Healthcare in Nigeria: Not Free, But Tiered

Nigeria does not have a universal free healthcare system. It operates a mixed, pluralistic system with significant gaps:

Public Sector (Government-Funded)

• Primary Health Centres (PHCs): ~30,000 nationwide. Officially free for: pregnant women, children <5, emergencies (first 24h), TB, HIV, malaria, immunizations (via NHIS/BHCPF). Reality: Stockouts, user fees for drugs/labs, informal payments common.
• General Hospitals (Secondary): Subsidized but not free. Fees for consultation, admission, surgery, drugs. NHIS enrollees (formal sector) get coverage.
• Teaching Hospitals / FMCs (Tertiary): Highest expertise; fee-based. NHIS covers enrollees.

National Health Insurance Authority (NHIA) Act 2022

Mandates universal health insurance (replaces voluntary NHIS). Vulnerable Group Fund subsidizes premiums for poor, elderly, disabled, children, pregnant women. Implementation ongoing—coverage still low (<10% formally insured).

Private Sector (Dominant Provider)

• 60–70% of outpatient visits to private clinics, hospitals, pharmacies, patent medicine vendors (PMVs).
• Fully fee-for-service. Quality varies wildly (world-class tertiary in Lagos/Abuja → unregulated quacks).
• Out-of-pocket (OOP) spending = ~75% of total health expenditure (WHO) – catastrophic for many.

Key Programs

• Basic Health Care Provision Fund (BHCPF): 1% Consolidated Revenue Fund → PHCs for minimum service package.
• Midwives Service Scheme (MSS), Saving One Million Lives (SOML).

Bottom line: Free care exists only for specific groups/services at PHCs. Most Nigerians pay OOP. Universal coverage is the policy goal, far from reality.