Traditional medicine may be defined as the sum total of all knowledge and practices used in the prevention, diagnosis, and therapy of physical or mental illnesses and relying exclusively on practical experience and observations handed down from generation to generation, whether orally or written.²

Traditional medicine has evolved over centuries as the indigenous health care system in Nigeria. Genuine indigenous health care practices are usually based on the cultural and religious beliefs of the people. In a multiethnic country like Nigeria with over 250 ethnic groups, there are expectedly some variations in the system of traditional medicine, with each variant being strongly bound to the local ethnic culture and beliefs. However, common to all the variants of traditional medicine are dualist explanations of the etiology of illness in natural and supernatural terms and the therapeutic use of herbs and magico-religious rituals.

Nigeria has more traditional healers than Western-trained doctors. Although traditional medicine is well known to be a popular option for Nigerians, official government involvement has been minimal, being generally limited to sponsorship of conferences on traditional medicine and programs for the training of traditional birth attendants.¹⁶

The only legal reference to traditional medicine was in the Medical and Dental practitioners’ decree of 1988, where the government referred to a traditional healer as “any person acknowledged by the members generally of the community to which he belongs as having been trained in a system of therapeutic medicine traditionally in use in that community.” This definition appeared to leave the accreditation of traditional healers to the community. Government boards of traditional medicine were set up first in Lagos in 1981, and subsequently in other states with the purpose of accreditation and attestation of bona fide traditional healers, in response to the endemic problem of infiltration by charlatans. Recently, the Federal Ministry of Health has announced plans to produce a draft traditional medicine policy for Nigeria.

Members or leaders of some of the numerous churches and mosques in Nigeria practice faith healing. They are not officially recognized or funded at any of the three tiers of government because of the constitutional secularity of the Nigerian State, but nevertheless enjoy wide patronage.

Conventional health care services in Nigeria evolved out of the medical services of the British colonial army. The army medical service, initially meant only for its members and dependents, began to provide medical services to government employees and their dependents following the integration of the army with the colonial administration after the Second World War, and later to the public living near such facilities. The colonial government started off the present system of conventional health services with a network of rural dispensaries and maternity homes to which rural health centers and hospitals were subsequently added.

The first national policy on health care services was introduced as part of the 1946–1956 development plan in the colonial era. The second and third development plans included revisions of this national health policy, with the third (1975–1980) containing a provision for primary health care.

The current national health policy⁸ was launched in 1989, and provided for a three-tier schedule of responsibilities of the federal, state, and local governments. Under this system, the delivery of primary health care is the responsibility of local governments, while the state governments are responsible for the delivery of secondary health care and the federal government for tertiary health care. This schedule of responsibilities is coordinated by the Federal Ministry of Health. The National Primary Health Care Development Agency (NPHCDA), formed in 1992, is responsible for the delivery of primary health care services and the construction of the new health centers. It establishes and trains local development committees to manage local health care.

Although both traditional and conventional health services form a plural system of health care, they remain functionally unrelated in any way. There are no official avenues for referral between the two systems.

Government health services are financed from the consolidated revenue fund. There are no special taxes or levies for generating funds for health care. The Western regional government had introduced government lotteries in 1955 and legislated¹⁰
that all monies received from the sale of tickets be paid into a medical development fund. However, this effort was eventually discouraged by poor receipts.

The nonexistence of a special health fund, tax, or levy and the relatively low fees paid by patients for health services have resulted in a widening gap between expenditure and resources. For example, most states devote up to 10% of their total annual budget to health services, whereas their annual health revenue usually constitutes <1% of the health budget. In federal teaching hospitals, internally generated revenue accounts for only 5% to 8% of the total annual expenditure.

In order to reduce the burden of the provision of health finances on the three tiers of government, a National Health Insurance scheme was launched in 2005. Federal government workers constitute the first core group to be covered by the pilot phase of the program. The program will later be extended to the organized private sector, but is unlikely to cover the majority of Nigerians, who are either self-employed or work for small enterprises.

Cost recovery through revolving funds is consistent with the national policy, which states that users shall pay for curative services but preventive services shall be subsidized.⁸ A seed fund is provided to purchase a good stock of drugs and other consumables employed in medical care. Subsequently, further replenishment of stocks is provided for by sales. Provision is made for losses, exemptions, inflation, and overheads by adding 5% to 20% of the actual cost to the amount charged to the patient. The revolving fund scheme has been quite successful in many teaching hospitals.

In 2002, the Nigerian public health expenditure as a percentage of the gross domestic product (GDP) was 1.2%, while the private health expenditure as a percentage of the GDP was 3.5%. State governments devote between 5% and 10% of their total annual budget to health care, while local governments spend 10% to 15%.

Government medical care is labor intensive. For example, 70% to 90% of each federal teaching hospital’s annual budget is spent on salaries and emoluments, leaving little for health care services and drugs.

The concept of “managed care” is practiced by all public and private companies and corporations who are obliged by law to provide free health care for their workers and their dependents. The companies enter into contracts with selected private hospital groups as health care providers, or provide limited cash reimbursements for medical expenses purchased by employees in the private health sector. The financial expenditure on health by companies is not usually made explicit in company financial statements, but the contribution to health care by this private sector financing of health is quite substantial, given the number of companies that offer this service and the large number of workers and relatives covered.

Public and institutional spending on health probably constitutes <30% of the total health expenditure in Nigeria. The majority of expenditure is by private individuals who purchase care as needed in private for-profit clinics and hospitals. These clinics and hospitals are commonly regarded as providing prompter, more courteous, and more efficient services.

Acutely ill patients receive substantial financial support from the immediate and extended families, which mitigates considerably the overall costs of health care to the patient and makes it possible for such patients to have access to health care that may otherwise be out of reach from pecuniary constraints. However, this family support tends to wane over time in patients with illnesses requiring chronic therapy, such as epilepsy.