Nigeria private sector health assessment.
At the request of the United States Agency for International Development (USAID) / Nigeria, Private Sector Partnerships-One (PSP-One) conducted an assessment of the private sector in Nigeria for the provision of reproductive health and family planning products and services. Increasingly USAID and other donors are seeing the limits of focusing exclusively on the public sector to achieve reproductive health goals. This assessment’s primary purpose was to identify ways for USAID and other stakeholders to engage the private sector to achieve Nigeria’s reproductive health goals. The assessment team met with product and service providers at all levels (hospitals, clinics, general practitioners, gynecologists, nurse and midwife clinics, traditional birth attendants, pharmacists, patent medicine vendors, and pharmaceutical wholesalers and sub-wholesalers). In addition the team met with the professional associations and regulatory bodies for different providers to understand the regulatory and enabling environment for providers. Given the importance and potential impact of the National Health Insurance Scheme (NHIS) that is being rolled out, the assessment team took a particularly close look at the possible consequences of the scheme and the opportunities and risks associated with it. Although a large portion of Nigeria’s population uses the private sector and consumers pay a high out-of-pocket share for health expenditures, much of those funds go toward low-quality products and services. Too little regulation is being enforced to ensure that minimum quality standards are met. Despite the large population, the demand for contraceptives and reproductive health services is in a market-building stage. Interventions that link supply to demand creation will produce the best results. The quality and quantity of private-sector providers can be increased, but it should be done in targeted areas and with targeted groups where demand is established and growing. Although there is no shortage of well-trained providers (doctors, nurses, midwives, and pharmacists), they are not being encouraged to open their own private practices. The main barriers are poor infrastructure, no access to credit, and unfair competition with unregulated, less-skilled providers. Furthermore, nurse and midwife practices are constrained by the requirement for physician supervision. The NHIS is a well-designed plan that could encourage higher quality practices among private providers, increase consumers’ financial access to services, and pool risk across a wider share of the population. That being said, there are major challenges in getting providers and consumers to understand how the scheme works as well as training providers, health maintenance organizations (HMOs), insurance regulators, and enrollees. (Excerpt)