Overview

Units: $ millions

Total Market Size for Healthcare

	2019	2020	2021	2022 (estimated)
Total Local Production	0	0	0	0
Total Exports	0	0	0	0
Total Imports	67	74	84	94
Imports from the U.S.	18	23	25	22
Total Market Size	67	74	84	94
Exchange Rate: 1 USD	360	380	410	420

Total Market Size = (Total Local Production + Total Imports) – Total Exports

Data Sources: 

Total Local Production:   Estimates from Industry Contacts

Total Exports: UN Comtrade

Total Imports:   UN Comtrade

Imports from U.S.:   UN Comtrade

Note: These figures represent medical devices, and diagnostic and laboratory testing instruments

The Nigerian healthcare industry is facing challenges associated with outbound medical tourism, deteriorating medical infrastructure, low government budget allocation, and poor compensation and subsequent emigration of skilled healthcare workers, The federal government allocated 5% of its budget to health in 2021, compared to the 15% it pledged as part of the 2001 Abuja Declaration.

Healthcare infrastructure in Nigeria is still underdeveloped and lacks modern medical facilities. The country’s healthcare indicators are some of the worst in Africa. It has one of the fastest growing populations globally with 5.5 live births per woman and a population growth rate of 3.2% annually. It is estimated to reach 400 million people by 2050, becoming the world’s third most populous country. Medical professionals are in short supply, with only about 35,000 doctors despite needing 237,000, according to WHO figures, partially due to the massive migration of healthcare workers overseas. Nigeria loses at least $2 billion every year to medical tourism, according to the Nigerian Medical Association (NMA). India accounts for more than half of this outflow.

To reverse this trend and ensure access to health for all Nigerians, the government of Nigeria approved the second National Strategic Health Development Plan (NSHDP II, 2018-2022). The Nigerian Sovereign Investment Authority (NSIA), in partnership with the Federal Ministry of Health (MOH), has signed a series of agreements to modernize and expand health care services through private sector participation. The agreements look to develop the capacity of specialist hospitals and diagnostic centers to provide advanced medical care services.

So far, a total of ten memorandums of cooperation have been signed between the NSIA, MOH, and various health care facilities throughout the country’s six geopolitical zones, with six of the agreements already in advanced stages.  Many of these facilities center around established teaching hospitals. In addition to its collaboration with the NSIA, MOH has also set ambitious new targets to increase access to health facilities, with a specific aim to increase the number of primary health care centers (PHCs). As part of its goal to ensure access to health care for 100 million Nigerians, MOH plans to build 10,000 PHCs throughout the country with at least one PHC per ward to facilitate healthcare access across a wide geographic area. However, five years after the launch of this project, much is still to be done due to the lack of sustainability plan, funding, and human resources.

In addition to improving the quality of care and expanding infrastructure, the Nigerian government is also looking to reduce barriers to insurance coverage. Introduced in 1999, the Nigeria’s National Health Insurance Scheme (NHIS) targeted universal coverage, yet penetration remained persistently low. Less than 5% of the population was enrolled in the NHIS, and an estimated 120 million Nigerians did not have health insurance coverage. In May 2022, President Muhammadu Buhari signed into law, the recently passed National Health Insurance Authority Bill 2022, repealing the National Health Insurance Scheme Act. The new law will ensure coverage of 83 million poor Nigerians who cannot afford to pay premiums as recommended by the Lancet Nigeria Commission.  Payment for treatment is largely out-of-pocket for most of the population. One major impediment to increasing participation rates is the non-mandatory nature of health insurance in Nigeria, according to the NHIS. While most employees in the federal civil service are currently subscribed to the program, the NHIS has yet to capture most citizens, especially those individuals working in the country’s large informal sector. Stakeholders in the health insurance sector such as the NHIS and health maintenance organizations (HMOs) are also calling for legislation that would make it mandatory for employers with more than 10 employees to provide health insurance. Private HMOs are developing personalized healthcare plans specifically designed for individuals and families to provide broader access to improved healthcare and more comprehensive coverage.

Meanwhile, the competitive nature of the insurance market means that HMOs often cut prices to gain market share, which in turn results in poorer quality services for patients. According to the NHIS, there are 58 HMOs registered with the NHIS, of which 49 (77.6%) of them have a nationwide presence.

The pandemic has helped highlight the need for significant investments in the healthcare sector. Consequently, Nigerian government has undertaken to build more testing and laboratory centers for the Nigeria Center for Disease Control (NCDC). In 2020, it rolled out the “National Strategy to Scale up Coronavirus Disease Testing in Nigeria.” This plan includes, expanding existing NCDC laboratory network for molecular RT PCR, leveraging capacity within the High Throughput HIV molecular testing laboratories, repurposing point of care tuberculosis testing, GeneXpert machines for COVID-19 testing, engaging private sector clinics and laboratories, and using antigen and antibody tests to learn more about the disease.

