Nigeria must rethink health financing to achieve universal health coverage, experts warn

Health experts in Nigeria have called for urgent and coordinated reforms to sustain health investment in the face of shrinking fiscal space and declining donor support.

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The call was made during a webinar on Wednesday titled “Investing in Health in a Limited Fiscal Space,” hosted by the Nigeria Health Watch, in partnership with PREMIUM TIMES and The Punch Newspaper.

The webinar, moderated by the Editor of Health and Development desk at PREMIUM TIMES, by Nike Adebowale-Tambe, brought together policymakers, development partners, and civil society organisations to explore practical strategies for improving efficiency, accountability, and value for money in the country’s health sector.

Universal health coverage

In her opening remarks, