgtabletAnxiolytics
Clonazepam
Teva
2 mg
tabletDiazepam(e.g.
Valium®
5 mgtabletvalium)Lorazepam
Ativan®
2 mg
tabletMedication for bipolar disorder/ manic depression
Carbamazepine (also
Tegretol®
200 mgtabletantiepileptic)
Medication for sleeping disorder; sedatives
Nitrazepam
Swidon®
5 mg
tabletZolpidem
Teva
10 mg
tabletZopicloneTeva
7.5 mgtabletTable 26: Details of medication available in the formal market 381

EUROPEAN UNION AGENCY FOR ASYLUM

Number ofunits in thecontainer

Price per box (USD)

28
28
28
10
30
20
15

6.8 (6.5-7.5)
10.2 (10.1-10.3)
27.3 (26.0- 28.6)
9.8 (9.5- 10.1)
29.3 (28.5- 30.1)
19.1 (18.8- 19.4)
9.8 (9.5- 10.1)

30

51.2 (50.9- 51.5)

30

22.2 (21.2- 23.2)

60

23.1 (22.6- 23.6)

1 000
10
5

22.3 (21.5- 23.1)
38.0 (36.0- 40.0)
26.8 (25.9- 27.7)

14
60
20

22.1 (21.9- 22.3)
99.9 (98.9- 100.9)
32.9 (31.8- 34.0)28
128.5 (8.3- 8.7)
5.9 (5.5-6.3)

28

9.4 (9.2-9.6)

50

14.9 (13.8- 16.0)

10
28
30

10.9 (10.4- 11.4)
22.2 (21.8- 22.6)
20.5 (19.9- 21.1)

8.5 Cost of treatment
There are no financial support programmes for the management of mental health conditions
in Nigeria. 382 Out-of-pocket payment is the most common mode of obtaining healthcare
services. 383 According to the 2017 National Health Accounts report, household healthexpenditure at the point of care was significant and stood at 77.5 % of the current health

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
382
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
383
Abdulmalik, J. et al., Sustainable financing mechanisms for strengthening mental health systems in Nigeria,
May 2019, url, p. 9381

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

expenditure. 384 For the majority of the population, financial difficulties present a significant
source of concern. 385
The prices of treatments were collected from five health facilities – two private hospitals andthree government-owned hospitals distributed across the north-central, south-south andsouthwestern regions of the country. The total costs incurred by patients can be calculated bysumming up all relevant services; however, indirect costs, such as bed rates, meals andtransportation, were not included. 386
Public outpatient
treatment price(USD)
Specialist consultation
Psychiatrist
42 (40.0-44.0)
Psychologist
Not available
Psychiatric nurse
Not available
at home (daily
rate)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

42 (40.0-44.0)
Not available
Not available

85.0 (84.0-86.0)
85.0 (84.0-86.0)
25.0 (24.0-26.0)

85.0 (84.0-86.0)
85.0 (84.0-86.0)
Not available

Table 27: Treatment cost by facility type 387
Treatment
Psychotherapy session
with cognitive behaviouraltherapy
Psychotherapy session
with eye movement
desensitisation andreprocessing (EMDR)
Clinical admittance in
psychiatric clinic (dailyrates)
Psychiatric treatment of
alcohol drug addiction in
specialised clinic(detoxification); daily
admission rate
Psychiatric treatment ofdrug addiction in a
specialised clinic(rehabilitation); daily
admission rate
Psychiatric treatment ofdrug addiction; outpatientcare; consultation rate

Public treatment price (USD)

Private treatment price (USD)

60.0 (58.0-62.0)

85.0 (84.0-86.0)

60.0 (58.0-62.0)

Not Available

50.0 (49.0-51.0)

188.0 (186.0-190.0)

25.0 (24.0-26.0)

188.0 (186.0-190.0)

25.0 (24.0-26.0)

188.0 (186.0-190.0)

42.0 (41.0-43.0)

188.0 (186.0-190.0)

Table 28: Cost of laboratory investigations by facility type 388

Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
Abdulmalik, J. et al., Sustainable financing mechanisms for strengthening mental health systems in Nigeria,
May 2019, url, p. 9386
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
387
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
388
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
384

385

79

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

8.6 NGOs
Local and international non-government organisations (NGOs) play a critical role in mental
healthcare at the national and sub-national level. Some examples of NGOs working in the
country are as follows:
•

•

•

•

389

Neem Foundation: A non-profit working in the northeast supports those who havesuffered trauma from attacks by the Boko Haram Islamic Militant Group. In 2017 alone,they delivered psychological services to over 7 000 persons in the Borno state.
Subsequently, they commenced the Counselling on Wheels programme, which
deployed counsellors on motorcycles or motor tricycles to take counselling services topeople’s doorsteps. In addition, the Neem Foundation provides training in counselling,trauma care and child-centred therapy.
Mentally Aware Nigeria Initiative (MANI): A Lagos-based non-profit focuses on
creating awareness on mental health and illnesses, as well as helping people in needof connecting with mental health professionals. MANI has a suicide/distress hotline
and is planning on launching a mobile App to connect mental health professionals to
people in need of help. The organisation promotes its advocacy campaigns online
using the social media and its website to draw attention to different mental healthillnesses or other related topics each month.
She Writes Woman: This organisation was established in Lagos, Southwest Nigeria in
April 2016. It hosted the first privately held, 24-hour mental health line in July 2016,
and in April 2018 added a helpline chat service that has received 6 000 messages todate. The organisation also founded and curates Safe Place – a support group where
women in Nigeria can meet, discuss mental health issues and get the help they need.
So far, more than 800 women have benefitted. In partnership with Airtel Nigeria, they
have grown and founded Safe Place Nigeria – a walk-in clinic where young people
can seek mental healthcare.
Love, Peace and Mental Health Foundation (LPM): Launched in 2012 in Lagos, LPM
carries out advocacy and awareness campaigns for the youth in Nigeria. LPM also
founded and curates Umbrella, a men-only support group, which meets on a monthly
basis. 389

The Borgen Project, 4 Organizations Improving Mental Health In Nigeria; September 2019, url

80EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

9 Neurology: Epilepsy, Cerebrovascular
Accident (Stroke), Multiple Sclerosis andParkinson’s Disease
9.1 General information
Neurological diseases include a range of disorders that affect the central and peripheral
nervous system, including the brain, spinal cord, cranial nerves, peripheral nerves, nerveroots, autonomic nervous system, neuromuscular junction and muscles. Examples of these
conditions include epilepsy, Alzheimer’s disease and other dementias, cerebrovasculardiseases including stroke, migraine and other headache disorders, multiple sclerosis (MS),Parkinson's disease (PD), neuroinfections, brain tumours, traumatic disorders of the nervous
system due to head trauma and neurological disorders as a result of malnutrition. However,the focus in this report is on epilepsy, cerebrovascular accident (stroke), MS and PD. 390
Epilepsy is a brain condition of neural origin characterised by seizures, as well as by their
cognitive, psychological, neurobiological and social consequences, while stroke is a
syndrome of vascular origin, rapid in onset and resulting in brain dysfunction which may last
beyond 24 hours in the absence of death or surgery. 391 MS is a chronic autoimmune disorderof the nervous system (the brain and spinal cord), of unknown aetiology, arising from immune
system malfunction leading to inflammation of the nerves – altering electrical impulses in thebrain. 392 PD is a progressive disorder of the nervous system which affects the nerve cells in
the part of the brain – called substantia nigra – responsible for body movements. 393 The
affected nerve cells die or become impaired leading to trembling or stiffness of the limbs,
slowed movement and poor coordination of movement. 394

9.1.1 Epidemiological context
Stroke is the seventh leading cause of deaths in Nigeria. 395 According to the 2019 Global
burden of disease study, it is estimated that stroke accounted for 3.98% (63 431) of total
deaths with an estimated 1.3 million people living with the condition. 396
Globally, a 2017 meta-analysis estimated the pooled point prevalence of active epilepsy to be
6.38 per 100 000 people. 397 In Nigeria, a systematic review and meta-analysis of communitybased door-to-door surveys conducted in 2018 suggested that the prevalence isapproximately 8 per 1 000 (1 280 000 people) which is within the global average; higher
among rural (15 per 1 000 people) than the urban dwellers (6 per 1 000) and highest (11 per 1000) in the southwestern region. 398

WHO, Mental Health: Neurological disorders, May 2016, urlWHO, Neurological Disorders: Public Health Challenges, 2006, url, p. 56
392
Johns Hopkins Medicine, Neurology and Neurosurgery: Multiple Sclerosis (MS), n.d., url393
Bloem, B.R. et al., Parkinson's disease, April 2021, url; AANS, Parkinson’s Disease, n.d., url
394
AANS, Parkinson’s Disease, n.d., url
395
IHME, Nigeria Dashboard, 2020, url
396
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
397
Fiest, K.M. et al., Prevalence and incidence of epilepsy, January 2017, url, p. 298
398 Owolabi, L.F. et al., Prevalence and burden of epilepsy in Nigeria: A systematic review and meta-analysis ofcommunity-based door-to-door surveys, March 2019, url, pp. 230-231
390
391

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According to the 2019 Global Burden of Disease Study, MS and PD are estimated to accountfor 0.01% (205.4) and 0.21% (3 334) of total deaths in Nigeria, respectively; and a prevalenceof 0.01% (MS) and 0.02% (PD), both less than the global average. 399

9.1.2 Strategies and policies for neurology
In October 2013, the Federal Government of Nigeria (FGoN) kick-started the National Stroke
Prevention Programme aimed at influencing Nigerians to embrace risk reduction measures,such as regular medical check-ups, physical exercise and other healthy lifestyle options. 400
Subsequently, the Federal Ministry of Health articulated the country’s first strategy for thecontrol and prevention of non-communicable diseases (NCDs) in fulfilment of an earlier
commitment made at the United Nations (UN) General Assembly High-Level Meeting on
NCDs in September 2011. 401 The policy intention was to integrate the management of NCDs at
all levels of government and healthcare delivery system in Nigeria. However, this national
effort lacked the whole-of-government, whole-of-society and multisectoral approach required
to address NCDs and their risk factors, some of which lie beyond the health sector, such as
education, environment and agriculture. Lessons learnt from this effort led to the National
Multisectoral Action Plan (NMSAP) for the Prevention and Control of NCDs (2019 to 2025). 402
This policy put emphasis on the integration of hypertension (a risk factor for stroke)
prevention, care and treatment into basic primary healthcare with referral to secondary andtertiary levels of care; it also scales up coverage of early detection, diagnosis and treatment atprimary healthcare level. However, there is no mention of MS, PD, epilepsy and stroke among
the indicators for tracking the NSHDP II’s implementation progress. 403
Road traffic accidents (RTAs) resulting in head trauma have been identified as one of thepossible causes of post-traumatic epilepsy. 404 The FGoN developed and is currently
implementing the Nigeria Road Safety Strategy (2014 to 2018) to prevent road traffic crashes
and respond to post-crash injuries. 405
The above policies may suggest the presence of political will and strategic direction;
however, information on evaluation of these interventions detailing the reality on the groundwas not found. 406

9.1.3 Healthcare provisions for neurology

IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 33
401
Nigeria, FMoH, National Policy and Strategic Plan of Action on Prevention and Control of Non-Communicable
Diseases (NCDs), 2013, url, p. 26
402
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 43
403
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url; Nigeria, FMoH,
Monitoring And Evaluation Plan for the Second National Strategic Health Development Plan (2018-2022), url
404
Ogunrin, O.A. and Adeyekun, A.A., Profile of post-traumatic epilepsy in Benin City, Nigeria, June 2010, url, p.
154
405
Nigeria, FMoH, National Multi-sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), 6 August 2019, url, p. 37; Nigeria, FRSC, Nigeria Road Safety Strategy (NRSS) 2014-2018,2013, url
406
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
399

400

82

EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAThe NMSAP for the Prevention and Control of NCDs (2019-2025) prioritises the strengtheningof primary care services. 407 However, neurological care is extremely limited at primary healthcentres and patients are rather referred to tertiary facilities for better management. Strokecases mostly present themselves at accident and emergency departments and at medical
outpatient clinics of secondary and tertiary facilities before being transferred to the medical
wards. Patients’ stroke type is identified using computed tomography scan – the gold
standard and cornerstone in the diagnosis of stroke types; however, use of this imaging
investigation is limited by its high cost – a 2012 study estimated it to cost from USD 250 to
USD 380 (see table 32 for the current price).408
Neurology services are provided in most Nigerian Teaching Hospitals (see list of tertiary
centres in table 13). Other private facilities that deliver neurological care include Lagoon
Hospital, Lagos; Primus Super Specialty Hospital, Abuja; St. Nicholas Hospital, Lagos; and Eko
Hospital, Lagos. 409

9.2 Access to treatment
The primary objective of managing a patient with acute stroke is to minimise the progressionof brain damage and timing is critical in achieving this. However, the general perception in therural communities is that stroke is a spiritual disease and this is listed in some Nigerian
languages: ‘mba agbara’ (a hug from the spirit) in Igbo; ‘ekpo mia’ (a slap from the ghost) in
Ibibio and Efik, ‘ofa’ (an evil arrow) in Yoruba; and ‘shan inna’ (paralysis by the spirit) in Hausa
language. This belief system impacts on the health-seeking behaviour of patients and theirrelatives leading to early presentation in churches or traditional healers and delayed resort tohospitals where early intervention may be potentially life-saving. 410 A study in Nigeria
assessed the time of presentation of 128 stroke patients and found that only 13 (10.1 %) arrived
at the hospital within 3 hours of onset of symptoms while the rest arrived later but within 24
hours. Late presentation interferes with timely management leading to high stroke mortality. 411
Other factors impacting on access to treatment include high cost of care, shortage of
specialised cadre of health workers – the neurologists – and a poorly implemented NHIS that
only covers 5% of the population, while the rest pay out of pocket at the point of care.412

Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 40
408Bell-Gam, H.I. et al., Improving Stroke Management through Specialized Stroke Units in Nigeria: A Situational
Review, June 2012, url, p. 31
409
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
410
Ekeh, B.C., Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access andAction, April 2017, url, p. 2
411
Ekeh, B. and Isamade, E.I., Time of presentation of stroke patients in a tertiary hospital in Northern Nigeria,
West Africa, June 2014, url, p. 1
412
Alawode, G.O. and Adewole, D.A., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers, January 2021, url, p. 1
407