According to the NCDC, the rapid investment in establishing molecular laboratories highlights the critical need for a well-defined hub and spoke model for public health laboratories in Nigeria. The goal is to ensure that every state in the country establishes a molecular laboratory, which will be linked to the NCDC National Reference Laboratory. The molecular lab in each state will also serve as a state-level hub, to ensure that every state has a well-coordinated structure for other disease specific laboratories such as for HIV and tuberculosis. The MOH is also rehabilitating Federal Medical Centers in each state and building new ones where needed. The plan for Nigeria’s local vaccine production project, Biovaccine, is yet to take off despite the government’s commitment of $26.3 million (10 billion naira) to set up a vaccine production company. Some private healthcare companies have expressed interest in setting up vaccine manufacturing in the country. MilliporeSigma, the North American life sciences business of Merck and KGaA, Darmstadt of Germany, a leading science and technology company, have announced their life science business segment has signed an agreement with biotechnology company Innovative Biotech (IB) to design the manufacturing process for the first vaccine production facility in Nigeria.

Leading Sub-Sectors

Most private clinics cannot afford new equipment and therefore employ used equipment. The United States is competitive with medical diagnosis and therapy equipment. These include magnetic resonance imaging (MRI), computed tomography scan (CT), digital x-ray, mammography, ultrasound scans, radiation therapy, and other advanced devices. Test kits, especially those for testing for malaria parasites, drug abuse, HIV/AIDS, and tuberculosis will also do well in Nigeria. With respect to vitamins, the United States has a better opportunity than most countries due to the quality of U.S. medicines. China is a dominant offshore supplier of medical consumables like syringes, needles, sutures, staples, packaging, tubing, catheters, medical gloves, gowns, masks, adhesives, and sealants for wound dressing.  All medical devices and medicines entering Nigeria must first be registered with the National Agency for Food and Drug Administration and Control (NAFDAC) and the Standards Organization of Nigeria (SON) prior to import. 

Opportunities

The Nigeria National Petroleum Corporation Limited (NNPC) began building 14 medical centers as well as expanding and upgrading two intensive care units (ICU) in the country’s six geopolitical zones. The project will cost about $58 million. The Nigeria Sovereign Investment Authority (NSIA) is undertaking a phased expansion of its healthcare program which aims to establish several diagnostic centers and interventional cardiology suites across Nigeria which will for the most part be domiciled in existing tertiary healthcare institutions. The scope of the expansion includes 22 new modern medical diagnostic centers which will provide modern radiology and pathology services and six cardiac catheterization labs spread over the six geo-political zones of the country. Phase one will consist of ten diagnostic centers and two cardiac catheterization labs embedded in tertiary hospitals. Phase two will be made up of 12 diagnostic centers and four cardiac catheterization labs embedded in tertiary hospitals. The procurement would be done either as an outright purchase or a six-year lease.

With the government lacking the funds to implement its health sector plans, the private sector is emerging as the indispensable player to improve Nigeria’s healthcare capacities. The federal and state governments are using the public-private partnership (PPP) model to attract private sector participation in health projects. For example, Lagos state is building a 120-150 hospital bed Medical Park (MediPark) through a PPP to offer a full spectrum of high-tech, cutting-edge specialist medical and diagnostic services. The project will cost $247.3 million and will be developed on an 18,750.15 square meter site previously used for the Lagos State School of Nursing. In April 2021, the State also began the construction of Massey Children’s Hospital, a 150-bed specialist hospital for children which the government says will be the biggest such hospital in sub-Sahara Africa.

Nigerian medical professionals in the diaspora are also making investments in the country’s healthcare sector.  They are opening specialist hospitals to provide care to patients with cancer, heart, and renal problems.

Most Nigerian hospitals still store patient records manually using traditional paper methods. This indicates a good market opportunity for simple and affordable electronic medical record (EMR) systems. Medical expertise remains in short supply. Therefore, medical training and education services will do well. Prospects are also emerging in hospital administration, management, and consulting services. Some innovative Nigerian companies have also identified this opportunity and are moving into the space.

The COVID-19 pandemic uncovered opportunities for telemedicine. In 2020 and 2021, e-health service providers reported a surge in new subscription levels. They say more people are turning to telemedicine platforms for medical consultation with doctors to avoid visiting hospitals for fear of getting infected. The Nigerian government, which before the pandemic paid little attention to telemedicine, has begun adopting the technology as part of its public health intervention programs. E-health professionals foresee a continuing upsurge in demand for telemedicine services after the pandemic, a trend they say could be sustained through persistent user engagement and education on the importance of telemedicine. Other companies such as Zipline are developing strategies to overcome the supply chain challenges for medicines and medical supplies.

Challenges[SWB1] 

Medical devices and pharmaceutical products must be registered with the NAFDAC before they can be imported into Nigeria. This process can be painfully long and rigorous, involving the submission of several documents. Product counterfeiting is rampant, and rights enforcement is weak. Nigeria is experiencing declining revenues due to large scale oil bunkering and theft, and this is affecting the government’s ability to fund its healthcare procurements and projects that require overseas inputs. Therefore, U.S. companies must plan to back their project propositions with financing to be competitive.

Local Trade Shows

Medic West Africa

September 21-23, 2022

Eko Convention Center, Victoria Island

Lagos, Nigeria

https://www.medicwestafrica.com/en/home.html

 

Resources

https://www.nafdac.gov.ng/

For more sector information, e-mail:  Chamberlain Eke, Commercial Specialist, U.S. Commercial Service, Nigeria, at Chamberlain.Eke@trade.gov