Requirements Setting Up Medical Facility In Nigeria (Clinic And Nursing Home)

There are different types of healthcare facilities in Nigeria. Some are managed by the government and the others by private or joint owners. The two most popular are hospital and clinic and Nursing Home

Clinic And Nursing Home

Clinics are small health care facilities where minor ailments and diagnosis can be done and thereafter treated. They are meant to handle our patients. Premises where medical care is given on out-patient basis and observation purposes before referral or transfer to a hospital for further management. These establishments are not allowed to run 24 hours service. They can ONLY open for a maximum of 12 hours per day.

Read Also: The Process Of Obtaining Treatment In A Nigerian Government Hospital

Nursing home is similar to a clinic but more specifically designed to cater for pregnant women and labour. Premises where maternal and child care services are provided including ante-natal, delivery and post-natal care, with bed care and nursing services. They are allowed to run 24 hours services.

Registration of hospital and clinic

Registration of clinics or primary health centres (PHC) in Nigeria is done by the government using the name of the government. It is simple and straightforward. But we are talking about private clinics.

There are only two health care professionals that can open and operate a clinic and Nursing Home. They are medical doctors and registered nurses. They must have at least five years working experience from the year they started practicing.

The clinic and Nursing Home must be registered with the corporate affairs commission (CAC). Then after getting a licence from the federal ministry of health (FMH) to operate. Some states also have regulatory bodies that monitor the operation or clinic and Nursing Home. Example is Lagos state health facility monitoring accreditation agency (HEFAMAA).

Clinic And Nursing Home Requirements

1. Supervisor that is a matron

2. Passport of proprietor and medical doctor

3. Pharmacist with license in premises with pharmacy store. The store must be registered with the Pharmacists Council of Nigeria (PCN). They accept pharmacy technicians for a store that does not handle extemporaneous preparation or compound.

4. Laboratory scientists registered with their body or laboratory technician when it involves minor laboratory investigations.

5. Certificate of registration and current practice licence of staff with regulatory bodies.

6. Equipment such as patient bedz stethoscope, blood pressure monitor and blood sugar machines.

7. Organogram, sketch of the clinic and Nursing Home including labels of every room and measurements.

Registration Requirements For Clinic

General Medical Practice and Out-Patient Facility

Minimum Requirements

PART A: Out-patient

Waiting/Reception Area 4 x 3 metres with the following in place:

1. Sitting facilities

2. Registration table

3. Record keeping facilities (preferably digital).

4. Consulting Room of 4 x 3 metres with:

5. Examination couch and screen for physical examination

6. Proper hand washing facilities with disposable serviettes

7. Appropriate medical waste management.

8. Treatment Room of 4 x 3 metres with the following in place:

a. Treatment couch (optional)

Proper hand washing facilities

b. Appropriate medical waste management.

c. Trolley containing various instruments and articles as needed by the facility.

PART B: Equipment

Basic Hospital equipment required are:

1. Suction machine

2. Oxygen Cylinders (complete with flow metre and other apparatus for administration)

3. Oxygen concentrator

4. Autoclave

5. Patient monitors

6. Any other Hospital Equipment/Instrument that may enhance the services of the facility.

PART C: In-Patient

1. Small operating theatre (optional) not less than 4 x 3 metres for minor day surgeries needing local anesthesia only.

2. Observation room with not more than 2 beds (optional) and a minimum distance of 1 x 3 metres between 2 beds.

PART D: Diagnostic Facilities

Facilities for Basic Diagnostic Investigations (e.g. Side room Laboratory) such as:

1. Blood – e.g. Hemoglobin, Full Blood Count, Blood sugar serum electrolytes, urea etc.

2. Urine and stool test i.e. Urinalysis, Stool examination.

3. RDTS: Malaria Parasite, HIV

NOTE: Other complex tests are done by arrangements with an approved Laboratory in the state.

PART E: Medical Waste Management

Registration with LAWMA Medical waste management is compulsory

a. Use of appropriate waste bins with cover in all sections of the facility

b. Use of appropriate colour coded bags for all medical waste disposal i.e.