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9.3 Insurance and national programmes
The National Health Insurance Scheme (NHIS) was launched in 2005 and provides healthinsurance coverage for Nigerians through three major programmes (see table 29). 413
Programme

Focus

Requirements

Formal Sector
Social Health
Insurance
Programme(FSSHIP)For individuals
employed within the
public/organised private
sector or willing to makevoluntary
individual/family/groupcontributions

1. Public/federal tier Government pays
3.25 % and employee
pays 1.75 % of
employee's basic salary
2. Armed forces Government pays
entire 5 % of
employee's basic salary
3. Private/othergovernment tiers Employer pays 10 %and employee pays 5 %of employee's basic
salaryInformal
Sector Social
HealthInsurance
Programme(ISSHIP)For individuals in theinformal sector. It covers
employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers and others notcovered under theFormal Sector or the
Vulnerable Group

Vulnerable
Group

For indigents and thevulnerable (children
under five, physicallychallenged persons,prison inmates,
pregnant women,orphans and internallydisplaced persons)Community-based
health insurance
scheme - actuariallydetermined flat rate fee
perhousehold/individual
household member ormember of an
occupation-based
group and paid in cash
monthly or seasonallyin advance
Register with a PHCC
under the Basic
Healthcare Provision
Fund programme

Scope ofcoverage
Coverhealthcare
benefits fortheemployee,aspouse and4 biologicalchildrenbelow theage of 18
years

For theregisteredindividualalone

For theregisteredindividual
alone

Neurology services
covered
1. Outpatient care (riskfactor monitoring andprescriptions forpsychosomatic illnesses,
insomnia and othermental health illnesses as
may be listed from time totime by the NHIS)
2. Admission for up to
three weeks
3. Consultation withspecialists (neurologists)
4. Prescribed drugs,
pharmaceutical care anddiagnostic tests as
contained in the NHIS
drugs list and NHIS
diagnostic test lists
As in public sector

As in public sector

Table 29: Health insurance programmes in Nigeria 414
There exist varying degrees of insurance coverage for certain cross-cutting services, which
may be required in treatment of neurology cases, for example, high-technology
investigations, such as computed tomography (CT) scan and magnetic resonance imaging(MRI), which are partially excluded (health maintenance organisation would pay 50 % ofcost). 415
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
414
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
415
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp.24-25
413

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9.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions such asneurological disorders. This may be due to prohibitive costs and lack of availability of key
medications. 416
The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 417
In addition, the National Agency for Food and Drug Administration (NAFDAC) maintains a
database for registered medications. 418
The prices of medications were collected from six private pharmacies across the country –four in the southern and two in the northern regions. 419 Medication prices were found to behigher in the north due to add-on costs in the supply chain – drugs are imported into thecountry through seaports in the south. 420 Medicines which are only available in the informal
market have been excluded. See more details of medication cost in the methodology sectionof the Introduction.
Generic Name

Brand name

DosageAntiepileptics (e.g. to reduce frequency of attacks)
Carbamazepine
Tegretol®
200 mgClonazepam
Teva
2 mg
Gabapentine
Teva
400 mgLamotrigine
Teva
100 mgLevetiracetam
Keppra®
500 mgPhenobarbital
Pitrofin®
30 mg
Pregabaline
Lyrica®
75 mg
Antiepileptics to treat acute attacks / status epilepticus
Diazepam (i.v.
Valium®
10 mg/2 ml
injection for
epileptic attacks)
Diazepam (rectiole / Diazepam
5 mg/2.5 ml
rectal suppository
Rectala solution
for epileptic attacks)
Midazolam (i.m.
Dormicum®
5 mg/mlinjection for
epileptic attacks)
Midazolam (i.v.
Dormicum®
5 mg/mlinjection for
epileptic attacks)
Valproate (for
Epilim®
200 mgepileptic attacks)
Anti-blood clotting medicines

Form

Numberof unitsin thecontainer

Price per box(USD)tablettablettablettablettablettabletcapsule

50
28
30
28
60
1 000
28

15.1 (14.8-15.4)
8.5 (7.9-9.1)
14.8 (14.0-15.6)
22.1 (21.5-22.7)
19.1 (18.9-19.3)
146.2 (144.6-147.8)
136.5 (135.2-137.8)

vial

10

29.2 (29.1-29.3)

suppository5

59.7 (58.3-61.1)

ampoule10109.6 (105.5-113.7)

ampoule10109.6 (105.5-113.7)

tablet1045.1 (44.8-45.4)

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, August-November 2021
417
Nigeria, FMoH, Nigeria Essential Medicines List, 2020, url
418
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, url
419
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
420
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
416

85

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand name

DosageForm

Price per box(USD)tabletNumberof unitsin thecontainer
28

Acetylsalicylic acid
(Aspirin®)
Apixaban
Clopidogrel
Enoxaparin
Heparin

Teva

75 mg

Generic
Teva
Clexane®
Generic

Rivaroxaban
Warfarin

Generic
Teva

2.5 mg
75 mg
40 iu/ml
5 000 iu/0.2
ml
10 mg
5 mg

tablettablet
vial
vial

30
28
2
1

73.1 (72.5-73.7)
13.6 (12.9-14.3)
21.9 (20.9-22.9)
13.4 (13.1-13.7)

tablettablet102868.2 (67.9-68.5)
13.6 (13.2-14.0)

Table 30: Details of medication available in the formal market 421

6.8 (6.2-7.4)

9.5 Cost of treatment
There are no financial support programmes for the treatment of neurological disorders. 422
The cost of public outpatient and inpatient treatments varies across the northern andsouthern regions of the country. 423 Public facilities provide cheaper consultation andlaboratory services but with longer waiting times. 424
The prices below were obtained from eight health facilities – three public and five privately
owned centres – distributed across the north-central, south-south and south-western regionsof the country. 425 The total direct costs incurred by patients can be approximated by summing
all relevant services; indirect costs such as travel and lost wages were not included. All
medications incur supplementary charges. Of note, inpatient costs are not inclusive of foodand lost daily wage. 426

Specialist
Consultation byneurologist
Consultation byneurosurgeon
Consultation by aninternist
Consultation byrehabilitation
specialist

Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

41.5 (40.9-42.1)

41.5 (40.9-42.1)

85.3 (84.9-85.7)

85.3 (84.9-85.7)

41.5 (40.9-42.1)

41.5 (40.9-42.1)

85.3 (84.9-85.7)

85.3 (84.9-85.7)

41.5 (40.9-42.1)

41.5 (40.9-42.1)

60.9 (59.8-62.0)

60.9 (59.8-62.0)

41.5 (40.9-42.1)

41.5 (40.9-42.1)

85.3 (84.9-85.7)

85.3 (84.9-85.7)

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
422
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
423
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
424
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
425
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
426
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
421

86EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Table 31: Treatment cost by facility type 427
Laboratory researchLaboratory research: medicationlevel in the blood (e.g. for
antipsychotics/for antiepileptics
and/or for lithium carbonate)
Laboratory research of blood; INR
e.g. in case of acenocoumarol
anticlotting
Medical imaging
Diagnostic imaging by means of
EEG (Electro Encephalo Gram)
Diagnostic imaging by CT scan
Diagnostic imaging by MRI scan
Diagnostic imaging: angiography(=arteriography) of cerebral arteries
Lumbar puncture
Treatment
Clinical admittance in neurology
department (daily rates)
Clinical admittance in neurosurgery
department (daily rates)
Clinical admittance in (neuro)
rehabilitation department (dailyrates)
Outpatient treatment by physicaltherapist

Public treatment price (USD)

Private treatment price (USD)

219.3 (218.0-220.6)

302.1 (300.5-303.7)

73.1 (72.8-73.4)

120.1 (118.0-122.2)

146.2 (145.5-146.9)

219.3 (218.5-220.1)

97.5 (96.5-98.5)
219.3 (218.5-220.1)
Not available

219.3 (218.5-220.1)
390.0 (385.5-394.5)
292.5 (291.6-293.4)

48.7 (48.5-48.9)

73.1 (72.8 – 73.4)

8.6 (8.4-8.8)

187.6 (185.5-189.7)

8.6 (8.4-8.8)

187.6 (185.5-189.7)

8.6 (8.4-8.8)

187.6 (185.5-189.7)

8.6 (8.4-8.8)

60.9 (60.2-61.6)

Table 102: Cost of laboratory investigations by facility type 428

9.6 NGOs
Examples of NGOs working to support care of stroke and epileptic patients include:
•

•

•

•

Angie Epilepsy Foundation: A non-profit, based in Benin, southwest Nigeria, involvedin awareness creation and sensitisation of communities on the causes and dangers of
epilepsy, provides non-discriminating services and treatment, boosts the self-esteem
and fosters hope among parents whose children are suffering from epilepsy.
Epilepsy Foundation of Nigeria: A non-profit, based in Lagos, southwest Nigeria. The
Epilepsy Foundation of Nigeria is a NGO established to create awareness, provide
treatment and care to those suffering from the neurological condition, support families
and individuals impacted with epilepsy, seizures and convulsions.
Seizure Support Foundation: A non-profit, based in Enugu, southeast Nigeria. The
Seizure Support Foundation provides care and support to children challenged by
seizure disorders, such as epilepsy, and also provides them with best practices which
are aimed at improving sensory and behavioural outcomes of the children.
Epilepsy Association of Nigeria: A non-profit, based in Abia, southeast Nigeria. The
Epilepsy Association of Nigeria is affiliated to the International Bureau for Epilepsy

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
428
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
427

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429

EUROPEAN UNION AGENCY FOR ASYLUM(IBE), which is an international organisation that aims to create awareness, provide
treatment and support to the sufferers of the health condition.
Stroke Care International Foundation: A non-profit based in Nigeria and the United
Kingdom (UK) with the aim of reaching 2 million stroke patients by the year 2025
through awareness creation on the causes and symptoms of stroke. 429

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021

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10 Nephrology
10.1 General information
Nephrology is a field of medicine that focuses on the study of kidneys and kidney diseases. 430
This report will focus on chronic kidney disease (CKD) and kidney failure.

10.1.1 Epidemiological context
National prevalence data on CKD is unavailable and only a few population-based andhospital-based studies exist. 431 A 2018 systematic review identified seven studies, five fromthe southern region and two from the northern part. In this review, estimates for theprevalence of CKD ranged from 2.5 % to 26 %. 432 A 2020 population-based survey in northcentral Nigeria estimated CKD prevalence to be 12 %, within the range suggested by theearlier review. 433 Also, review findings were corroborated by estimates from the 2019 Global
Burden of Disease Study, which estimated the prevalence of CKD to be 3.9 % equivalent toover 8.2 million cases. 434 The major risk factors for CKD in developed countries include
diabetes, age and hypertension. 435

10.1.2 Strategies and policies for nephrology
During the research for this report, no national strategy that specifically targeted the burdenof CKD in Nigeria could be found. Also, the Second National Strategic Health Development
Plan 2018-2022 (NSHDP II) made no mention of CKD. 436 However, management of risk
factors, such as diabetes and hypertension, were referred to both in the NSHDP II and the
National Multi-Sectoral Action Plan for the Prevention And Control Of Non-Communicable
Diseases (2019-2025). 437

10.1.3 Healthcare provisions for nephrology
Primary healthcare facilities are the first entry point into Nigeria’s health system and only offer
basic services. These services include counselling and risk factor monitoring for conditions,such as hypertension and diabetes. However, severe cases upon presentation to PHCCs arereferred to secondary and tertiary facilities. 438 A systematic review undertaken to evaluateclinical outcomes relating to early versus late referral of patients to nephrology services in
Nigeria have noted late presentation to tertiary facilities, where nephrologists are available, asBritannica, Nephrology: medicine, n.d., url
Olanrewaju, T.O. et al., Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a
population-based survey, November 2020, url, p. 2
432
Chukwuonye, I.I. et al., Prevalence of chronic kidney disease in Nigeria: systematic review of population-based
studies, 2018, url, pp. 169-170
433
Olanrewaju, T.O. et al., Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a
population-based survey, November 2020, url, pp. 4-5
434
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
435
ISN, International Society of Nephrology (ISN) Response to WHO Discussion Paper on Updated Appendix 3 of
the WHO Global NCD Action Plan (2013-2020), September 2016, url, p. 1
436
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url
437
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases 2019-2025, August 2019, url, p. 56; Nigeria, FMoH, Second National Strategic Health Development
Plan (NSHDP II) 2018-2022, url, p. 72
438
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
430
431

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a major challenge. 439 This is important because early presentation and treatment of CKD
patients is helpful in halting disease progression to renal failure, reducing hospitalisation,
minimising cost of healthcare and improving patients’ survival. 440
Advanced care includes dialysis. There are dialysis centres – about 149 centres with 600
dialysis machines – across the 36 states in the country with varying levels of functionality. The
majority of tertiary centres and a few private facilities provide specialist kidney services
except for kidney transplant, which is uncommon and poorly resourced. 441 The first renaltransplant in Nigeria was performed in 2000. 442 As of 2016, a total of 13 additional facilities
had delivered at least 1 kidney transplantation. 443 Despite in-country availability, with about
700 being reported to have been performed since 2005 444, kidney transplantation has
emerged as a booming medical tourism industry among Nigerians with India as the mostpopular destination. 445 Studies have reported a kidney transplantation referral rate ranging
from 2.7 % to 95 %, with most patients requesting for referral. 446 The favourite kidneytransplant destinations include India, Egypt, Pakistan, China, Philippines, and Mexico. 447

10.2 Access to treatment
Treatment for kidney disease includes lifestyle consultations and pharmacologicalinterventions to manage high blood pressure and high cholesterol. These are similar totreatments required for cardiovascular disease. Treatments are accessible in primary carefacilities, such as health centres. 448
The cost of managing CKD is exorbitant and limits access to care in a setting where about
40 % of the total population live below the poverty line – less than USD 1.25 per day. Studies
have shown that the estimated minimum annual income required to provide basic needs
stands at USD 1 016 per annum in urban areas while USD 758 per year in rural regions. 449 A
2019 study conducted in southwestern Nigeria reported that the total direct cost of inpatientcare for CKD in a tertiary centre ranged between USD 50-1 345 with a median total cost of
USD 431. Major cost drivers of care were dialysis, ward and pharmacy expenses with a

