Who Can Open a Clinic or Hospital 🏥 in Nigeria 🇳🇬?

President of the Medical and Dental Consultants Association of Nigeria lays out the general requirements in a recent interview.

Oct 10, 2023

Funmilayo Aremu-Olayemi’s recent interview with Professor Muhammad Aminu the President of the Medical and Dental Consultants Association of Nigeria (MDCN) caught my attention and I decided to distill it, summarize its key points, and share it with my readers.

I hope you find it as a valuable resource.

About MDCN

The Medical and Dental Council of Nigeria (MDCN) plays a crucial role in Nigeria's healthcare system. Its primary functions are to establish and periodically update the standards of knowledge and skill required for individuals aspiring to join the medical or dental profession, and/or establish accredited healthcare institutions.

Types

Government-owned public hospitals
Private clinics
Public-Private Hospitals (partially owned by the government and partially owned by private investors)
Government-sponsored hospitals

Regulations

At least one of the shareholders of the partnership/company must be a registered medical practitioner of at least “5 years standing”.
Of the shareholders, one who is a medical practitioner must be registered by the MDCN

Three Categories of Registrations with MDCN

Fresh Doctors Registration: is a type of “Temporary Registration” given for 2 years and ultimately leads to a “Permanent Registration”
Temporary Registration: usually issued for expatriates practitioner registered somewhere else. It is renewable every 2 years
Permanent Registration

Spatial Regulatory Constraints

The general consensus is that the place must be decent, suitable for medical practice and treating patients, ensuring a certain minimum level of hygiene, comfort and satisfaction.

The spatial regulatory requirements depend on the type of medical institution.

The are more requirements for establishing a full-fledged hospital.

For an outpatient clinic, the general requirements according to Professor Aminu are:

a laboratory
wards
a pharmacy

What About Outsiders?

Outsiders who are not qualified medical practitioners can still open private hospitals and clinics in Nigeria provided that they do it through a partnership with at least one other stakeholder who is registered with MDCN and who is not convicted neither by a law court nor by the MDCN Medical Disciplinary Committee.

Prepare for the Various Licenses and Permits

The local state/city mandated permits; this will depend on the state or region. For instance, in the northern city of Kano, the Private Health Institution Management Agency (PHIMA) is the local government body that ensures regulatory complacency for hospitals, clinics, and private practices. PHIMA will do an advanced search in their records to ensure the name you’d chosen for your hospital in not already taken.

The director of the medical services of the state you are in will get you in touch with the MDCN. They will do their due diligence regarding the owners, the practitioners, the staff, and the authenticity of their qualifications.

Equipment

Again, this depends on whether you are aiming t establish an outpatient general clinic or a full-fledged hospital.

There are regulations for the number of staff (minimum required), for the number of basic and necessary equipment available—the ones that are capable of handling basic emergency functions.

The existence of a certain referral system is required so patients can be referred to other institutions.

→ For clinics:

at least 2 consultations rooms
at least 1 procedure room
at least 1 pharmacy store
a well-ventilated “adequate ambient environment”

→ For hospitals:

at east 2 to 3 wards for male, female, and children patients
a pharmacy
an accredited laboratory
a surgery room
at least 2 qualified registered nurses per shift
other technical requirements for the surgery room..

The Role of NHIA

The National Health Insurance Authority (NHIA) in Nigeria aims to provide mandatory health insurance for all Nigerians by establishing a minimum package of health services across all health insurance providers.

The timeline for approving and establishing a hospital in Nigeria varies based on preparedness and compliance with requirements. It can take as little as one month or longer, depending on factors like name selection, location, and compliance with state-specific requirements.

The NHIA plays a role in accrediting hospitals based on the standard of care they provide for NHIA clients. The accreditation requirements differ for primary, secondary, and tertiary care facilities, with specific standards for services and specialists depending on the level of care.

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What About Rural Areas?

In Nigeria, there are incentives for individuals or organizations that establish hospitals in under-served or rural areas, particularly in regions like Kano State. These incentives include reduced registration fees, where those establishing hospitals outside urban centers pay only a fraction of the usual fee, as an encouragement to expand healthcare services in under-served areas where the majority of private hospitals are concentrated in cities, leaving many local governments without private healthcare facilities.

The Hurdles

Establishing a hospital in Nigeria poses several challenges, including:

Providing essential services like water, electricity, and security, which are not readily available.
High operational costs, especially in the medical field.
Multiple taxation from federal, state, and local governments, making it financially burdensome for practitioners.
Lack of government support in the form of soft loans for healthcare facilities.
The need for a health bank to provide low or no-interest loans to promote healthcare infrastructure.
The goal of reducing medical tourism and making Nigeria a healthcare hub by supporting the establishment of standard hospitals.

On Accreditation and Penalties:

Hospitals in Nigeria must be accredited to practice, but there are various levels of accreditation.
Hospitals accredited to practice patient care are registered and monitored by state agencies.
Some hospitals operate without registration and are considered illegal, making it hard to provide a specific figure for unaccredited ones.
Accreditation is also required for the training of healthcare workers and is regulated by various agencies.
Penalties for not registering a hospital and practicing medicine in Nigeria include criminal charges, closure of the unregistered hospital, and potential prosecution of the operator.