# Yellow

# Red

# Brown

# Black

c. Use of safety boxes for all sharps object

d. Creation of an appropriate final waste collection point for all facility’s waste

PART F: Handwashing Facilities

Proper hand washing facilities must be available in all sections of the Clinic to facilitate frequent hand washing by the staff and patients. Basic facilities for hand washing are:

1. Wash hand basin with running water

2. Liquid antiseptic soap in dispensing bottle with plunger

3. Disposable Serviettes

4. Liquid hand sanitizers

5. Hand dryers (optional)

6. Pedal bin

7. Handwashing poster

PART G: Public health facilities

Public health facilities shall include:

1. Adequate ventilation

2. Adequate illumination

3. Washable floors i.e. tiled appropriately for easy cleaning and disinfection.

4. Adequate drainage in and outside the facility

5. Clean and adequate Water Supply

6. Pipe borne water

7. Borehole (regularly treated)

8. Toilet facilities (W.C.) exclusive to the clinic

9. Fire extinguisher and other safety gadgets with valid service records attached.

10. Power Supply

i. PHCN

ii. Standby Generators

iii. Inverter (Optional)

11. Ambulance (optional)

PART H: Minimum Staff Complement

1. One Medical Practitioner in-charge who serves as the Operating Officer.

2. One Registered Nurse/Midwife registered to practice in Nigeria

3. One Clinic Assistant/Attendant

4. One Laboratory Technician /Assistant (if operating a side laboratory)

5. A trained Community Health Aide (optional)

6. Medical Records and Secretarial Staff

7. One Clerk/Receptionist

Read Also: Similarity And Difference Between Clinic And Hospital In Nigeria

Registration Requirements For Maternity Home

PART A: Out-Patient

Waiting/Reception Area 4 x 3 metres with:

1. Sitting facilities

2. Registration facilities

3. Record keeping facilities (preferably digital).

4. Consulting Room of 4 x 3 metres with:

5. Examination couch for physical examination

6. Proper hand washing facilities with disposable serviettes

7. Appropriate medical waste management.

8. Treatment Room of 4 x 3 metres with the following in place-

9. Proper hand washing facilities

10. Appropriate medical waste management.

11. Procedure room for I&D, suture

PART B: In-Patient

1. Wards of admission with minimum distance of one (1) metre between two adjoining beds or 1 x 3 metres between two rows of beds.

2. Labour/Delivery Room of 4 x 3 sq. metres with necessary equipment e.g.

a. Standard Delivery Couch (1 stage room)

b. Standard Delivery Bed/Couch

c. Delivery Instruments and Trolley

d. Placenta receiver

e. Baby Resuscitaire machine

f. Patient monitors

g. Sonicaid/Fetoscope

h. Suction machine & mucous extractor

i. Weighing scales (Pediatrics and adult).

j. Proper hand washing facilities.

PART C: Equipment

Basic Maternity Centre equipment i.e.

1. Suction machine (manual and automated)

2. Oxygen Cylinders (complete with flow metre and other apparatus for administration)

3. Oxygen concentrator

4. Autoclave

5. Anglepoise lamp

6. Patient monitors

7. Suitable equipment for monitoring fetal heart rate and uterine contractions (please note that a partograph must be used for all deliveries).

7. Any other Hospital Equipment and Instruments that may enhance the services of the centre.

PART D: Diagnostic Facilities

Facilities for Basic Diagnostic Investigations (e.g. side room Laboratory) such as:

1. Blood – e.g. Hemoglobin, Full Blood Count, Blood sugar serum electrolytes, urea etc.

2. Urine and stool test i.e. Urinalysis, Stool examination.

3. RDTS: Malaria parasite, HIV

NOTE: Other complex tests are done by documented arrangements with an approved Laboratory in the state.

PART E: Medical Waste Management

1. Registration with LAWMA Medical waste management is compulsory

2. Use of appropriate waste bins with cover in all sections of the facility

3. Use of appropriate colour coded bags for all medical waste disposal i.e.

# Yellow

# Red

# Brown

# Black

4. Use of safety boxes for all sharps object

5. Availability of an appropriate final waste collection point for all facility’s waste

PART F: Hand Washing Facilities

Proper hand washing facilities must be available in all sections of the Maternity Centre to facilitate frequent hand washing by the staff and patients.

Basic facilities for hand washing are:

1. Wash hand basin with running water

2. Liquid antiseptic soap in dispensing bottle with plunger

3. Disposable Serviettes

4. Liquid hand sanitizers

5. Hand dryers (optional)

6. Handwashing poster

7. Pedal bin

PART G: Public health facilities

These shall include:

1. Adequate ventilation

2. Adequate illumination

3. Clean and adequate Water Supply

i. pipe borne water

ii. treated borehole

iii. Tank water

4. Toilet/Bathroom facilities (1 water closet per 8 in-patient beds).

5. Fire extinguisher and other safety gadgets with valid service records attached.

6. Washable floors i.e. tiled appropriately for easy cleaning and disinfection.

7. Ambulance (optional)

8. Power Supply

i. PHCN

ii. Standby Generators

iii. Inverter (Optional)

PART H: Minimum Staff Complement

1. A supervising doctor to attend to ANC patients at least twice before delivery

2. One registered nurse/midwife with a minimum of 5 years post-registration in charge of nursing services.

3. One registered staff Registered Nurse/Midwife or staff Midwife per 8 in-patient beds per shift

4. A trained Community Health aide per 5 in-patient beds to assist at the center

5. One Clerk/Receptionist

6. Other domestic and secretarial staff as needed by the facility.

7. Laboratory technician/assistant if facility has a side laboratory

8. A referring obstetrician for emergency obstetric cases whose hospital is within the proximity of 30 minutes’ drive

NOTE: Midwives must be conversant with the use of Misoprostol, Magnesium Sulphate and Anti-shock Garment. They must also be conversant with the use of partograph.

PART I: Other Services

1. Kitchen (optional) with evidence of regular food handlers screening.

2. Laundry Service and housekeeping services

3. Fire Extinguisher and other safety gadgets with valid service records

4. Muster point

5. Valid fire certificate

6. Ambulance (Mandatory)

Hospital

They are bigger than clinics and Nursing homes. Hospitals are premises with facilities for medical investigation, diagnosis and treatment. They include bedcate, nursing and other relevant professional services.

They perform medical check up, drug prescription, child delivery, transplant, fertility treatment, etc. Premises with facilities for medical investigation, diagnosis and treatment including bed care, nursing and other relevant professional services. Such premises shall be composite and shall not form part of normal residential accommodation. Because of the complex nature of hospitals, only registered medical doctors with five years of experience can open hospitals.

Read Also: The Different Type Of Hospitals Found In Nigeria

The first step is to register it with CAC. Then get an operation permit from the FMH. Just like in clinics, some states have their own regulatory body that is responsible for the monitoring of hospitals.

Hospital Requirements

1. The medical administrator must be a consultant or a medical or dental officer or more than ten years experience.

Private Hospital Registration Requirements

Out-Patient and In-Patient Facility

Minimum Requirements

PART A: Out-Patient

Waiting/Reception Room of 4 x 3 sq. metres with:

1. Sitting facilities

2. Registration table.

3. Medical Record Facilities (preferably digital).

4. Consulting Room(s) of 4 x 3 sq. metres with:

i. Examination couch and screen

ii. Basic hand washing facilities under running water

iii. Appropriate medical waste bins and management.

5. Treatment Room of 4 x 3 sq. metres with the following:

i. Treatment couch

ii. Basic hand washing facilities under running water

iii. Appropriate medical waste bins and management.

iv. Trolley containing various instruments and articles as needed by the facility.

6. Dispensing Room with Pharmacy Technician dispensing. If compounding is done, a registered Pharmacist and compounding facilities are required.

7. Toilet facilities as approved by the Agency

8. Staff Room/Call room/Staff changing rooms.

9. Ambulance (optional).

PART B: In-Patient

1. Ward(s) of admission with minimum distance of one (1) metre between two adjoining beds or 1 x 3 metres between two rows of beds.

2. Ward(s) with locker and over-bed table for each bed (separate for male and female patients).

3. First Stage Labour room (where applicable) of 12 sq. metres

4. Delivery Room (where applicable) of 12 sq. metres equipped with the following:

a. Delivery Bed/couch

b. Delivery Instruments/Trolley /Packs (sterile)

c. Oxygen Cylinders (complete with flow metre and other apparatus for administration)/concentrators

d. Sonicaid/Fetoscope

e. Weighing scales (Pediatrics and adult).

f. Baby Resuscitaire machine

g. Suction Machine/Sterile Mucus Extractors

h. Standard Led Light for illumination

i. Anglepoise Lamp

j. Basic hand washing facilities under running water

k. Appropriate medical waste bins and management etc.

l. Proper hand washing facilities as approved by the Agency.

5. Suitably equipped Theater with basic equipment such as:

i. Theatre Light (Standard)

ii. Operating table (Standard)

iii. Anaesthetic Machine (Standard)

iv. Suction machine

v. Oxygen Cylinders (complete with flow metre and other apparatus for administration)/concentrator

vi. Oxygen concentrator

vii. Patient monitor

viii. Resuscitaire Machine

ix. Scrub room with appropriate facilities

x. Red Line area (well defined)

xi. Changing room

xii. Sluice room

xiii. Toilet/Bathroom facilities – 1 water closet per 8 beds (separate for male and female).

xiv. Nurses’ Station.

PART C: Diagnostic Facilities

Minimum investigations required are for:

A. Blood – e.g. Hemoglobin, Full Blood Count, Blood sugar serum electrolytes, urea etc.

B. RDTS: HIV, VDRL, Malaria Parasite

C. Urine and stool test i.e. Urinalysis, Stool examination.

NOTE: Other complex tests are done by documented arrangements with an approved Laboratory in the State.

D. X-ray Services (optional).

This needs special permission as the walls of the room shall be lined according to acceptable international regulations for preventing and protecting individuals from radiation hazards.

a. Lead apron

b. TLD badge with appropriate documentation that has not expired

PART D: Equipment:

Basic Hospital equipment required are:

1. Suction machine (automated and manual)

2. Oxygen Cylinders (complete with flow metre and other apparatus for administration)

3. Oxygen concentrator

4. Autoclave

5. Patient monitors

6. Any other Hospital Equipment/Instrument that may enhance the services of the facility.

PART E: Hand Washing Facilities

Proper hand washing facilities must be available in all sections of the hospital to facilitate frequent hand washing by the staff and patients.

Facilities to provide are:

1. Wash hand basin with clean running water

2. Liquid antiseptic soap in dispensing bottle with plunger

3. Disposable Serviettes

4. Liquid hand sanitizers

5. Hand dryers (optional)

6. Hand washing poster

7. Pedal bin

PART F: Medical Waste Management

A. Registration with LAWMA Medical waste management is compulsory

B. Use of appropriate pedal waste bins with cover in all sections of the facility

C. Use of appropriate colour coded bags for all medical waste disposal i.e.

# Yellow

# Red

# Brown

# Black

D. Use of safety boxes for all sharps object

E. Creation of an appropriate secure final waste collection point for all facility’s waste

PART G: Minimum Staff Complement

1. One Medical Practitioner in-charge who serves as the Operating Officer.

2. One Registered Nurse in charge of Nursing Services

3. One Registered Staff Nurse/Midwife or Staff Nurse per 8 in-patient beds per shift.

4. One Laboratory Technician/Assistant if operating a side laboratory or a laboratory scientist for a full laboratory

5. One Registered Pharmacist (for a Hospital Pharmacy) or Pharmacy Technician (if a dispensary)

6. Medical records and secretarial Staff

7. Ward Assistant or Aides (Optional)

8. Kitchen section with food handlers regularly screened accordingly.

9. Any other staff as may be needed by the facility.

PART H: Public health facilities

These shall include:

1. Clean and adequate water supply

2. Pipe borne

3. Borehole (regularly treated)

4. Washable floors i.e. tiled appropriately for easy cleaning and disinfection.

5. Adequate drainage in and outside the facility

6. Adequate ventilation

7. Adequate illumination

8. Toilet/Bathroom facilities (1 water closet/bathroom per 8 in-patient beds).

PART I: Power Supply

i. PHCN

ii. Standby Generators

ii. Inverter (optional)

PART J: Other Services

1. Fire extinguisher and other safety gadgets with valid service records attached.

2. Muster point

3. Valid fire safety certificate

Pharmacists, pharmacy technicians, medical laboratory scientists, medical laboratory technicians, other health care workers and the general public cannot open a clinic, nursing home or hospital. They must use the license of a medical doctor for a clinic, nursing home or hospital or registered nurse to open a nursing home or clinic.