Smart, N.A. and Titus, T.T., Outcomes of early versus late nephrology referral in chronic kidney disease: asystematic review, November 2011, url, p. 1073
440
Smart, N.A. and Titus, T.T., Outcomes of early versus late nephrology referral in chronic kidney disease: asystematic review; November 2011, url, pp. 1077-1079
441
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
442
Badmus, T.A. et al., Kidney transplantation in a developing economy: challenges and initial report of threecases at Ile Ife, 2005, url, p. 2
443
Bamgboye, E.L., The challenges of ESRD care in developing economies: Syb-Saharan African opportunities for
significant improvement, 2016, url, pp. 18-22
444
Vanguard, Health: 700 kidney transplants so far performed in Nigeria, Nephrology Association says, March
2020, url
445
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; Okafor, U.H., Transplant tourism among kidney transplant patients in Eastern
Nigeria, July 2017, url, pp. 1, 5
446
Liman, H.M. et al., Kidney transplant-related medical tourism in patients with end-stage renal disease: A reportfrom a renal center in a developing nation, March 2020, url, p. 8; Okafor U.H., Transplant tourism amongkidney transplant patients in Eastern Nigeria, July 2017, url, p. 4
447
Adamu, B. et al., Commercial kidney transplantation: Trends, outcomes and challenges-A single-centre
experience, March 2012, url, pp. 72-73; Budiani-Saberi, D.A. and Delmonico, F.L., Organ trafficking andtransplant tourism: a commentary on the global realities, url, pp. 3-4
448
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
449
This Day, Report: Income Inequality Skewed Wealth, Resources to Pockets of 20% of Nigerians, June 2016, url
439

90EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

median cost of USD 200, USD 80 and USD 63.5, respectively. All the patients in this study
paid the whole sum as out-of-pocket expenditure. 450
According to the Nigerian Association of Nephrologists, there are an estimated 160
nephrologists in Nigeria, less than 1 per 1 000 000 of the population and they are skewed
towards facilities in urban regions. This implies a significant geographical barrier and highcost of transportation for most of the population residing in rural areas. 451 Most tertiary centres
where kidney diseases are managed lack facilities and expertise in various support services.
For instance, there are few histopathologists to analyse kidney biopsy specimens and theirassessment is limited to light microscopic studies; whereas, skills in the more beneficial
advanced electron microscopy and immunohistochemistry techniques are lacking. 452

10.3 Insurance and national programmes
The National Health Insurance Scheme (NHIS) was launched in 2005 and provides healthinsurance coverage for Nigerians through three major programmes (see table 33). 453
Programme

Focus

Requirements

Scope ofcoverage

Kidney services covered

FormalSectorSocialHealthInsurance
Programme(FSSHIP)For individuals
employed within the
public/organised
private sector or willingto make voluntaryindividual/family/groupcontributions

Cover
healthcare
benefits fortheemployee,a spouse
and 4
biologicalchildrenbelow theage of 18
years

1. Outpatient/preventive
care (voluntary counselling,
screening and treatment)
2. Admission for up to three
weeks for co-morbidities
3. Consultation withspecialists(internists/nephrologists)
4. Prescribed drugs,
pharmaceutical care anddiagnostic tests as
contained in the NHIS
drugs list and NHIS
diagnostic test lists

Informal
SectorSocialHealthInsurance
Programme(ISSHIP)For individuals in theinformal sector. It
covers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers, and others
not covered under theFormal Sector or the
Vulnerable Group

1. Public/federal tier Government pays
3.25 % and employee
pays 1.75 % of
employee's basic
salary2. Armed forces Government pays
entire 5 % of
employee's basic
salary3. Private/othergovernment tiers Employer pays 10 %and employee pays
5 % of employee's
basic salaryCommunity-based
health insurance
scheme - actuariallydetermined flat rate
fee perhousehold/individual
household member ormember of an
occupation-based
group and paid in
cash monthly orseasonally in advanceFor theregisteredindividualalone

As in public sector

Adejumo, O.A. et al., Cost implication of inpatient care of chronic kidney disease patients in a tertiary hospitalin Southwest Nigeria, January 2020, url, pp. 209, 211-212
451
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
452
Okafor, U.H. et al., Challenges of kidney care in a resource poor nation: A study of private kidney care centre in
Nigeria, August 2012, url, pp. 47-49
453
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

Kidney services covered

Vulnerable
Group

For indigents and thevulnerable (children
under five, physicallychallenged persons,prison inmates,
pregnant women,orphans and internallydisplaced persons)Register with a PHCC
under the Basic
Healthcare Provision
Fund programme

For theregisteredindividualalone

As in public sector

Table 33: Health insurance programmes in Nigeria 454
Some services required to appropriately manage kidney conditions, such as high-technology
investigations, including computed tomography (CT) scan, magnetic resonance imaging (MRI)
and dialysis for acute renal failure (maximum 6 sessions), are partially excluded (healthmaintenance organisation would pay 50 % of cost) from the NHIS benefit package. 455

10.4 Cost of medication
All the rugs listed in the table below are contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 456
In addition, the National Agency for Food and Drug Administration (NAFDAC) maintains a
database for registered medications. 457
The prices of medications were collected from six private pharmacies across the country –four in the southern and two in the northern regions. Medicines that are only available in theinformal market have been excluded. 458 See more details of medication cost in themethodology section of the general country report.
Generic nameBrand name

DosageForm

Hematopoietic growth factor; for anemia due to renal problems
Epoetin beta
Recormon®
4 000
vial
iu/ml
Erythropoietin
Recormon®
2 000
vial
iu/ml
Phosphate binders
Magnesium hydroxide Maalox®
225 mgsuspension+ aluminiumhydroxide(combination)
Medication to treat metabolic acidosis
Sodium bicarbonate
Moko®
100 g
powder(= sodium hydrogencarbonate)

Number ofunits in thecontainer

Price per box (USD)6

158.0 (155.0-161.0)

6

158.0 (155.0-161.0)

1

8.7 (8.5-8.9)1

6.1 (5.8-6.4)

Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
455
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 24-25
456
Nigeria, FMoH, Nigeria Essential Medicines List, 2020, url
457
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, url
458
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
454

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Table 34: Details of medication available in the formal market 459

10.5 Cost of treatment
The NHIS covers for kidney care, including procedures, such as dialysis, for up to a maximumof six sessions, at secondary and tertiary facilities. 460 However, this is targeted at a small
fraction of the population given that the majority of households use out-of-pocket payments
at the point of care. 461
In private facilities, a specialist consultation costs more for both inpatient and outpatient careas compared to public facilities. The total costs incurred by patients can be calculated bysumming up all relevant services; however, indirect costs, such as bed rates, meals andtransportation, were not included. The prices below were obtained from eight health facilities– five privately owned and three public centres – in the country. 462 Thus, the values indicatedin each cell is the average sum of the values collated from the visited facilities.

Specialist
Consultation by aninternist
Consultation by anephrologist

Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

41.4 (40.5-42.3)

41.4 (40.5-42.3)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

41.4 (40.5-42.3)

41.4 (40.5-42.3)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

Table 35: Treatment cost by facility type 463
Laboratory research
Acid-base balance in blood andurine; e.g. serum and urine pH,
electrolyte levels
Bacterial cultures
Electrolytes; potassium, sodium,
calcium and magnesium
Parathyroid hormone (PTH),
calcium, phosphate
Renal/kidney function (creatinine,urea, proteinuria, sodium,
potassium levels)
Medical imaging
Ultrasound of the kidney
Treatment
Clinical admittance in nephrology
department (daily rates)
Chronic haemodialysis(three/week); cost of one session

Public treatment price (USD)

Private treatment price (USD)

8.5 (8.2-8.8)

10.2 (9.9-10.5)

8.5 (8.2-8.8)
8.5 (8.2-8.8)

25.6 (24.5-26.7)
36.6 (35.8-37.4)

9.8 (8.9-10.7)

25.6 (24.9-26.3)

8.5 (8.2-8.8)

25.6 (24.9-26.3)

8.5 (8.2-8.8)

25.6 (24.8-26.4)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
460
Nigeria, NHIS, Operational Guidelines, October 2012, url, p. 25
461
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
462
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
463
EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
459

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Acute haemodialysis
Peritoneal dialysis; costs of one
sessionKidney transplantation and followup
Surgical placement of an arterial
shunt for haemodialysis

EUROPEAN UNION AGENCY FOR ASYLUM

170.6 (168.0-173.2)
48.7 (47.5-49.9)

53.5 (52.5-54.5)
70.7 (68.0-73.4)

14 251.6 (11 450.0-17 053.2)

21 925.6 (19 489.4-24 361.7)

146.2 (145.8-146.6)

438.5 (437.0-440.0)

Table 36: Cost of laboratory investigations by facility type 464

10.6 NGOs
There are a few active local non-government organisations (NGOs) supporting patients withkidney disease to obtain quality care and they are as follows:•••

Julie Donli Kidney Foundation: The foundation was established to help patients get
aid of kidney disease treatment through frequent updates to an existing database formatching kidneys between patients and donors. Also, poor patients with kidney
ailments requiring dialysis are assisted to obtain care.
Kidney Foundation for Africa: It is a local NGO set-up to sensitise communities on thecauses, prevention and benefits of early detection of chronic kidney disease andkidney failure. It is located in Lagos, Southwest Nigeria.
Nathan Kidney Foundation: The foundation focuses on awareness creation andcommunity sensitisation on the prevalence of kidney failure, free kidney screenings
and fundraising for indigents desiring to access kidney transplant care. It is located in
Lagos, Southwest Nigeria. 465

EUAA2, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
465
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
464

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11 Pulmonology: Asthma and Tuberculosis
11.1 General information
Pulmonology is a branch of medicine concerned with the anatomy, physiology and diseasesof the lungs and other parts of the respiratory system. The term ‘pulmonology’ can be usedinterchangeably with ‘respiratory’ and this will be done throughout this topical report.
Respiratory illnesses, which can be infections in nature or non-communicable, in particularasthma and tuberculosis (TB) are a significant burden in Nigeria. 466

11.1.1 Epidemiological context
The 2019 Global Burden of Disease (GBD) study estimates that the combined prevalence ofchronic respiratory illnesses in Nigeria stands at 4.33 %, equivalent to over 9.1 million people,of which the disaggregated prevalence of asthma is estimated at 3.67 % (over 7.7 million
cases). 467 Other studies suggest that the prevalence of asthma in Nigeria is higher withvariations across cities and age groups. 468 Also, in a 2017-2018 cross-sectional population
survey conducted in five cities across five out of the six geo-political regions in Nigeria theprevalence of asthma was estimated to be higher in female (52 %) as compared to the male
(48 %) population. 469 In addition, a 2017 survey of asthma management practices among
doctors in the southeast geopolitical zone found that the most frequently identified key risk
factors for asthma in Nigeria are atopy, genetics, air pollution, smoking and urbanisation,
while diet and birth weight were less frequently identified. 470
Nigeria ranks sixth among the 30 countries with the highest burden of TB and multidrugresistant tuberculosis (MDR-TB) globally. 471 In 2019, the burden of TB was estimated at
429 000 cases; of these TB cases, 27 % were diagnosed and notified to the National TB
Programme (NTP). 472 This means that the remaining cases were not diagnosed or werediagnosed but not notified to the NTP that year, thereby, making the country one of the mostsignificant contributors (accounting for 11 %) to the estimated global gap (2.9 million) between
the number of people newly diagnosed and reported. 473 This has been attributed tounderreporting of people diagnosed with TB and underdiagnosis. A 2019 study identified NTP
non-engaged health facilities and patient factors (previously treated, extrapulmonary,
unknown TB site, HIV negative and HIV unknown) as key drivers to underreporting of people

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
467
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
468
Musa, B.M. and Aliyu, M.D., Asthma prevalence in Nigerian adolescents and adults: systematic review andmeta-anaylsis, September 2014, url; Ozoh, O.B. et al., The prevalence of asthma and allergic rhinitis in Nigeria:
A nationwide survey among children, adolescents and adults, September 2019, url469
Ozoh, O.B. et al., The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children,
adolescents and adults, September 2019, url, p. 7
470
Chima, E.I. et al, A survey of asthma management practices and implementation of Global Initiative for Asthma
guidelines among doctors in a resource-limited setting in Nigeria, September 2017, url, pp. 985-986
471
WHO, Global Tuberculosis Report, 2020, url, p. 23; Nigeria, FMoH, National Tuberculosis and Leprosy Control
Programme: Draft 2019 Annual TB Report, 2020, url, p. 7
472
Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme: Draft 2019 Annual TB Report, 2020, url,
pp. 8, 18
473
WHO, Global Tuberculosis Report, 2020, url, p. xvii
466

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diagnosed with TB. 474 Upon disaggregating the notified cases, 35 % were women, 57 % weremen and 8% were children. 475
TB/HIV comorbidity and MDR-TB has continued to be an increasingly huge challenge in
Nigeria. A study carried out in 2014 in north-central Nigeria estimated the prevalence of TB
among HIV-positive people to be 34.5 % 476, which is similar to an earlier study in thesouthwest in which combined TB/HIV prevalence stood at 33.9 %. 477 It is estimated that 4.3 %of new cases and 15 % of previously treated cases are either MDR-TB or rifampicin-resistanttuberculosis (RR-TB). 478 However, in 2019, of the estimated 21 000 MDR-TB and RR-TB
patients, only 9 % (1 975 cases) were under treatment. 479 The critical drivers of TB burden in
Nigeria are HIV and undernourishment. 480

11.1.2 Strategies and policies for pulmonology
The Second National Strategic Health Development Plan (NSHDP II) 2018-2022 makes little
reference to the management of asthma. 481 However, respiratory care, including asthma, iswithin the list of essential services to be provided at PHCCs as listed in the Ward Health
System Strategy document – which represents the current national strategic thrust fordelivery of quality PHC services in Nigeria for improved health outcomes. 482 In addition, theNational Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025) details priority interventions (symptomatic relief and treatment forasthmatic patients, reduction of indoor air pollution, improved access to influenza vaccine andcontrol of environmental pollution) for managing chronic respiratory diseases, including
asthma and its risk factors. 483
As part of efforts to reduce the prevalence of TB to a level which no longer constitutes apublic health threat, the Federal Government of Nigeria established the National Tuberculosisand Leprosy Control Programme (NTBLCP) in 1989 within the department of public health in
the FMoH. 484 However, the programme has been constrained by governance issues, such as
absence of TB-specific legislation, poor spending on TB control, and limited institutional
capacity among others. 485 In 2015, the FMoH articulated the National Strategic Plan (NSP) for
Tuberculosis Control 2015-2020 to galvanise a whole-of-society and whole-of-government
effort towards the attainment of universal access to ‘high-quality, patient-centred TB

KNCV Tuberculosis Foundation, Assessment Of Tuberculosis Underreporting By Level Of Reporting System In
Lagos, Nigeria, 2020, url
475
USAID, Nigeria Tuberculosis Roadmap Overview, Fiscal Year 2021, n.d., url, p. 1
476
Gyar, S.D, e al., Prevalence of Tuberculosis in HIV/AIDS Patients in Lafia, Central Nigeria, March 2014, url, p.
833
477
Affusim, C.C., The Pattern of Presentation and Prevalence of Tuberculosis in HIV-Seropositive Patients Seen at
Benin City, Nigeria, March 2012, url, p. 3
478
Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme: Draft 2019 Annual TB Report; 2019, url,
p. 29
479
Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme: Draft 2019 Annual TB Report, 2019, url,
p. 30
480
Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme: Draft 2019 Annual TB Report, 2019, url,
p. 8
481
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 24
482
Nigeria, NPHCDA, Ward Health System, 2018, p. 20
483
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 59
484
Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme (NTBLCP): About us, n.d., url
485
Ogbuabor, D.C. and Onwujekwe, O.E., Governance of tuberculosis control programme in Nigeria, 2019, url, p. 2
474

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prevention, diagnosis and treatment services’ for all Nigerians by 2020. 486 No studies were
found on post-evaluation of the strategy. Currently, the FMoH in collaboration with partners is
working to finalise a new NSP for TB 2021-2025, which will focus on reducing TB prevalence
and TB mortality by 50 % and 75 %, respectively. 487 In addition, the NSHDP II includes several
TB control activities as part of essential package of care, namely case detection of all forms of
TB and access to diagnosis and treatment (including MDR-TB).488

11.1.3 Healthcare provisions for pulmonology
Services available for respiratory illnesses from PHCCs include consultations with nonspecialist medical staff, access to basic medications such as salbutamol inhaler for managing
asthmatic crises and delivery of laboratory services such as sputum collection for TB
microscopy, culture and sensitivity tests. 489 In addition, healthcare workers (HCWs), including
pharmacists, laboratory scientists, nurses, community health officers and community healthextension workers, all play varying roles in diagnosing, treating and following up of TB cases
within PHCCs based on their level of training. The HCWs refer cases to secondary and tertiary
centres, in the absence of such services in their facility or when complications arise. 490 For
specialist consultations, patients can access infectious disease clinics in the teaching
hospitals below: 491
S.No.

Geo-politicalzone

Facility name1
2

South-east

Abia State University Teaching Hospital, Aba
Nnamdi Azikiwe University Teaching Hospital,
Nnewi
Ebonyi State University Teaching Hospital,
Abakiliki
University of Nigeria Teaching Hospital, Enugu
Imo State University Teaching Hospital, Orlu
Anambra State University Teaching Hospital,
Amaku Awka
Madonna University Teaching Hospital, Okija
Federal University Teaching Hospital, Abakiliki
University of Uyo Teaching Hospital, Uyo
University of Calabar Teaching Hospital, Calabar
University of Benin Teaching Hospital, Benin City
Delta State University Teaching Hospital, Oghara
Niger Delta University Teaching Hospital,
Okolobiri
Igbinedion University Teaching Hospital, Okada
Lagos University Teaching Hospital, Idi-Araba
Olabisi Onabanjo (Ogun state) University
Teaching Hospital, Sagamu
LAUTECH University Teaching Hospital,
Osogbo/Ogbomosho
Obafemi Awolowo University Teaching HospitalComplex, IIe-ife

3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

South-south

South-west

Facility Type
PublicX
X

Private

X
X
X
X

X
X
X
X
X
X
X

X
X

X

X
X

Nigeria, FMoH, The National Strategic Plan for Tuberculosis Control 2015-2020: Towards Universal Access toPrevention, Diagnosis and Treatment, July 2014, url, pp. 1-2
487
USAID, Nigeria Tuberculosis Roadmap Overview, Fiscal Year 2021, n.d., url, p. 1
488
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, pp. 65-66
489
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
490
Nigeria, FMoH, The National Strategic Plan for Tuberculosis Control 2015-2020: Towards Universal Access toPrevention, Diagnosis and Treatment, July 2014, url, p. 26
491
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
486

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

S.No.
19
20
21
22
23
24
25
26

Geo-politicalzone

North-central

27
28
29

North-east

30
31
32
33
34

North-west

EUROPEAN UNION AGENCY FOR ASYLUM

Facility nameFacility Type

University College Hospital, Ibadan
Babcock University Teaching Hospital, Ilishan
University Teaching Hospital, Ado-ekiti
Lagos State University Teaching Hospital, Ikeja
Federal Teaching Hospital Ido-Ekiti
University of Ilorin Teaching Hospital, Ilorin
Jos University Teaching Hospital, Jos
University of Abuja Teaching Hospital,
Gwagwalada
Benue State University Teaching Hospital,
MakurdiBingham University Teaching Hospital, Jos
University of Maiduguri Teaching Hospital,
Maiduguri
Abubakar Tafawa Belewa University Teaching
Hospital, Bauchi
Federal University Teaching Hospital, Gombe
Aminu Kano Teaching Hospital, Kano
Ahmadu Bello University Teaching Hospital, Zaria
Usmanu Danfodio University Teaching Hospital,
SokotoPublic
X
X
X
X
X
X
X

Private
X

X
X

X

X
X
X
X
X

Table 37: Regional distribution of tertiary facilities with specialised services for respiratory
care in Nigeria 492

11.2 Access to treatment
In a 2014 study evaluating out-of-pocket expenditure on asthma follow-up care, the monthly
direct cost of asthma care was estimated at USD 30.7; of which about USD 26.7 were spent
on medications. 493 The monthly household income of the study participants was below USD
100; 494 hence, the cost of procured medicines was unaffordable according to the World
Health Organization (WHO) standards. 495 Another factor that militates against access tohealthcare includes poor availability of medicines and equipment at health facilities; arepresentative sample of tertiary centres were reviewed between June and December 2009
to assess the equipment and resources available to support internationally endorsed
standards of asthma care at teaching hospitals in Nigeria. This found that less than 40 % of
tertiary centres had not lacked basic equipment, such as peak flow meter, spirometer, skinallergy test kits, pulse oximeter and arterial blood gas analyser. 496
Between 2018 to 2019, the number of public facilities providing TB treatment services,
including DOTS increased from 8 174 to 9 024; the majority (72 %) are publicly-owned while

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
493
Onyedum, C.C. et al., Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African
Country, March 2014, url, p. 2
494
Onyedum, C.C. et al., Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African
Country, March 2014, url, p. 3
495
WHO, Measuring medicine prices, availability, affordability, and price components, 2nd edition, 2008, url, p. 12;
Medication affordability estimations take into account the number of days’ wages (daily wage of the lowestpaid unskilled government worker) required in order to purchase a given number of courses of treatments forcommon acute and chronic conditions.
496
Desalu, O.O. et al., Asthma in Nigeria: Are the facilities and resources available to support internationallyendorsed standards of care? March 2011, url, p. 251
492

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28 % (3 582) of the facilities providing TB services are private centres. 497 Despite of the
expected increase in the number of facilities providing care in 2019 and 2020, only 27 % of
those requiring treatment received services resulting in a coverage gap of approximately
73 % in 2019. 498 Critical factors responsible for poor coverage rates can be attributed toavailability of treatment and diagnostic services at health facilities. 499
Effectiveness and efficiency of the NTP were hindered by inadequate human resources,
dilapidated service delivery infrastructure, weak drug supply system, and poor TB
surveillance system. 500

11.3 Insurance and national programmes
The NHIS was launched in 2005 and provides health insurance coverage for Nigerians
through three major programmes (see table 38). 501
Programme

Focus

Requirements

Formal sectorsocial healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised private
sector or willing to
make voluntaryindividual/family/groupcontributions

Informalsector social
healthinsurance
programme

For individuals in theinformal sector. It
covers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers and others notcovered under theformal sector or thevulnerable group

Vulnerable
group

For indigents and thevulnerable (children
under-5, physically

1. Public/federal tier Government pays
3.25% and employee
pays 1.75 % of
employee's basic
salary2. Armed forces Government pays
entire 5 % of
employee's basic
salary3. Private/othergovernment tiers Employer pays 10 %and employee pays 5% of employee's basic
salaryCommunity-based
health insurance
scheme - Actuariallydetermined flat rate
fee perhousehold/individual
household member ormember of an
occupation-based
group and paid in cash
monthly or seasonallyin advance
Register with a PHCC
under the Basic Health

Scope ofcoverage
Coverhealthcare
benefits fortheemployee,aspouse andfour
biologicalchildrenbelow theage of 18
years

For theregisteredindividualalone.

For theregistered

Respiratory services
covered
1. Outpatient/preventive
care (voluntary counselling,
screening and treatment)
2. Admission for up to
three weeks for comorbidities
3. Consultation withspecialists(internists/infectious
diseasespecialists/pulmonologists)
4. Prescribed drugs,
pharmaceutical care anddiagnostic tests as
contained in the NHIS
Drugs List and NHIS
Diagnostic Test Lists
As in public sector

As in public sector

Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme: Draft 2019 Annual TB Report, 2019, url,
pp. 9-10
498
Nigeria, FMoH, National Tuberculosis and Leprosy Control Programme: Draft 2019 Annual TB Report, 2019, url,
pp. 9-10, 18
499
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021.
500
Nigeria, FMoH, The National Strategic Plan for Tuberculosis Control 2015-2020: Towards Universal Access toPrevention, Diagnosis and Treatment; July 2014, url, p. 178
501
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5497

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Programme

Focus

Requirements

challenged persons,prison inmates,
pregnant women,orphans and internallydisplaced people)

Care Provision Fund
Programme

EUROPEAN UNION AGENCY FOR ASYLUM

Scope ofcoverage
individual
alone

Respiratory services
coveredTable 38: Health Insurance Programmes in Nigeria 502
Emergency care of asthmatic attacks is provided for within the NHIS Basic Minimum Packageof health services (BMPHS). 503 Consultations and TB testing is covered for in the NHISBMPHS, while anti-TB drugs are completely excluded. Some services required toappropriately manage respiratory conditions, such as high-technology investigations,
including computed tomography (CT) scan, and magnetic resonance imaging (MRI), arepartially excluded (health maintenance organisation would pay 50 % of cost) from the NHIS
benefit package. 504 However, the NTBLCP with funding from government and donors
provides free treatment for TB patients at public facilities. 505

11.4 Cost of medication
The Federal Government of Nigeria procures anti-TB drugs and commodities from the Global
Drug Facility 506 – established in 2001 to help increase access to high-quality and affordable
TB treatments and diagnostics to populations in need – using in-country budgeted funds, aswell as grants from the Global Fund, and the United States Agency for International
Development (USAID). 507 The NTBLCP in collaboration with Global Fund and partners
coordinates the procurement process, while NTBLCP alone oversees quarterly distribution to
the zones, from where they are further distributed to the states and facilities based onreported caseload and consumption data. 508
The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 509
In addition, the National Agency for Food and Drug Administration (NAFDAC) maintains a
database for registered medications. 510
The prices of medications were collected from six private pharmacies across the country –four in the southern and two in the northern regions. 511 Medication prices were found to behigher in the north due to add-on costs in the supply chain – drugs are imported into the
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
503
Nigeria, NHIS, Operational Guidelines, October 2012, url, p. 20
504
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 24-25
505
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
506
Stop-TB Partnership, GDF’s resources, n.d., url
507
Nigeria, FMoH, The National Strategic Plan for Tuberculosis Control 2015-2020: Towards Universal Access toPrevention, Diagnosis and Treatment, July 2014, url, p. 34
508
Nigeria, FMoH, The National Strategic Plan for Tuberculosis Control 2015-2020: Towards Universal Access toPrevention, Diagnosis and Treatment, July 2014, url, p. 34
509
Nigeria, FMoH, Nigeria Essential Medicines List, 2020, url
510
Nigeria, NAFDAC, NAFDAC Green Book: Registered Product Database Search, n.d., url
511
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
502

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

country through seaports in the south. 512 Medicines which are only available in the informal
market have been excluded. See more details of medication cost in the methodology sectionof the general country report.
Generic Name

Brand name

Separate anti-asthmatics
Montelukast sodiumMontiget®
Salbutamol
Ventolin®
Combined anti-asthmatics
Salmeterol +Saltrol HFA®
fluticasone(propionate)
Inhalation corticosteroids
Fluticasone
Flixonase®
Parasympatholytics
Ipratropium
Generic
Ipratropium bromide
Atrovent®
monohydrateFirst line TB medicines
Ethambutol
Generic
Isoniazid
Generic/INH
Pyrazinamide
Generic
Rifampicin
Generic
Second/ third line TB medicines
Moxifloxacin
Moxiget®

DosageForm

Number ofunits in thecontainer

Price per box (USD)

10 mg
100 mcg/dose

tabletinhaler

101

6.1 (5.9-6.3)
3.4 (3.1-3.7)

25 mcg/125
mcg

inhaler1

8.5 (8.1-8.9)

60 doses

aerosol

1

8.5 (8.1-8.9)

250 mcg/ml
250 mcg/ml

vial
vial

20
20

51.2 (49.9-52.5)
51.2 (49.8-52.6)

400 mg
300 mg
50 mg
300 mgcapsuletabletcapsuletablet

100
100
500
10

12.2 (11.8-12.6)
36.5 (35.5-37.5)
60.9 (58.9-62.9)
1.6 (1.2 -2.0)

400 mgtablet109.9 (8.9-10.9)

Table 39: Details of medications available in the formal market 513

11.5 Cost of treatment
The NHIS covers for asthmatic care as well as treatment of co-morbidities. 514 However, this istargeted at a small fraction of the population given that most households use out-of-pocket
payments at the point of care. 515 The NTBLCP, with funding from the Federal government andgrants from USAID and Global Fund, provides free treatment for TB cases. 516
The cost of public outpatient and inpatient treatments varies across the northern andsouthern regions of the country. In private facilities, a specialist consultation costs more forboth inpatient and outpatient care than in public facilities. The total costs incurred by patientscan be calculated by summing up all relevant services; however, indirect costs such as bed
rates, meals and transportation were not included. The prices below were obtained from eight
health facilities – three public and five privately owned centres – situated in the northern andsouthern zones of the country. 517 Thus, the value indicated in each cell is the average sum of
the values collated from the visited facilities.

