The predicament of mid-level private providers in Nigeria

According to the National Bureau of Statistics (NBS), approximately 83 million people, or 40% of Nigeria’s population, live below N137 430 ($381.75) per year. According to a combined report by the World Health Organization and the World Bank, paying for health care out of pocket has pushed many people into extreme poverty.

Despite Nigeria’s strategic position in Africa, the country’s healthcare system is severely underserved. Data from World Bank shows that out-of-pocket expenditure in Nigeria was 70.5 per cent of the overall health expenditure as of 2019. From medical examinations to treatment, the burden of healthcare falls primarily on Nigerians, who are already affected by dramatic inflation rates.

The involvement of private actors in health care provision has been pivotal, particularly mid-level private providers, who will be the focus of this article. Because of their accessibility, affordability, and capacity to provide secondary care, midlevel providers have been lifesavers in the healthcare system. However, several factors within and outside the healthcare industry stifle their activities and growth, resulting in poor decision-making, poor quality of service, and inadequate patient care.

Among other factors, here are a few challenges frequently encountered by mid-level providers:

Demand and supply

According to the 2021 NOI Polls, West Africa’s first country-specific opinion survey firm, 8 out of every 10 adults in Nigeria are uninsured. When people have to pay out-of-pocket for healthcare, they are constrained by other competing needs such as feeding their family, transportation, and other necessities. As a result, going to the hospital becomes a secondary concern. On the other hand, healthcare receives little funding because it does not appeal to investors as an investment that will yield a lot of profit, considering Nigerians’ out-of-pocket spending and financial capacity.

Staff attrition

The staff attrition rate experienced in the Nigerian health sector has become alarming, particularly among mid-level providers. The attrition rate could be attributed to the possibility that most healthcare workers are unable to keep up with the country’s rising living standards, and with the perceived job dissatisfaction and insecurity in the industry.

In addition, due to the inability to afford the remuneration of experienced professionals, mid-level providers tend to hire fresh graduates with little or no experience. Most times, these graduates leave their jobs in mid-level hospitals in search of better remuneration and career advancement. Employee turnover impacts the quality of care because knowledge is not retained within the system.


The global healthcare industry is rapidly evolving in response to technological advancements. Some Nigerian hospitals have embraced technology in their operations; however, how many mid-level providers can afford such technology? Most tertiary hospitals currently use technology for patient diagnosis and records, financial transactions and pharmaceuticals. Many mid-level providers lack the essential equipment needed to provide standard and quality care, more or less application and use of technology. 

What can be done about it?

Public-private collaboration

We have a rapidly expanding and growing population, with more people concentrated at the lower demographic ends of the spectrum. As a result, most healthcare services will be provided at the primary and mid-levels. Neither the government nor the private sector can do it alone. Thus, the government needs to devise initiatives, strategies and measures to create a more conducive environment for business operations, especially for the mid-level healthcare service providers. A conducive business environment will improve access to infrastructures, resources and other requirements for a competitive improvement in the healthcare sector. 


Some mid-level hospitals were established with the wrong business orientation. The owners require proper orientation on how a hospital should operate; managing a hospital solely based on the owner’s clinical knowledge is not ideal. Administrative and managerial experts can help them better manage the facility and make their vision a reality.

In conclusion, progress can be achieved, no matter how gradual, when there is a collaboration among all players. There is a critical need for interventions on both the demand and supply sides of our healthcare system. To enable private providers to thrive and improve health outcomes and indices, we must first create a conducive business environment, especially for private healthcare providers, and health coverage for all Nigerians.


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