Overview
The Nigerian healthcare system is broadly classified into 3 tiers. There is the primary healthcare system comprising of the healthcare centres and community health, the secondary healthcare system comprising of the General hospitals, and the tertiary healthcare settings comprising of specialist and teaching hospitals. Hospitals can either be privately owned or government/public owned.

Private hospitals are run by individuals or groups of individuals with the aim of providing healthcare services to the immediate community or local government area. Public hospitals are run by government agencies under the ministry of health with most services supposedly subsidized, relatively, compared to the private sector by the government. People pay either directly for healthcare services out of pocket or through insurance schemes, which include The National Health Insurance Scheme (NHIS) for government workers for free or subsidized healthcare services at the NHIS approved government or private hospitals or through the HMO (health management organizations) who liaise with private companies and organizations to provide healthcare insurances for their workers at private hospitals.

What happens if you need to see a doctor?
When on health insurance, hospital visits and prescription bills are paid for or subsidized depending on the insurance plans. If not on insurance, visits to doctors and prescription expenses are paid by individuals out of pocket. Once admitted at the hospital, depending in the category of the hospital – whether a primary, secondary or tertiary – and the nature of the issue, individuals can be referred for better management from the primary healthcare setting to the secondary or from the secondary to the tertiary.

Who decides what doctors can prescribe?
At the national level medications available to end users are controlled by The National Agency for Food and Drug Administration Control (NAFDAC). Most hospitals have developed treatment regiments in line with standard procedures and local community research and observations.

Practically, what is it like to live with type 1 diabetes in Nigeria?
Data on living with type 1 diabetes in Nigeria is low compared to type 2 due to poor awareness of diabetes affecting children, but with recent improved awareness, Nigeria is seeing a growing number of cases of children living with diabetes. Access to medications like insulin and consumables still remain low and the financial burden coupled with poor knowledge, distance to hospitals and social stigmatization has made children living with diabetes mostly present with complications. There is no insurance scheme yet that covers insulin for children living with diabetes.

What about getting admitted to hospital?
Before an individual is admitted into a hospital he must be registered at the particular hospital and issued a hospital card and number which the doctor uses in care. A long wait time at government/public hospitals has made the private hospital a preferred place for care. Depending on the nature of the condition, the attending doctor determines whether such individuals should be admitted or treated on an outpatient basis.

How does diabetes care vary throughout Nigeria?
Diabetes care varies a lot across the different tribes and regions in Nigeria. This can be attributed to varying factors such as access to healthcare facilities, religion and cultural inclinations, accessibility to medications and consumables and finally the socioeconomic status of the family of the child or person living with diabetes, which may not allow them to afford diabetes treatment.

The Nigerian ministry of health usually spends about 70% of its budget in urban areas where only 30% of the population resides. It is assumed by some scholars that the health care service is inversely related to the need of patients.

A special thanks to Hakeem Adejumo of the Nigerian Diabetes Online Community (NGDoc) for providing this information.