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
513
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
514
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 20-25
515
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
516
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
517
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
512

101

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIASpecialist
Consultation by apulmonologist
Consultation by ageneral practitioner
Consultation by TB
specialist*

EUROPEAN UNION AGENCY FOR ASYLUM

Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

4.1 (3.9-4.3)

4.1 (3.9-4.3)

85.3 (84.9-85.7)

85.3 (84.9-85.7)

4.1 (3.9-4.3)

4.1 (3.9-4.3)

60.9

60.9

4.1 (3.9-4.3)

4.1 (3.9-4.3)

85.3 (84.9-85.7)

85.3 (84.9-85.7)

Table 40: Treatment cost by facility types 518* Provided for free at public facilities.

Diagnostic research
Diagnostic research, in theform of lung function tests(i.e. spirometry)
Diagnostic research:measuring arterial blood gas;arterial pH, pCO2, “baseexcess", arterial oxygen
saturation
Diagnostic research:measuring of blood oxygen
level (e.g. pulse oximetry)*
Diagnostic research:measuring of blood
oxygenation for home use*
Diagnostic research: PCR for
M.Tuberculosis*
Medical devices pulmonology
Breathing machines(ventilator, respirator etc.)
Nebulizer
Spacer (with mask) for inhaler
with asthma medication
Medical devices
pulmonology: oxygentherapy with device andnasal catheter (per hour)
Medical devices
pulmonology: oxygentherapy with O2 pressuretank (per hour)
Laboratory measurements
Resistance test for
tuberculosis drugs*
Sputum smear microscopy(tuberculosis)*
Treatment
Clinical admittance inpulmonology department(daily rates)

518

Public treatment price (USD)

Private treatment price (USD)

34.1 (33.8-34.4)

48.7 (36.5-60.8)

14.6 (145.8-146.4)

Not availableFree

Not availableFree

Not available

Free

48.7 (48.5-48.9)

Not available

609.4 (608.2-610.6)

12.2 (11.9-12.5)

127.9 (126.8 - 129)12.2 (11.9-12.5)

29.2 (28.9-29.5)

Adults – 4.9 (4.8-5.0)
Children – 3.7 (3.2-4.2)

Adults – 10.9 (9.5-12.3)
Children – 7.3 (6.5-8.1)

Adults – 4.9 (4.8-5.0)
Children – 3.7 (3.2-4.2)

Adults – 10.9 (9.5-12.3)
Children – 7.3 (6.5-8.1)

Free

42.7 (42.6-42.8)

Free

7.3 (7.1-7.5)

3.7 (3.5-3.9)

187.7 (185.6-189.8)

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Table 41: Cost of laboratory investigations by facility type 519* Provided for free at public facilities.

11.6 NGOs
Respiratory disease programming benefits immensely from huge international and local NGO
support. 520 Over the years, the USAID has supported the NTBLCP implementation activities in
Nigeria; for the 2020 fiscal year, USAID proposed a USD 13 million budget which covers TB
diagnosis, community TB care, drug-susceptible TB treatment, MDR-TB treatment and efforts
at halting TB transmission. 521 Other development partners providing support to Nigeria on TB
include the WHO, International Federation of Anti-Leprosy Associations (ILEP), The Leprosy
Mission Nigeria (TLMN), Netherlands Leprosy Relief (NLR), German Leprosy and TB Relief
Association (GLRA) and the Damien Foundation Belgium (DFB); International Union Against
TB and Lung Disease (IUATLD), Canadian International Development Agency (CIDA),
Department for International Development (DFID). 522

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
520
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
521
USAID, Nigeria Tuberculosis Roadmap Overview, Fiscal Year 2021, n.d., url, pp. 1-3
doi:
522
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
519

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUM

12 Haematology: Iron Deficiency Anaemia(IDA), Sickle Cell Anaemia (SCA) and Blood
Clotting Disorders (BCDs)
12.1 General information
Haematological disorders are disease conditions that affect the functions of the blood or
blood-producing organs. 523 The focus of this report will be on IDA, SCA, and BCDs. IDA is a
blood disorder characterised by deficient haemoglobin production leading to abnormallysmall-sized red blood cells containing reduced amount of haemoglobin. Consequently, thecapacity of the blood to supply oxygen to the body cells is adversely affected. 524 SCA is an
inherited birth defect that occurs when a newborn inherits the gene for sickle haemoglobin(HbS), a variant of the normal adult haemoglobin (HbA, the protein in the red blood cells
responsible for conveying oxygen within the body), from both biological parents. 525 BCDs area group of conditions, either inherited or acquired, which are characterised by the inability ofthe body to control the formation of blood clots during bleeding due to disorders of bloodvessels, platelets or coagulation factors. Although it is not clear which BCDs are the mostcommon in Nigeria, a study reported that disseminated intravascular coagulation (DIC) andhaemophilia are the most encountered cases in health facilities. 526

12.1.1 Epidemiological context
Nigeria leads the top three countries, including India and the Democratic Republic of theCongo (DRC) with the highest burden of SCA in the world and it is projected to continue inthis trajectory till 2050. 527 Population prevalence data are limited; however, it has been
estimated that about 25 % of the adult population are carriers of the sickle cell trait. 528
Available evidence suggests a relationship between the occurrence of sickle cell trait andmalaria endemicity thereby. 529 According to the 2019 Global Burden of Disease (GBD) study,
the estimated prevalence of sickle cell anaemia in Nigeria is 12 times higher than the global
estimate (0.08 %) and stands at 0.97 % equivalent to over 2 million people. The estimatedprevalence was highest in persons aged 0-1 year, at almost 2.9 % equivalent to 188 108
people. 530 The estimated prevalence decreased in the higher age groups, suggesting ahigher mortality rate with increasing age. 531

Nature portfolio, Haematological diseases, n.d., url
Akodu, O.S. et al., Iron deficiency anaemia among apparently healthy pre-school children in Lagos, Nigeria,
March 2016, url, p. 61
525
Piel, F.B. et al, Global Burden of Sickle Cell Anaemia in Children under Five, 2010-2050: Modelling Based on
Demographics, Excess Mortality, and Interventions, July 2013, url, p. 2
526
Okoye, H.C. et al, Challenges in the management of bleeding disorders in Nigeria, April 2018, url, pp. 468, 471
527
Piel, F.B. et al., Global Burden of Sickle Cell Anaemia in Children under Five, 2010-2050: Modelling Based on
Demographics, Excess Mortality, and Interventions, July 2013, url, pp. 4-7
528
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 29
529
Piel, F.B. et al., Global distribution of the sickle cell gene and geographical confirmation of the malaria
hypothesis, November 2010, url, p. 29
530
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
531
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 29
523

524

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Iron deficiency is the most common cause of anaemia globally. A 2020 systematic review
found that 3 out of 6 studies carried out in Nigeria reported a prevalence of IDA in pregnancy
ranging from 25 % to 45.6 %. The key predictors associated with IDA include multiparity, third
trimester of pregnancy, low educational level and low economic status. 532 Another study
conducted in Southwest Nigeria found the prevalence of IDA among apparently healthy preschool children to be 10.11 %, with a higher prevalence in children less than 2 years of age. 533
This finding was lower than the 25.0 % reported in a different research carried out in thesame region among children aged 0-5 years.534
There are limited data on the prevalence and characterisation of haemophilia in Nigeria.
However, by applying estimates regarding the global prevalence of haemophilia (105 and 28
per million males of haemophilia A and B, respectively) it is estimated that there are 9 00012 000 haemophiliacs in Nigeria. 535

12.1.2 Strategy and policies for haematology
No information was found during the researching of this report on a specific in-country
strategy wholly targeted at haematological diseases, except for SCA. One of the key prioritiesof the NSHDP II 2018-2022 is to reduce morbidity and mortality due to NCDs, including SCA,
by 20 % by the year 2022. 536 Also, the National Multi-Sectoral Action Plan for the Prevention
and Control of NCDs (2019-2025) has, as part of its priority actions, the following:
1. Raise public awareness on pre-marital/pre-conception screening for sickle cell diseaseusing point-of-care devices.
2. Promote collaborative work with faith-based organisations (FBOs), religious and traditional
leaders.
3. Scale-up universal screening for sickle cell diseases using point-of-care devices. 537 The
FMoH in collaboration with partners and the academia, articulated the National Guideline for
the Control and Management of SCA, which will engender uniformity and standardisation ofcare at all levels. 538

12.1.3 Healthcare provisions for heamatology
The availability of treatments for haematological disorders at primary healthcare level islimited to nutritional consultations and dispensing of basic medications for those sufferingfrom anaemia, including IDAs. 539 Genetic counselling and genotype profiling of the general
population is recommended to be provided at the PHCCs while diagnosis and treatment of
SCA complications are restricted to secondary and tertiary centres where there are moreskilled health workers. 540 Although teaching hospitals in the country provide care for SCA
cases, the federal government established sickle cell disease centres in 6 out of 22 federal
Ugwu, N.I. and Uneke, C.J., Iron deficiency anemia in pregnancy in Nigeria - A systematic review, July 2020,
url, pp. 890-891
533
Akodu, O.S. et al., Iron deficiency anemia among apparently healthy pre-school children in Lagos, Nigeria,
March 2016, url, pp. 64-66
534
Olufemi, S.S, et al., Infant feeding practices and Prevalence of Iron Deficiency Anaemia among Children of 0-5
Years in Ondo State, Nigeria, February 2013, url, p. 35
535
Okparaoka, S. et al., Frequency of hemophilia and hemostatic evaluation in persons with bleeding symptoms inSoutheast, Nigeria, August 2019, url, pp. 18-19
536
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 72
537
Nigeria, FMoH, National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable
Diseases (2019-2025), August 2019, url, p. 52
538
Nigeria, FMoH, National Guideline for the Control and Management of Sickle Cell Disease, 2014, url, pp. 1-2
539
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021.
540
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 73
532

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medical centres across the 6 geopolitical zones in the country to run clinics and programmes
for the management and control of SCAs:
•
•
•
•
•
•

Federal Medical Centre, Abakaliki, Ebonyi State (southeast);
Federal Medical Centre, Birnin-Kebbi, Kebbi State (northwest);
Federal Medical Centre, Ebute- Metta, Lagos State (southwest);
Federal Medical Centre, Gombe, Gombe State (northeast);
Federal Medical Centre, Keffi, Nasarawa State (north-central);Federal Medical Centre, Yenagoa, Bayelsa State (south-south). 541

12.2 Access to treatment
Access to haematological care in Nigeria is confronted with various challenges. Between 2011
and 2012, the FGoN established six sickle cell disease centres 542, equipped each one of themwith high-performance liquid chromatography (HPLC) machines 543, and developed national
protocols to ramp up screening for SCA cases. However, by 2017, fewer than 2 000 newborn
babies had been screened across all the centres. The identified constraints to these efforts
were attributed to poor budgetary allocation, inadequately trained personnel, expired
reagents, paucity of consumables, absence of mechanisms to collect samples from babies ona regular basis and frequent power outages. 544 In addition, there is limited knowledge among
doctors on the use of hydroxyurea, a newly approved medication capable of altering
treatment outcomes for SCA patients. 545
Routine iron supplementation therapy in pregnant women is one of the key approaches foraddressing IDA. Studies carried out in southeast and southwest regions of the country
identified poor utilisation of antenatal care services, low educational attainment, distance to ahealth facility, single and teenage pregnancy, and age of the pregnant woman as key drivers
to poor compliance with routine iron therapy. 546 More importantly, there is a strong
association between IDA and nutritional status. Hence, interventions to address IDA must go
beyond iron supplementation therapy to include efforts at improving food security andnutritional diversity. 547 Most of these interventions fall outside the scope of the health system.
For example, the National Home-Grown School Feeding Programme was shown to have
improved the nutritional status of children amongst other non-health indicators – classattendance, school enrolment and academic performance. 548

Nigeria, FMoH, National Guideline for the Control and Management of Sickle Cell Disease, 2014, url, p. 59
Nnodu OE et al., Implementing newborn screening for sickle cell disease as part of immunisation programmesin Nigeria: a feasibility study, July 2020, url, p. e535
543
High-performance liquid chromatography (HPLC) machine is a device used to screen the blood for thepresence of crescent-shaped haemoglobin – which is diagnostic of sickle cell disease.
544
Nnodu OE et al., Implementing newborn screening for sickle cell disease as part of immunisation programmesin Nigeria: a feasibility study, July 2020, url, p. e535
545
Ofakunrin, A.O.D. et al., Level of Utilization and Provider-Related Barriers to Hydroxyurea Use in the Treatmentof Sickle Cell Disease in Jos, Nigeria, November 2019, url, p. 1029
546
Onyeneho, N.G. et al., Factors associated with compliance to recommended micronutrients uptake forprevention of anemia during pregnancy in urban, peri-urban, and rural communities in Southeast Nigeria,
November 2016, url, pp. 6-14; Dairo, M.D. and Lawoyin, T.O., Demographic factors determining compliance toiron supplementation in pregnancy in Oyo State, Nigeria, September 2006, url , pp. 242-243
547
Akodu, O.S. et al., Iron deficiency anaemia among apparently healthy pre-school children in Lagos, Nigeria,
March 2016, url, pp. 66-67
548
Awojobi, O.N. and Tinubu, R.A., Impact Evaluation of National Home-Grown School Feeding Programme in
Nigeria: Preliminary Findings from a Mixed-Methods Approach, July 2020, url, p. 11
541

