Healthcare provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy, private providers of healthcare have a visible role to play in healthcare delivery. The federal government's role is mostly limited to coordinating the affairs of the university teaching hospitals, while the state government manages the various general hospitals and the local government focus on dispensaries, which are regulated by the federal government through NAFDAC.
The total expenditure on healthcare as per percentage of GDP is 4.6, while the percentage of federal government expenditure on healthcare is about 1.5%. A long run indicator of the ability of the country to provide food sustenance and avoid malnutrition is the rate of growth of per capita food production; from 1970-1990, the rate for Nigeria was 0.25%. Though small, the positive rate of per capita may be due to Nigeria's importation of food products.
Historically, health insurance in Nigeria can be applied to a few instances: free healthcare provided and financed for all citizens, healthcare provided by government through a special health insurance scheme for government employees and private firms entering contracts with private healthcare providers. However, there are few people who fall within the three instances.
In May 1999, the government created the National Health Insurance Scheme, the scheme encompasses government employees, the organised private sector and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. In 2004, the administration of Obasanjo further gave more legislative powers to the scheme with positive amendments to the original 1999 legislative act.
The majority of mental health services is provided by 8 regional psychiatric centres and psychiatric departments and medical schools of 12 major universities. A few general hospitals also provide mental health services. The formal centres often face competition from native herbalists and faith healing centres. The ratio of psychologists and social workers is 0.02 to 100,000.
The Nigerian healthcare system is continuously faced with a shortage of doctors known as 'brain drain' due to the fact that many highly skilled Nigerian doctors emigrate to North America and Europe. In 2005, 2,392 Nigeria doctors were practising in the US alone, and 1,529 in the UK. Retaining these expensively-trained professionals has been identified as an urgent goal.