Executive Summary
According to the USAID, health indicators in Nigeria are some of the worst in Africa. The country has one of the fastest growing populations, globally. With 5.5 live births per woman and a population growth rate of 3.2% annually, the country is estimated to reach 440 million people by 2050. The rapidly growing population and developmental challenges tend to drag down the socioeconomic indicators for the entire African continent. However, these challenges represent enormous opportunities for U.S. companies interested in selling health equipment, solutions, and services. Nigeria loses more than $1 billion USD annually to medical tourism, while the brain drain of medical personnel has continued to increase, worsening the condition of the health sector. The Covid-19 pandemic exposed gaps in health infrastructure and services. This highlights the need to carefully analyze the state of the country’s healthcare infrastructure and make meaningful investments to improve access to quality health care. In response, the government is working to urgently address the deficiencies to meet the healthcare demands of its fast-growing population. Both federal and state governments as well as private sector investors are now undertaking new hospital projects and rehabilitating some existing healthcare centers. Nigeria largely depends on imports for medical devices and consumables, with China having a dominant market share, albeit in low-tech products. The U.S. has best prospects in hi-tech diagnostic medical imaging equipment such as, radiography (X-rays), magnetic resonance imaging (MRI), computed tomography (CT), fluoroscopy, ultrasound, echocardiography, and therapeutic respiratory apparatus. Demand for healthcare services in Nigeria is expected to increase with a value of over $18 billion USD in 2023. There are no barriers to entry into the Nigerian market, but medical and pharma products must be registered with the National Agency for Food and Drug Administration and Control (NAFDAC) https://www.nafdac.gov.ng/ prior to import.
Market Entry
American companies planning to access the Nigerian market are advised to utilize the services of the U.S. Commercial Service to help them find vetted distributors, agents, and partners. Working with a local company is the best way to sell products in Nigeria, due to their understanding of the market, distribution networks and contacts. Most Nigerian distributors would seek exclusivity with U.S. manufactures, and often sell the products of other suppliers.
Current Market Trends
Nigeria is largely dependent on imports for medical devices. Nearly 99% of the country’s use of medical devices and equipment are imported from foreign countries. Local production is very low and consists largely of syringes and some Personal Protective Equipment (PPE). As a result of the Covid-19 pandemic, new local manufacturers, largely in partnership with Asian companies, have set up facilities for making PPEs, pharmaceuticals, and other medical consumables. New diagnostic laboratories, including foreign entities are being established and are expanding their testing capabilities for all communicable and non-communicable diseases. Molecular testing using existing PCR platforms is getting popular and are being applied to testing other communicable diseases.
The Government of Nigeria has set priorities for the healthcare sector. The National Primary Healthcare Development Agency (NPHDA) plans to rehabilitate, equip and digitalize the more than 30,000 Primary Healthcare Centers (PHCs) across the country. The government is also fast-tracking legislation that would make universal health insurance mandatory for all citizens. Only about 5% of the population is currently covered under the national health insurance program. Nigeria has increased it health budget to more than 4% though this still falls far short of the recommended 15% agreed upon by African governments in 2001. The government is encouraging and supporting foreign direct investments in the healthcare sector to strengthen local capacity to handle nearly all medical cases and curb the more than $1 billion USD lost annually to medical tourism. Several new private and public hospital projects, and pharmaceutical and vaccine manufacturing are underway through direct financing and/or Public Private Partnership (PPP) arrangements.
The Nigeria Sovereign Investment Authority (NSIA) through its wholly owned subsidiary, NSIA Healthcare Development and Investment Company (NHDIC), is undertaking a phased expansion of its healthcare program which aims to establish several diagnostic centers and interventional cardiology suites across Nigeria which will for the most part be domiciled in existing tertiary healthcare institutions. The scope of the expansion includes 22 new modern medical diagnostic centers, which will provide modern radiology and pathology services, 6 cardiac catheterization labs spread over the 6 geo-political zones of the country. The NSIA also plans to build a world-class hospital in the country’s capital city, Abuja. With the disruption in global supply chains for pharmaceuticals and vaccines during the Covid-19 pandemic, the organization says it sees opportunities in these areas and will invest in local manufacturing of pharmaceutical products and vaccines.