542

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12.3 Insurance and national programmes
The National Health Insurance Scheme (NHIS) was launched in 2005 and provides healthinsurance coverage for Nigerians through three major programmes (see table 42). 549 Amongst
haematological disorders covered in this report, only care for anaemia is provided for within
the NHIS Basic Minimum Package of Health Services (BMPHS). 550
Programme

Focus

Requirements

Formalsector social
healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised
private sector or
willing to makevoluntary
individual/family/groupcontributions

Informal
Sector Social
HealthInsurance
Programme(ISSHIP)For individuals in theinformal sector. It
covers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers, and others
not covered under theFormal Sector or the
Vulnerable Group

Vulnerable
Group

For indigents and thevulnerable (children
under five, physicallychallenged persons,prison inmates,
pregnant women,orphans, andinternally displaced
persons)

1. Public/federal tier Government pays
3.25 % and employee
pays 1.75 % of
employee's basic
salary2. Armed forces Government pays
entire 5 % of
employee's basic
salary3. Private/othergovernment tiers Employer pays 10 %and employee pays
5 % of employee's
basic salaryCommunity-based
health insurance
scheme - actuariallydetermined flat rate
fee perhousehold/individual
household member ormember of an
occupation-based
group and paid in
cash monthly orseasonally in advance
Register with a PHCC
under the Basic
Healthcare Provision
Fund programme

Scope ofcoverage
Cover healthcare
benefits for theemployee, aspouse and 4
biologicalchildren below
the age of 18
years

Haematology services
covered
1. Outpatient/preventive
care (consultation,screening, and treatment)
2. Admission for up to 3
weeks for co-morbidities
3. Consultation withspecialists(internists/heamatologists)
4. Prescribed drugs,
pharmaceutical care, anddiagnostic tests as
contained in the NHIS
drugs list and NHIS
diagnostic test lists

For theregisteredindividual alone

As in public sector

For theregisteredindividual alone

As in public sector

Table 42: Health insurance programmes in Nigeria 551
There exist varying degrees of insurance coverage for certain haematological services; forexample, high-technology investigations, such as computed tomography (CT) scan and

Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes; October 2020, Available from: url, p. 5
550
Nigeria, NHIS, Operational Guidelines; October 2012, url, p. 19
551
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
549

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magnetic resonance imaging (MRI), are partially excluded (health maintenance organisation
would pay 50 % of cost. 552

12.4 Cost of medication
Patients often have poor adherence to treatments, particularly for chronic conditions, such as
those related to SCA. 553 This is due to prohibitive costs and lack of availability of key
medications. 554 The drugs listed in the table below are all contained within the seventh
edition of Nigeria’s Essential Medicines List – a list that is frequently reviewed by the National
Drug Formulary and Essential Medicines List Review Committee established by Decree
Number 48 of 1989. 555 In addition, the National Agency for Food and Drug Administration(NAFDAC) maintains a database for registered medications. 556
The prices of medications were collected from six private pharmacies across the country –four in the southern and two in the northern regions. 557 Medicines that are only available in
the informal market have been excluded. See more details of medication cost in themethodology section of the general country report.
Generic name
Hemostatics
Tranexamic acid
Against anemia
Ferrous gluconate
Folic acid
Ferrous sulphate +folic acid(vitamin B9)Hydroxycarbamide
or hydroxyurea(Hydrea)
Iron (oral/ tablets)
Pain killers
Diclofenac
Morphine
Tramadol
Antibiotics
Amoxicillin
Amoxicillin +clavulanic acid(combination)
Azithromycin
Cefuroxime
Ciprofloxacin
Clarithromycin

Brand name

DosageForm

Number ofunits in thecontainer

Price per box (USD)

Tranexamic
Acid®

500 mg/5 ml

ampoule524.4 (22.2-26.6)

Emzor®
Teva®
Ferrogard®

300 mg5 mg
65/400 mg

tablettablettablet100
30
30

14.9 (13.8-16.0)
7.3 (6.9-7.7)
10.9 (9.8-12.0)

Oxyurea®

100 mgtablet30

2.9 (2.1-3.7)

Astyfer®

1 capsulecapsule30

12.4 (12.1-12.7)

Voltaren®
Morphine®
Pengesic®

75 mg
10 mg/ml
50 mg

tabletampoulecapsule30
10100

15.2 (15.1-15.3)
102.4 (101.8-103.0)
48.8 (47.5-50.1)

Amoxil®
Augmentin®

500 mg625 mgcapsuletablet100
1424.4 (24.1-24.7)
10.2 (9.8-10.6)

Zithromax®
ZinnatCiproxin®
Klatril®

250 mg
500 mg
500 mg
500 mgcapsuletablettablettablet61010
1421.9 (20.9-22.9)
14.9 (14.2-15.6)
60.9 (59.5-62.3)
13.7 (13.3-14.1)

Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 24-25
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
554
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
555
Nigeria, FMoH, Nigeria Essential Medicines List, 2020, url
556
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, n.d., url
557
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
552
553

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Generic nameBrand name

DosageForm

Clindamycin
Metronidazole
Tetracycline
Trimethoprim andsulfamethoxazole(cotrimoxazole)
Vaccinations
Diphtheria,
tetanus, pertussis(acellular)
haemophilus
influenzae type b(Hib) vaccine
Influenza vaccine
Measles vaccine

Dalacin®
Flagyl®
Tetramac®
Septrim®

150 mg
400 mg
250 mg80/400 mg

Tetraxim®

Mumps vaccine
Pneumococcal
vaccinePoliomyelitis(inactivated)vaccineRubella vaccine
Hib vaccine
Meningococcal
vaccine (to prevent
meningitis)

Price per box (USD)

capsuletabletcapsuletabletNumber ofunits in thecontainer
100
100
10
100

0.5 mlVial

1

21.6 (20.9-22.3)

Vaxigrip®
Available as
Priorix,
Combination®
Available as
Priorix,
Combination®
Prevener 13®

0.5 ml
0.5 ml

vial
Vial

1
1

7.3 (7.1-7.5)
10.9 (9.9 -11.9)

0.5 mlVial

110.9 (9.9-11.9)

0.5 mlvial

126.8 (25.9-27.7)

IPV®

0.5 mlvial

1

10.9 (9.9-11.9)

Priorix,
Combination®
Vaxigrip®
Nimenrix®

0.5 mlVial

110.9 (9.9-11.9)

0.5 ml
0.5 ml

vial
vial

1
1

22.2 (21.8-22.6)
22.2 (21.8-22.6)

4.9 (4.1-5.7)
4.9 (4.1-5.7)
3.7 (3.1-4.3)
4.9 (4.1-5.7)

Table 43: Details of medication available in the formal market 558

12.5 Cost of treatment
The NHIS covers for IDA, as well as treatment of co-morbidities. However, this is listed only ata small fraction (about 5 % coverage) of the population given that most households use outof-pocket payments at the point of care. 559
In private facilities, a specialist consultation costs more for both inpatient and outpatient careas compared to public facilities. The total costs incurred by patients can be calculated bysumming up all relevant services; however, indirect costs, such as those for bed, meals andtransportation, were not included. The prices below were obtained from a range of secondary
and tertiary facilities situated in the northern and southern zones of the country. 560 Thus, thevalue indicated in each cell is the average sum of the values collated from the visited facilities.

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
559
Alawode, G.O. and Adewole, D.A., Assessment of the design and implementation challenges of the National
Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare andinsurance providers; January 2021, url, p. 1
560
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
558

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIASpecialist
Consultation by ahaematologist
Consultation by apaediatrician

EUROPEAN UNION AGENCY FOR ASYLUM

Public outpatient
treatment price(USD)

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

4.1 (3.9-4.3)

4.1 (3.9-4.3)

60.9 (59.9-61.9)

60.9 (59.9-61.9)

4.1 (3.9-4.3)

4.1 (3.9-4.3)

60.9 (59.9-61.9)

60.9 (59.9-61.9)

Table 44: Treatment cost by facility type 561
Laboratory research
Full blood count; e.g. haemoglobin(Hb), white blood cells (WBCs) andplatelets
Diagnostic research: measuring blood
oxygen/arterial blood gas (Astrup)
Laboratory research of bacterial
cultures
Treatment
Clinical admittance in haematology
department (daily rates)
Clinical admittance in paediatricdepartment (daily rates)
Intensive care treatment (daily rates)(Safe) blood transfusion(safe=checked/screened for humanimmunodeficiency virus (HIV) andhepatitis A/B/C)
Clinical treatment in case of sickle cell
crisis (exchange blood transfusion)Fresh frozen plasma (FFP)
replacement/unit
Haematology: transfusion oferythrocytes/red blood cells/unit
Haematology: phlebotomy/
venepuncture/blood collection
Oxygen therapy with device, such as
nasal catheter/hour
Platelets/thrombocytes
transfusion/unit transfused

Public treatment price (USD)

Private treatment price (USD)

8.5 (8.2-8.8)

12.7 (11.9-13.5)

6.0 (5.8-6.2)

36.5 (35.9-37.1)

8.5 (8.2-8.8)

6.0 (5.9-6.1)

3.7 (3.5-3.9)

93.8 (92.5-95.1)-187.7 (187.1-188.3)

2.4 (2.2-2.6)

93.8 (92.5-95.1)

12.2 (12.1-12.3)
12.1 (11.8-12.4)

73.1 (72.5-73.7)

24.3 (23.8-24.8)

438.7 (435.2-442.2)

19.5 (18.9-20.1)

97.5 (95.6-99.4)

19.5 (18.8-20.2)

73.1 (72.8-73.4)

Free

73.1 (72.8-73.4)

2.4 (2.1-2.7)

Not available

19.5 (18.9-20.1)

121.8 (120.9-122.7)

Table 45: Cost of investigations by facility type 562

12.6 NGOs
Of all the haematological disorders, this report was able to find information mainly on
available non-government organisation (NGO) support for sickle cell disease. Examples
include:EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
562
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
561

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•
•

•
•

•
•
•
•
•

563

MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Association of people living with sickle cell disorder: Situated in Southeast Nigeria.
The foundation was created to help save children with sickle cell anaemia, and tocater for the medical and welfare needs of persons living with the disorder.
Samira Sanusi Sickle Cell Foundation: Situated in Abuja Federal Capital Territory(FCT), Nigeria. The foundation provides services in the prevention, treatment,
management, control and cure of sickle cell disorder through sickle cell awareness,genotype compatibility and genetic counselling.
Sickle Cell Hope Alive Foundation (SCHAF): Situated in Southwest Nigeria. SCHAF
improves the quality of care for those living with sickle cell disorder, and also
promotes awareness and education on SCA management.
Sickle Cell Support Society of Nigeria: Situated in Abuja FCT, Nigeria. The society
was established to help in bring together doctors skilled in managing sickle celldiseases, NGOs and patients together with the aim of creating awareness, research
and advocacy for the disease.
The Sickle Cell Aid Foundation (SCAF): Situated in Abuja FCT, Nigeria. SCAF is an
NGO created to help expand SCA awareness and also provide quality healthcare
solutions and treatment to people living with the disorder.
Agatha Sickle Cell Foundation: Situated in south-south, Nigeria. This is an NGO thataims to educate the public about sickle cell disease, and also inspire, empower andprovide them with access to quality health care and treatment.
Ayabime Okpoh Sickle Cell Foundation: Situated in Southwest Nigeria. This wasestablished to create awareness on sickle cell disorder and increase access to quality
care.
Crystal Shape Sickle Cell Foundation: Situated in north-central zone. The Crystal
Shape Sickle Cell Foundation was established to support sickle cell anaemic patientsin hard-to-reach communities in Nigeria, with quality treatment and drugs.
Nirvana Initiative: Situated in southwest zone. Nirvana Initiative is dedicated toeducating and spreading awareness about SCA.563

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021

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13 Paediatrics
13.1 General information
Paediatrics is the field of medicine that deals with children and their diseases. This field is
crucial to the Nigerian context because the majority of the population are within 0-14 years,
depicting a young population, high fertility rate and dependency. 564 Also, low levels of birth
registration – as much as 46.9 % of children under the age of five whose births are reported
as registered – imply that the young population may be higher than the official statistics. 565
More importantly, Nigeria’s under 5 mortality rate (U5MR) (132 per 1 000 live births) is among
the highest in the world (see table 46 for other child survival indicators) 566; in Nigeria, eachyear, about 262 000 babies die at birth, the world’s 2nd highest national total, while every day
in Nigeria, 257 babies die within their first month of life. 567
Total population (millions)
Crude birth rate (CBR) (per 1 000)
Total fertility rate (TFR) births per woman (ages 15-49)
Unmet need for family planning (FP) (%)
Infant mortality rate (IMR) (per 1 000)
Under 5 mortality rate (U5MR) (per 1 000)Child mortality rate (CMR) (per 1 000)
Neonatal mortality rate (per 1 000)Children with low birth weight (%)
Children age 0-5 months exclusively breastfed (%)
Stunted children under age 5 (height-for-age, below 2 standard deviation (SD) (%))
Wasted children (weight-for-height, below 2 SD) (%)
Underweighted children (weight-for-age, below 2 SD) (%)
Per cent of children 12-23 months fully immunised
Maternal mortality ratio (per 100 000 live births)
Orphans under age 18 (double, maternal, paternal and all causes) (%)

211.4 568
38
5.3 569
18.9 570
67
132
69
39 571
7 572
29 57337
7
22 57421 575512 576
6 577

Nigeria, NBS, Demographic Statistics Bulletin 2017, May 2018, url, p. 4
Nigeria, NBS and UNICEF, Multiple Indicator Cluster Survey 2016-17, National Survey Finding Report, February
2018, url, pp. 217-218
566
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018 , url, p. 164
567
UNICEF, New Year’s Babies: More than 25,000 babies will be born in Nigeria on New Year’s Day – UNICEF,
January 2019, url
568
UNFPA, World Population Dashboard: Nigeria, 2021, url
569
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018 , October 2019, url, p. 104
570
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018 , October 2019, url, p. 149
571
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. 164
572
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. 224
573
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. 260
574
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. 257
575
Nigeria, NBS and UNICEF, Multiple Indicator Cluster Survey 2016-17, National Survey Finding Report, February
2018, url, p. 54
576
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. xxxvii
577
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, p. 11
564

565

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Table 46: Child survival indicators in Nigeria
According to a verbal/social autopsy study carried out on a representative sample of 986
neonatal and 2 268 1-59-month-old deaths from 2008 to 2013 identified by the 2013 Nigeria
Demographic and Health Survey (NDHS), the principal causes of neonatal deaths were sepsis(31.5 %), birth asphyxia (22.3 %) and neonatal pneumonia (19.9 %); and that for 1-59-month-old
deaths were malaria (36.4 %), diarrhoea (26.0 %) and pneumonia (16.4 %). 578 This report will
focus on the most common causes of childhood mortality – malaria, diarrhoea, pneumonia,
birth asphyxia and sepsis.

