Country Policy and Information Note Nigeria: Medical and healthcare issues Version 3.0 January 2020 Preface Purpose This note provides country of origin information (COI) for decision makers handling cases where a person claims that to remove them from the UK would be a breach Articles 3 and / or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition . It is not intended to be an exhaustive survey of healthcare in Nigeria. Country of origin information The country information in this note has been carefully selected in accordance with the general principles of COI research as set out in the Common EU [European Union] Guidelines for Processing Country of Origin Information (COI), dated April 2008, and the Austrian Centre for Country of Origin and Asylum Research and Documentation’s (ACCORD), Researching Country Origin Information – Training Manual, 2013. Namely, taking into account the COI’s relevance, reliability, accuracy, balance, currency, transparency and traceability. The structure and content of the country information section follows a terms of reference which sets out the general and specific topics relevant to this note. All information included in the note was published or made publicly available on or before the ‘cut-off’ date(s) in the country information section. Any event taking place or report/article published after these date(s) is not included. All information is publicly accessible or can be made publicly available, and is from generally reliable sources. Sources and the information they provide are carefully considered before inclusion. Factors relevant to the assessment of the reliability of sources and information include: • the motivation, purpose, knowledge and experience of the source • how the information was obtained, including specific methodologies used • the currency and detail of information, and • whether the COI is consistent with and/or corroborated by other sources. • Multiple sourcing is used to ensure that the information is accurate, balanced and corroborated, so that a comprehensive and up-to-date picture at the time of publication is provided of the issues relevant to this note. • Information is compared and contrasted, whenever possible, to provide a range of views and opinions. The inclusion of a source, however, is not an endorsement of it or any view(s) expressed. • Each piece of information is referenced in a brief footnote; full details of all sources cited and consulted in compiling the note are listed alphabetically in the bibliography. MedCOI MedCOI is an Asylum and Migration Integration Fund financed project to obtain medical country of origin information. The project allows 11 European Union member Page 2 of 40 states plus Denmark, Norway and Switzerland to make use of the services of the ‘MedCOI’ team in the Netherlands and Belgium. The MedCOI team makes enquiries with qualified doctors and other experts working in countries of origin. The information obtained is reviewed by the MedCOI project team before it is forwarded to the UK or other national COI teams. Previous MedCOI responses are stored on its database which participating states are able to access. Feedback Our goal is to continuously improve our material. Therefore, if you would like to comment on this note, please email the Country Policy and Information Team. Page 3 of 40 Contents Assessment .............................................................................................................. 5 Country information ................................................................................................. 6 1. Overview of healthcare system ........................................................................ 6 2. Organisation of healthcare system .................................................................. 7 3. Numbers of facilities ........................................................................................ 8 4. Healthcare human resources ........................................................................... 9 5. Pharmaceutical sector ................................................................................... 10 6. Treatment for specific conditions .............................................................. 11 6.1 Cancer .................................................................................................... 11 6.2 Diabetes ................................................................................................. 12 6.3 Gastroenterology .................................................................................... 13 6.4 Gynaecology .......................................................................................... 13 6.5 Heart disease ......................................................................................... 14 6.6 Hepatitis ................................................................................................. 14 6.7 HIV/AIDs ................................................................................................. 15 6.8 Malaria.................................................................................................... 16 6.9 Mental health .......................................................................................... 16 6.10 Neurology ............................................................................................... 18 6.11 Ophthalmology ....................................................................................... 18 6.12 Paediatrics .............................................................................................. 18 6.13 Renal disease ......................................................................................... 19 6.14 Sickle cell anaemia/disease ................................................................... 20 6.15 Tuberculosis ........................................................................................... 21 7. Other conditions/specialisms ......................................................................... 22 8. Palliative care ................................................................................................ 22 Annex A: Alphabetical list of available medication according to MedCOI sources accessed in October 2019....................................................................... 24 Terms of reference ................................................................................................. 34 Bibliography ........................................................................................................... 35 Sources cited ...................................................................................................... 35 Sources consulted but not cited ....................................................................... 38 Version control ....................................................................................................... 40 Page 4 of 40 Assessment Updated: 31 October 2019 Guidance on medical claims For general guidance on considering cases where a person claims that to remove them from the UK would be a breach Articles 3 and / or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition, see the instruction on Human rights claims on medical grounds. Back to Contents Page 5 of 40 Country information Section 3 updated: 31 October 2019 1. Overview of healthcare system 1.1.1 The 2018 Nigeria Demographic and Health Survey was ‘designed to provide data for monitoring the population and health situation in Nigeria.’ This extensive document contained behavioural and statistical information, particularly about the health of women and children, and conditions such as HIV, malaria and sickle cell anaemia1. 1.1.2 The UNICEF Nigeria Multiple Indicator Cluster Survey (MICS) 2016-17 provided ‘data on main indicators related to survival, development and protection of children, women and men.’ 2 1.1.3 The Foreign and Commonwealth Office (FCO) Travel Advice for Nigeria noted ‘Medical facilities in some parts of Nigeria may only be very basic.’3 1.1.4 The US Embassy in Nigeria noted that ‘Nigeria imports the majority of its pharmaceutical and medical supply needs, primarily from European sources. Medical shortages have hindered medical practice, research, and training.‘ 4 1.1.5 The Australian Department of Foreign Affairs and Trade noted that ‘Nigerians have poor access to health care and poor health outcomes, particularly outside major urban centres. Nigeria spent USD94 per person on health care in 2016 and demand for public health care significantly exceeds supply. Medical and health services are the responsibility of all levels of government. Access to and availability of quality medical services are inadequate, with most Nigerian unable to afford health care.’5 1.1.6 A SocialProtection.org article from 2019 noted: ‘…the inability to effectively address the country’s numerous public health challenges has contributed to the persistent and high level of poverty and the weakness of the health system. ‘…Although…vulnerable groups sometime benefit from free health care services and exemption mechanisms, they largely have to pay for health care services. Free health care services and exemption mechanisms are often politically motivated, are poorly implemented, do not become fully operationalised, and sometimes only last a few years. ‘States such as Osun, Niger, Kaduna, Kano, Ekiti, Lagos, Ondo, Enugu and Jigawa are known to have provided some free health policies at one point or 6 another since