Nigerian society is divided by language, ethnicity, and religion. While English is the official language, over 500 languages are currently spoken; most Nigerians speak Hausa (in the north), Yoruba (in the southwest), or Igbo (in the southeast). During 1967-1970 Nigeria experienced a bloody civil war as members of the Igbo ethnic group tried to establish a separate country. Currently the most significant division in Nigerian society lies between the the predominantly Muslim and Hausa speaking north, and the Christian south of the country. Shariah law has been proclaimed in many of Nigeria's northern states, and in the last couple of years tensions between Muslims and Christians have resulted in some isolated yet bloody clashes. Sporadic ethnic conflicts in the oil-rich delta region have also become a problem.

After 16 years of military rule (1983-1999), Nigeria has been holding elections and electing civilian leaders; President Umaru Masa Yar'adua took office in 2007, marking the first time a civilian has succeeded another civilian since independence. Foreign aid has risen in recent years, including support for programs like PEPFAR and the GFATM.

Not quite 6 percent of Nigeria's adult population is living with HIV or AIDS. This is low by Sub-Saharan standards, but even if the rate of infection does not increase Nigeria is predicted to suffer 4.3 million AIDS deaths by 2015; only South Africa is predicted to have higher AIDS mortality. As is the case in most countries, HIV prevalence rates are much higher in Nigeria's cities, and the HIV prevalence rate exceeds 10 percent in the Federal Capital Territory.

Nigeria is also a high-burden country for other communicable diseases. Malaria is endemic throughout Nigeria, and the WHO estimates the malaria mortality rate for children under five in Nigeria at 729 per 100,000. In April 2004 Nigeria's Minister of Health reported that his country spent over $1 billion annually in treating malaria, and that malaria was the cause behind one out of three deaths in children, and one out of ten deaths of pregnant women. He cited chloroquine resistance as a growing problem, owing in part to counterfeit drugs.

The annual incidence of tuberculosis is estimated at almost 300,000, and over 70,000 Nigerians die of that disease each year.

Sources: BBC country profile; DFID Country Assistance Plan; Synergy Project; AllAfrica.com, Daily Trust (Abuja), December 22, 2003; AllAfrica.com, Daily Trust (Abuja), April 28, 2004; United Nations Statistics Division; USAID in Nigeria

Per capita expenditure on health is about $35 annually. In 2000 Nigeria devoted about 3.1 percent of its GDP on health (Source: WHO 2000, in Awaad, Brunegraber and Grimm); this marks a significant increase over health spending in the 1990s, when only 2 to 2.5 percent of GDP was spent on health (Stop TB Ministerial Conference in Amsterdam, March 2000).

On March 22, 2002, Nigeria launched a National Health Insurance Scheme (NHIS). Under this scheme workers contribute 5 percent of their salaries, with a 2-to-1 match from their employers, to an NHIS approved HMO. The HMO will then cover their health needs. Twice before Nigeria has attempted to launch an NHIS, so it remains to be seen if this launch will prove successful. Two cost-containment features limiting the value of NHIS are that it will not cover HIV/AIDS treatments, and it will not cover more than six members of any family. The latter restriction is expected to have greatest impact among Muslims.

In February 2001 Nigeria launched an ambitious HIV/AIDS Emergency Action Plan (HEAP). HEAP identifies over 200 actions to be implemented in the period 2001-2004, and the estimated cost of the program is $182 million. The national government of Nigeria has committed $54 million; IDA has committed $62 million, DFID $36 million, and USAID $22 million. Other donor agencies have committed smaller amounts as well. The national HIV-infection rate among adult TB patients was estimated to be about 27 percent in 2002.

In 2001, Nigeria developed a 2001-5 plan for TB control. In 2002 Fifty-five percent of Nigerians lived in an area where DOTS is implemented at the local level. The DOTS detection rate is only 11 percent, far below WHO objectives; the successful treatment rate is 79 percent. Implementation of DOTS is largely delivered through NGOs. The GDF is providing necessary TB drugs, but shortages of basic equipment, such as vehicles and microscopes, inhibit the Nigerian TB program. (Source: WHO Report 2004: Global Tuberculosis Control).

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

In 2001 the Nigerian government allocated 64 billion Naira (approximately $580 million) to upgrading the facilities at eight of the country's teaching hospitals. These hospitals include: Port Harcourt, Enugu, Lagos, Ibadan, Maiduguri, Zaria, Ilorin and Jos. (Source: This Day Online, November 8, 2001)

Nigeria's pharmaceutical industry appears to be growing. Evans Medical PLC, a subsidiary of GlaxoSmithKline, is about to begin manufacturing ARV drugs in Nigeria. The company has been working with the WHO to approve its facility for good manufacturing practices (GMP) so that it can also export the ARV drugs to other African countries. Archy Pharmaceuticals, a company funded by Nigerian expatriates living in the US, is also about to begin production of ARV medications in Nigeria. (Sources: THISDAYOnLine.com; AllAfrica.com, Vanguard (lagos), July 29, 2004.)

Ahmadu Bello University Teaching Hospital

Federal Medical Center

Nigerian Institute of Medical Research ( website )

Nnamdi Azikiwe University

Obafemi Awolowo College of Health Sciences

Contact information for OSTH: osth@anpa.net.ng; 234-37-640121

University of Calabar, University of Calabar Teaching Hospital

The University of Calabar Teaching Hospital also has a strong program in cancer research.

Dr. Etetim Asuquo is the Chief Medical Director of the Teaching Hospital.

University of Ibadan, College of Medical Sciences ( website )

University of Ilorin Teaching Hospital

University of Jos, Jos University Teaching Hospital ( website )

JUTH has a shortage of staff, is short of equipment such as microscopes and computers, and is served by a poor telephone and transportation network.

For more information on JUTH, see its strategic plan.

University of Nigeria, College of Medicine

University of Port Harcourt Teaching Hospital

With the institutions listed above, Nigeria's infrastructure for research includes a total of 16 medical schools. Contact information for these 16 schools can be found in the IIME Database.

1. As mentioned above, Nigeria's HIV/AIDS Emergency Action Plan (HEAP), is a very ambitious multi-year program launched in early 2001. Actions listed on the HEAP timeline:
   • Training legal professionals
   • Advocating laws against sexual harrassment
   • Training community volunteers and alternative medicine workers
   • Conducting HIV and syphillis serosurveillance
   • Promoting condom access, including using police to sell
   ... additional information

2. CDC's Global AIDS Program (GAP) has identified the following "Priorities for future action":
   • Developing a voluntary counseling and testing (VCT) program aimed at reducing mother to child transmission (MTCT).
   • Continuing involvement in behavior change communications, especially those targeted at youth and fiath-based organizations.
   • Monitoring the development of resistance to anti-retroviral drugs.