13.1.1 Epidemiological context
Malaria is a preventable and curable life-threatening disease that is caused by parasites thatare transmitted from person to person through the bites of the female Anopheles mosquitoes.
Children under the age of 5 years are most prone to malaria infection; in 2019, theyaccounted for 2/3 (274 000) of all malaria deaths globally. Nigeria contributed more than onefifth of the global malaria deaths. 579 The 2019 Global Burden of Disease (GBD) study estimatesof malaria prevalence for age groups <5 years, 5 to <9 years, and 10 to <14 years are 23.01 %,24.66 % and 22.84 %, respectively. 580 This is similar to a 2020 hospital-based study carriedout in southeast Nigeria, which estimated the prevalence of malaria to be 16.7 %, 26.7 % and29.9 % in children <5 years, 5 to < 10 years and 10 to <15 years, respectively. 581 However, amuch lower prevalence (7.4 %-8.6 %) in children under 5 years was found in a study
conducted in the south-south geopolitical zone. 582
According to the 2019 GBD study, the prevalence of diarrhoeal diseases in age groups of <5years, 5 to <10 years and 10 to <15 years was estimated to be 3.44 %, 1.47 %, and 0.97 %,respectively. This implies that diarrhoeal prevalence was highest in under 5 and decreased
with increasing age.
Sepsis has been recognised as the chief cause of neonatal mortality in Nigeria, leading toapproximately 26 864 neonatal deaths in 2019. The 2019 GBD study estimated theprevalence of neonatal sepsis to be 0.86 %, equivalent to 4 273 cases. 583 The key drivers ofearly neonatal sepsis (up to 72 hours after birth) include maternal febrile illnesses, low birthweight and premature rupture of membranes. 584
According to the International Vaccine Access (IVAC) Pneumonia and Diarrhoea 2020
progress report, Nigeria is one of the countries with the highest burden of pneumonia anddiarrhoea in children under 5 years accounting for over 208 439 deaths. 585 According to two
hospital-based studies carried out in the southwestern region of the country, the prevalence

Adewemimo, A. et al., Direct estimates of cause-specific mortality fractions and rates of under-five deaths in thenorthern and southern regions of Nigeria by verbal autopsy interview, May 2017, url, p. 15
579
WHO, Malaria, April 2021, url; site updated since accessed, old data to be found in the archive of WHO
website.
580
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
581
Nwaneli, E.I. et al., Malaria prevalence and its sociodemographic determinants in febrile children - a hospitalbased study in a developing community in South-East Nigeria, June 2020, url, p. 176
582
Oboro, I.L. et al., Prevalence of Malaria among Children under Five Years in the Niger Delta Region of Nigeria,
May 2021, url, p. 13
583
IHME, Global Health Data Exchange, GBD Results Tool, n.d., url
584
Olorukooba, A.A. et al., Prevalence and factors associated with neonatal sepsis in a tertiary hospital, NorthWest Nigeria, May 2020, url, pp. 60-61
585
IVAC and Johns Hopkins Bloomberg School of Public Health, Pneumonia and diarrhea progress report 2020,
n.d., url, p. 3
578

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of childhood pneumonia ranges from 13.3 % to 23.9 %. 586 The most common causes are
Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), both of which arepreventable by pneumococcal conjugate vaccines (PCVs) and Hib vaccines, respectively. 587
According to the 2018 NDHS, it is estimated that about 69 % of children aged 12-23 months
had not yet received all basic vaccinations at the time of the survey, while 21 % had received
all age-appropriate vaccinations. 588
Nigeria has the highest burden of birth asphyxia when compared to its sub-Saharanneighbours. 589 According to the United Nations (UN) Inter-agency Group for Child Mortality
Estimation reports, Nigeria was among the two countries that contributed one-third of global
under-five deaths between 2018 and 2019, and within the same period accounted for
267 000 neonatal deaths, while intrapartum complications (asphyxia or lack of breathing after
death) accounted for more than 1/5 of the under-five deaths globally. 590 In Nigeria, studies
have reported a prevalence of birth asphyxia ranging from 3.2 % to 24.9 % across the northand southern regions. 591 In addition, asphyxia contributes between 18.2 % and 30.1 % of total
newborn admissions in the country. 592

13.1.2 Strategy and policies for paediatrics
There is no overarching national strategy for the management of paediatric diseases (sepsis,
pneumonia, diarrhoeal diseases) except for malaria, which has a dedicated in-country strategy
document to inform malaria-specific programmes and interventions. 593 The National Strategic
Health Development Plan II (NSHDP II) (2018-2022) incorporated the management of sepsis,
pneumonia, malaria and diarrhoeal diseases within the packages of newborn and childhealthcare services to be provided at PHCCs with provision for referral to secondary andtertiary health centres. 594
Given the high burden of malaria in Nigeria, the overall country goal, as articulated within the2016 National Health Policy, is to reduce the malaria burden to pre-elimination levels andbring malaria-related mortality to 0 by 2030. 595 To monitor progress, relevant malaria

Abdulkarim, A.A. et al, Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria, July
2013, url, p. 285; Kuti, B.P. and Oyelami, A.O., Childhood community-acquired pneumonia at the Wesley Guild
hospital, Ilesa: Prevalence, pattern, and outcome determinants, 2015, url, pp. 99-100
587
WHO, Pneumonia, November 2021, url
588
Nigeria, National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health
Survey 2018, October 2019, url, pp. 224-225
589
Usman, F. et al., Newborn Mortality in Sub-Saharan Africa: Why is Perinatal Asphyxia Still a Major Cause?
August 2019, url, pp. 1, 3
590
UNICEF, Levels and Trends in Child Mortality: Report 2019, 2019, url, pp. 12, 16, 19, 41
591
Ilah, B.G. et al., Prevalence and Risk Factors for Perinatal Asphyxia as Seen at a Specialist Hospital in Gusau,
Nigeria, May 2015, url, pp. 65-66; Mcgil Ugwu, G.I. et al., Incidence of birth asphyxia as seen in central hospitaland GN children's clinic both in Warri Niger Delta of Nigeria: an eight year retrospective review, August 2012,
url, p. 141; West, B.A. and Opara, P.I., Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria, June
2013, url, pp. 206-207
592
Mukhtar-Yola, M. and Iliyasu, Z., A review of neonatal morbidity and mortality in Aminu Kano Teaching Hospital,
northern Nigeria, July 2007, url, p. 131; Okposio, M.M. and Ighosewe, O.I., Morbidity and mortality pattern
among neonates admitted to the general paediatric ward of a secondary health care centre in the Niger deltaregion of Nigeria, June 2016, url, p. 85; Ilah, B.G. et al., Prevalence and Risk Factors for Perinatal Asphyxia as
Seen at a Specialist Hospital in Gusau, Nigeria, May 2015, url, p. 65
593
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
594
Nigeria, FMoH, Second National Strategic Health Development Plan (NSHDP II) 2018-2022, url, p. 60
595
Nigeria, FMoH, National Health Policy 2016: Promoting the Health of Nigerians to Accelerate Socio-economic
Development, 2016, url, pp. 10, 29
586

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indicators were included as key parameters for tracking implementation status of NSHDP II. 596
However, no mid-term evaluation studies were found on the status of implementation. In
addition, to engender more focused efforts at malaria elimination, the Federal Ministry of
Health (FMoH) articulated the National Malaria Strategic Plan (NMSP) 2014-2020, whichhighlighted 7 key objectives, including scaling up of preventive measures (more than 80 % oftarget population by 2020), testing of all suspected cases, treatment of all confirmed cases,
nationwide sensitisation, ensuring availability of antimalarial medicines and routine healthfacility malaria reporting, as well as better governance and coordination mechanisms for
effective national malaria programming. 597 An evaluation of the National Malaria Elimination
Program (NMEP) in Nigeria, between 2008 and early 2016 to assess the progress of malariainterventions and outcomes in states supported by the United States Agency for International
Development (USAID) President’s Malaria Initiative (PMI) – Cross River, Ebonyi, Nassarawa,
and Sokoto – showed there was greater availability of malaria commodities, trained healthworkers in malaria case management and malaria in pregnancy, and other necessary inputs in
PHCCs supported by PMI as compared to those that did not receive direct PMI support. 598
This implies that partner support helped to enhance government-led interventions.

13.1.3 Healthcare provisions for paediatrics
Services available for paediatric illnesses from primary healthcare (PHC) facilities include
consultations with non-specialist medical staff, access to basic medications, such as zincoxide and Vitamin A for managing diarrhoeal diseases, and delivery of laboratory services,such as rapid diagnostic tests for detecting malaria. 599 In addition, healthcare workers (HCWs),
including pharmacists, laboratory scientists, nurses, community health officers and community
health extension workers, all play varying roles in diagnosing, treating and follow-up of
paediatric conditions within PHCCs, based on their level of training and designated roles. The
HCWs refer cases to secondary and tertiary centres, in the absence of such services in theirfacility or when complications arise. 600 For specialist consultations, patients can accesspaediatric clinics in the teaching hospitals provided below: 601
S. No.
1
2
3
4
5
6
7
8
9
10
11

Geopoliticalzone
Southeast

South-south

Facility name
Abia State University Teaching Hospital, Aba
Nnamdi Azikiwe University Teaching Hospital, Nnewi
Ebonyi State University Teaching Hospital, Abakiliki
University of Nigeria Teaching Hospital, Enugu
Imo State University Teaching Hospital, Orlu
Anambra State University Teaching Hospital, Amaku Awka
Madonna University Teaching Hospital, Okija
Federal University Teaching Hospital, Abakiliki
University of Uyo Teaching Hospital, Uyo
University of Calabar Teaching Hospital, Calabar
University of Benin Teaching Hospital, Benin City

Facility type
PublicPrivate
X
X
X
X
X
X
X
X
X
X
X

Nigeria, FMoH, Monitoring And Evaluation Plan for the Second National Strategic Health Development Plan
2018-2022: Ensuring healthy lives and promoting the wellbeing of Nigerian populace at all ages, 2018, url,
pp. 7-8
597
Nigeria, FMoH, National Malaria Strategic Plan 2014-2020, 2014, url, pp. 33-34
598
MEASURE Evaluation, National Malaria Elimination Programme (NMEP), and the President’s Malaria Initiative(PMI/Nigeria), Assessment of malaria interventions in four Nigerian States: Final report, August 2017, url, p. 3-4,
99
599
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
600
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
601
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
596

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

S. No.
12
13
14
15
16

Geopoliticalzone

Southwest

17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

North
centralNortheast

Northwest

EUROPEAN UNION AGENCY FOR ASYLUM

Facility name
Delta State University Teaching Hospital, Oghara
Niger Delta University Teaching Hospital, Okolobiri
Igbinedion University Teaching Hospital, Okada
Lagos University Teaching Hospital, Idi-Araba
Olabisi Onabanjo (Ogun state) University Teaching Hospital,
SagamuLAUTECH University Teaching Hospital, Osogbo/Ogbomosho
Obafemi Awolowo University Teaching Hospital Complex, IIeife
University College Hospital, Ibadan
Babcock University Teaching Hospital, Ilishan
University Teaching Hospital, Ado-ekiti
Lagos State University Teaching Hospital, Ikeja
Federal Teaching Hospital Ido-Ekiti
University of Ilorin Teaching Hospital, Ilorin
Jos University Teaching Hospital, Jos
University of Abuja Teaching Hospital, Gwagwalada
Benue State University Teaching Hospital, Makurdi
Bingham University Teaching Hospital, Jos
University of Maiduguri Teaching Hospital, Maiduguri
Abubakar Tafawa Belewa University Teaching Hospital,
BauchiFederal University Teaching Hospital, Gombe
Aminu Kano Teaching Hospital, Kano
Ahmadu Bello University Teaching Hospital, Zaria
Usmanu Danfodio University Teaching Hospital, Sokoto

Facility type
PublicPrivate
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

X

X

X
X
X
X

Table 47: Regional distribution of tertiary facilities with specialised services for paediatric carein Nigeria

13.2 Access to treatment
A 2012 study that examined child healthcare demand in Nigeria found that the key drivers toaccessing care amongst the paediatric population include the household head educational
level and the household size. Changes in child’s daily activities can also have an impact. 602

13.3 Insurance and national programmes
The NHIS was launched in 2005 and provides health insurance coverage for Nigerians
through three major programmes (see table 48). 603 Treatment of common uncomplicatedchildhood illnesses is provided for within the NHIS Basic Minimum Package of HealthServices (BMPHS). 604

Olaniyan, O. and Sunkanmi, O.A., Demand for Child Healthcare in Nigeria, September 2012, url, p. 129
Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5
604
Nigeria, NHIS, Operational Guidelines; October 2012, url, p. 19
602
603

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Programme

Focus

Requirements

Formal sectorsocial healthinsurance
programme(FSSHIP)For individuals
employed within the
public/organised private
sector or willing to
make voluntaryindividual/family/groupcontributions

Informalsector social
healthinsurance
programme

For individuals in theinformal sector. It
covers employees ofcompanies employing
10 or less people,
artisans, voluntary
participants, rural
dwellers and others notcovered under theformal sector or thevulnerable group

Vulnerable
group

For indigents and thevulnerable (children
under five, physicallychallenged people,
prison inmates,
pregnant women,orphans and internallydisplaced people)

1. Public/federal tier Government pays
3.25 % and employee
pays 1.75 % of
employee's basic salary
2. Armed forces Government pays entire
5 % of employee's basic
salary3. Private/othergovernment tiers Employer pays 10 % andemployee pays 5 % of
employee's basic salaryCommunity-based
health insurance
scheme - Actuariallydetermined flat rate fee
perhousehold/individual
household member ormember of an
occupation-based
group and paid in cash
monthly or seasonally inadvance
Register with a PHCC
under the Basic HealthCare Provision Fund
Programme