Best Prospects
The U.S. has best prospects in high-end medical devices such as the following diagnostic medical imaging equipment:
- Radiography (X-rays)
- Magnetic resonance imaging (MRI)
- Computed tomography (CT)
- Fluoroscopy
- Ultrasound
- Echocardiography
Market Size
Healthcare spending (including investment) |
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4.1% as percent of GDP | https://www.nigerianstat.gov.ng/ |
… of which spent on inpatient services (including long-term care) |
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… of which spent on pharmaceuticals/consumables |
|
… of which spent on investments |
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… of which spent on outpatient services |
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Hospitals, Procedures, Healthcare Professionals UN: http://data.un.org/Explorer.aspx?d=WHO
Number of hospitals | 3605 |
…Public | 970 |
…Private | 2605 |
Number of hospital beds | 192, 709 beds |
… available beds per capita | 0.8 beds per thousand population |
…of which in general hospitals | - |
…of which in specialized clinics and rehabilitation centers | - |
Number of surgical procedures | NA |
…of which | NA |
…of which [second highest procedure] | NA |
Physicians | 19 per thousand population |
…of which surgeons | 40 (Neurologists); 50 (Neurosurgeons) |
…of which internists | - |
…of which pediatricians | - |
Dentists | - |
Demographics
Population | 206 million |
Life expectancy men/women | 54.7/55.7 years |
Infant mortality | 65 per thousand population |
Percent of population older than 65 | 3% of population |
…projection, 2030 | >262 million (2030) % of Population older than 65 years by 2030 – 2.8% |
Annual deaths | 12.4 per thousand population |
…caused by [highest disease burden] | Lower respiratory tract infection |
…caused by [second highest] | Neonatal diseases |
Prevalence of [fastest growing disease burden] | HIV/AIDS |
Main Competitors
China has remained the leading supplier of medical devices in Nigeria, accounting for nearly 40% of the volume sold to the Nigerian market by the top ten suppliers. Germany accounts for about 10%, France 9%, India 8% while the U.S. is responsible for nearly 6% of total imports. Over the past 10 years, Chinese imports have been increasing at a high year-on-year rate. It is projected that China will continue to be the leading medical devices supplier to Nigeria due to its continued aggressive spread, innovative pricing and distributor relationships. In Nigeria, a medical device supplier called AfricaMed, which has been in existence for 20 years, partnered with over 50 Chinese medical device manufacturers in 2018 to increase market access for these manufacturers in Nigeria. AfricaMed has declared its intention to partner with at least 500 more medical device companies to supply the Nigerian market.
Current Demand
According to 2021 market size estimates of medical devices in Nigeria by Fitch Solutions, consumables represent the largest product area ($65.2 million USD), followed by other medical devices ($45.8 million USD), diagnostic imaging ($27.8 million USD), patient aids ($17.8 million USD) and orthopedics & prosthetics ($5.8 million). Dental products have the smallest share of $5 million USD.
Registration Process
The National Agency for Food and Drug Administration and Control (NAFDAC https://www.nafdac.gov.ng/) regulates food, drug products and medical devices in Nigeria. The supervising ministry for national provision of healthcare services is the Federal Ministry of health. (not working). Guidelines for registering medical devices and drugs with NAFDAC and the fees payable can be found at https://www.nafdac.gov.ng/wp-content/uploads/Publications/NAFDAC-2019-Tariff_Final_Combined.pdf. NAFDAC’s promised registration timeline is 90-120 days but that could extend to 360 days or more due to painful bureaucratic bottlenecks. Also, new devices registration fees are relatively expensive. The U.S. Commercial Service recommends that U.S. exporters persuade their Nigerian associates to facilitate the registration process on their behalf or hire an experienced consultant.
Reimbursement
In Nigeria, the government pays for equipment supplied, or services completed directly to the foreign company’s local distributor. Therefore, U.S. suppliers need to negotiate with their local partners on how they can receive payment.
Barriers
There are no barriers to trade and investments in the healthcare sector. The list of prohibited imports, including healthcare products can be found at https://customs.gov.ng/?page_id=3075.
U.S. Commercial Service Contact Information
Name: Chamberlain Eke
Position: Commercial Specialist
Email: Chamberlain.Eke@trade.gov
Phone: 234-1- 460-3400 ext 3414