Scope ofcoverage
Coverhealthcare
benefits forthe employee,aspouse andfour biologicalchildren below
the age of 18
years

For theregisteredindividualalone

For theregisteredindividualalone

Paediatric services
covered
1. Outpatient/preventive
care (consultations,screening, and treatment)
2. Admission for up to three
weeks for co-morbidities
3. Consultation withspecialists(paediatricians/internists)
4. Prescribed drugs,
pharmaceutical care, anddiagnostic tests as
contained in the NHIS
Drugs List and NHIS
Diagnostic Test Lists
As in the public sector

As in the public sector

Table 48: Health insurance programmes in Nigeria 605
The NHIS benefit package totally excludes treatment of congenital abnormalities requiring
advanced surgical procedures, such as tetralogy of Fallot, atrial septal defect and ventricularseptal defect. 606

13.4 Cost of medication
The drugs listed in the table below are all contained within the seventh edition of Nigeria’s
Essential Medicines List – a list that is frequently reviewed by the National Drug Formularyand Essential Medicines List Review Committee established by Decree Number 48 of 1989. 607
In addition, the National Agency for Food and Drug Administration (NAFDAC) maintains a
database for registered medications. 608

Nigeria, NHIS, Membership Handbook: A guide for enrolees on the operations of the NHIS Formal Sector
Programmes, October 2020, url, p. 5; Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 16-23, 3536, 42-44
606
Nigeria, NHIS, Operational Guidelines, October 2012, url, p. 25
607
Nigeria, FMoH, Nigeria Essential Medicines List, 2020, url
608
Nigeria, NAFDAC, NAFDAC Green book: Registered Product Database Search, url
605

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAEUROPEAN UNION AGENCY FOR ASYLUMChildhood vaccinations for under-fives are provided for free in public facilities but may be
paid for in private ones. 609
The price of medications was collected from pharmacies within five health facilities – two
private hospitals and three government-owned hospitals. 610 Medicines that are only available
in the informal market have been excluded. See more details of medication cost in themethodology section of the Introduction.
Generic nameAntibiotics
Amoxicillin
Cefuroxime
Levofloxacin
Amoxicillin + Clavulanic
acid (combination)
Trimethoprim andsulfamethoxazole(Cotrimoxazole)
Metronidazole
Clindamycin
Azithromycin
Clarithromycin
Vaccinations
Diphtheria, tetanus,
pertussis (acellular), Hib
vaccinePoliomyelitis(inactivated) vaccine
Influenza vaccine
Measles vaccine
Mumps vaccine
Pneumococcal vaccine
Rubella vaccine
Pain killers
Diclofenac
Morphine
Tramadol

Brand name

DosageForm

Number ofunits inthecontainer

Price per box (USD)

Amoxil®
Zinnat®
Tavanic
Acid®
Flixonase®

250 mg/5 ml
125 mg/5 ml
500 mg

Syrup
PowderVial

1
1
1

8.5 (8.3-8.7)
10.2 (9.9-10.5)
19.5 (18.9-20.1)

60 doses

Aerosol

1

8.5 (8.0-9.0)

Atrovent®

250 mcg/ml

Vial

20

51.2 (50.9-51.5)

Emgyl®
Dalacin C®
Zithromax®
Klatrix®

100 mg/5 ml
150 mg
200 mg/5 ml
500 mg

Syrup
CapsulePowderTablet1100
1
14

3.2 (3.0-3.4)
48.8 (47.8-49.8)
10.2 (9.8-10.6)
13.7 (12.9-14.5)

Tetraxim®

0.5 mlVial

120.7 (19.9-21.5)

Inactivatedpolio vaccine
Vaxigrip®
Priorix,
Combination
Priorix,
Combination
Prevener 13®
Priorix,
Combination®

0.1 mlVial

110.9 (9.9-11.9)

0.5 ml
0.5 ml

Vial
Vial

1
1

7.3 (6.8-7.8)
10.9 (9.5-12.3)

0.5 mlVial

110.9 (10.0-11.3)

0.5 ml
0.5 ml

Vial
Vial

1
1

26.8 (25.9-27.7)
10.9 (10.5-11.3)

75 mg
10 mg/ml
50 mg

TabletAmpouleCapsule30
10100

15.2 (14.8-15.6)
102.4 (101.0-103.8)
48.8 (45.3-52.3)

Voltaren®
Morphine®
Pengesic®

Table 49: Details of medication available in formal market 611

13.5 Cost of treatment
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
610
EUAA2, Medical Doctor and local consultant responsible for supporting in-country data collection of the report,
email correspondence, April-May 2021
611
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
609

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EUROPEAN UNION AGENCY FOR ASYLUMMEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIAThe NHIS covers for paediatric care, as well as treatment of co-morbidities. 612 The NHIS only
covers children – less than 18 years of age – whose parents are currently enrolled and haveentered their children’s names as dependents. 613 However, this is targeted at a small fractionof the population given that most households use out-of-pocket payments at the point ofcare. 614
In private centres, specialist consultation costs more for both inpatient and outpatient care ascompared to public facilities. The total costs incurred by patients can be calculated bysumming up all relevant services; however, indirect costs, such as bed rates, meals andtransportation, were not included. The prices below were obtained from a range of secondary
and tertiary facilities situated in the northern and southern zones of the country. 615 Thus, thevalues indicated in each cell are the average sum of the values collated from the visited
facilities.
Public outpatient
treatment price(USD)

Specialist consultations
Consultation by
2.4 (2.2-2.6)
paediatrician
Consultation by
2.4 (2.2-2.6)
paediatric cardiologist
Consultation by
2.4 (2.2-2.6)
paediatric neurologist
Consultation by
2.4 (2.2-2.6)
paediatric surgeon
Consultation by
2.4 (2.2-2.6)
paediatric psychiatrist
Consultation by
2.4 (2.2-2.6)
paediatric physicaltherapist
Consultation by
2.4 (2.2-2.6)
paediatricpulmonologist
Consultation by
2.4 (2.2-2.6)
paediatric oncologist
Consultation by
2.4 (2.2-2.6)
paediatrician
specialised inmetabolic diseases
Consultation by
2.4 (2.2-2.6)
speech therapist

Public inpatient
treatment price(USD)

Private outpatient
treatment price(USD)

Private inpatient
treatment price(USD)

2.4 (2.2-2.6)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

2.4 (2.2-2.6)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

2.4 (2.2-2.6)

85.3 (84.8-85.8)

85.3 (84.8-85.8)

2.4 (2.2-2.6)

85.3 (84.8-85.8)

85.3 (84.8-85.8)

2.4 (2.2-2.6)

Not available

Not available

2.4 (2.2-2.6)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

2.4 (2.2-2.6)

60.9 (59.5-62.3)

60.9 (59.5-62.3)

2.4 (2.2-2.6)

85.3 (84.8-85.8)

85.3 (84.8-85.8)

2.4 (2.2-2.6)

Not available

Not available

2.4 (2.2-2.6)

Not available

Not available

Table 50: Treatment cost by facility type 616

Laboratory researchComplete blood count, e.g. haemoglobin (Hb),white blood cells (WBCs) and platelets
Coagulation tests: e.g. prothrombin time (PT)

Public treatment price(USD)

Private treatment price(USD)

8.5 (8.1-8.9)

12.8 (11.9-13.7)

4.9 (3.8-6.0)

24.4 (23.9-24.9)

Nigeria, NHIS, Operational Guidelines, October 2012, url, p. 25
Nigeria, NHIS, Operational Guidelines, October 2012, url, pp. 14-16
614
Nigeria, FMoH, National Health Accounts 2017, April 2019, url, p. 19
615
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021
616
EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:
url
612
613

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MEDICAL COUNTRY OF ORIGIN INFORMATION REPORT – NIGERIA

Serologic testing of blood types (A, B, O, rhesus,+/-)
Measuring blood oxygen/arterial blood gas(Astrup)
Treatment
Clinical admittance paediatrics
Clinical admittance of all above mentioned
paediatric subspecialists (except for speechtherapist)
Day care for children with medical conditions
Feeding/day: nutrition, liquid food high energy,
high protein, vitamin and mineral richFeeding: tube feeding/day
Feeding: tube feeding/dietary supplements forchildren below 18 months
Medical devices pulmonology: spacer (with mask)for inhaler with asthma medication
Phlebotomy/venipuncture/blood collection

EUROPEAN UNION AGENCY FOR ASYLUM

Public treatment price(USD)
4.9 (4.2-5.6)

Private treatment price(USD)
6.1 (5.9-6.3)

Not available

73.1 (72.8-73.4)

3.7 (3.5-3.9)
3.7 (3.5-3.9)

93.8 (92.5-95.1)
93.8 (92.5-95.1)

Not available
Not available

93.8 (92.5-95.1)
12.2 (11.8-12.6)

As part of nursing carecharges
As part of nursing carecharges12.2 (11.8-12.6)

12.8 (12.5-13.1)Free

4.9 (4.2-5.6)

Table 51: Cost of laboratory investigations by facility type 617

Not applicable
36.6 (35.8-37.4)

13.6 NGOs
Of all the paediatric illnesses, malaria has received more support from the partnerorganisations. For example, USAID through the PMI has provided USD 90 million to control
malaria, including continued distribution of insecticide treated nets, over the next five years
starting from the year 2021. This support will augment the Nigerian government’s efforts ateliminating malaria in eight states. 618

EUAA1, Medical Doctor and local consultant responsible for in-country data collection of the report, email
correspondence, April-May 2021; prices were obtained in NGN but converted to USD using the OANDA’s
internationally accepted exchange rate of USD 1 = NGN 410.48 which was valid on 21 July 2021. Available from:url
618
USAID, U.S. Launches New $90 Million Malaria Control Effort In Eight Nigerian States, May 2021, url
617

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Annex 2: Terms of Reference
Topical reports:
•
•
•
•
•
•
•
•
•
•

Cardiovascular diseases
Diabetes mellitus
Hepatitis
HIV/AIDS
Psychiatry
Neurology (epilepsy, cerebrovascular accident (stroke), multiple sclerosis, Parkinson’s
disease)Nephrology
Pulmonology (asthma, tuberculosis)
Haematology (iron deficiency anaemia, sickle cell anaemia, blood clotting disorders)
Paediatrics

Detailed content instructions for the topical reports:
General information
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Prevalence and incidence of disease/types of this disease (epidemiologic data)
How is the health care organized for this disease?
- How is the disease treated – at specific centres, in primary health care centers,
secondary care / hospitals, tertiary care etc.?
- Which kinds of facilities can treat the disease (public, private not for profit (e.g.
hospitals run by the church), private for profit sector)?
How are the resources organized in general to treat patients with this disease? Are
there sufficient resources available to treat all patients?
Is there a particular type of this disease for which no (or only partial) treatment exists inthe country?
Is there a (national) institute specialised in treating this disease?
Are there any national or international plans or (donor) programmes for certain
diseases; if yes could you elaborate on such a programme and what it entails?

Access to treatment
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Are there specific treatment programmes for this disease? If so, what are the eligibility
criteria to gain access to it and what does it contain?
Are there specific state (eg insurance or tax) covered programmes for this disease? If
so, what are the eligibility criteria to gain access to it?
Are there any factors limiting the access to healthcare for patients? If so, are theyeconomic, cultural, geographical, etc.? Are there any policies to improve access tohealthcare and/or to reduce the cost of treatments and/or medication? What is thenumber of people having access to treatment?
Is the treatment geographically accessible in all regions?
What is the ‘typical route’ for a patient with this disease (after being diagnosed withthe disease)? In other words: for any necessary treatment, where can the patient findhelp and/or specific information? Where can he receive follow-up treatment? Are there
waiting times for treatments? E.g. dialysis, psychiatric hospitals, oncologic treatments,
etc.
What must the patient pay and when?
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Is it the same scenario for a citizen returning to the country after having spent a
number of years abroad?
What financial support can a patient expect from the government, social security or apublic or private institution? Is treatment covered by social protection or an
additional/communal health insurance? If not, how can the patient gain access to atreatment?
What must the patient pay and when?
Is it the same scenario for a citizen returning to the country after staying abroad?
Any occurrences of discrimination for people with this disease?
Could you explain if there are any vaccination programmes (for children/adults)? For
which vaccinations (e.g. see also table chapter 12)? And how is access to thesevaccination programs organized (EPI and COVID19...)?

Insurance and national programmes•••

National coverage (state insurance)
Programmes funded by international donor programmes, e.g. Global Fund, UNAIDS,
Unicef, Gates foundation, Clinton foundation etc
Include any insurance information that is specific for patients of this disease

Cost of treatment
Guidance/ methodology on how to complete the tables related to treatments:• Delete treatments that are not available• In the table, indicate the price for inpatient and outpatient treatment in public andprivate facility and if the treatments are covered by any insurance or by the state.
• For inpatient, indicate what is included in the cost (bed/daily rate for admittance,
investigations, consultations…).
• Is there a difference with respect to prices between the private and public facilities?
• Are there any geographical disparities?
• Are the official prices adhered to in practice?
• Check that the availability information correlates with the availability information in the
MedCOI database. Any contradictions must be verified. Only information in the
MedCOI database from the last year should be considered.

Cost of medication
Guidance/ methodology on how to complete the tables related to medication:• Delete medication that is not available• Are the available medicines in general accessible in the whole country or are there
limitations?
• Are the medicines registered in the country? If yes, what are the implications of it
being registered?
• Indicate in the tables: generic name, brand name, dosage, form, pills per package,
official prices, source, insurance coverage:• Are (some of the) medicines mentioned on any drug lists like national lists, insurance
lists, essential drug lists, hospital lists, pharmacy lists etc.?
- If so, what does such a list mean specifically in relation to coverage?
• Are there other kinds of coverage, e.g. from national donor programmes or otheractors?
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Check that the availability information correlates with the availability information in the
MedCOI database. Any contradictions must be verified. Only information in the
MedCOI database from the last year should be considered.

NGOs
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Are any NGOs or international organisations active for patients of this disease? What
are the conditions to obtain help from these organisations? What help or support canthey offer?
Which services are free of charge and which ones are at a cost? Is access provided to
all patients or access is restricted for some (i.e. in case of faith-based institutions or incase of NGOs providing care only to children for instance…).

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doi:

doi: 10.2847/082990

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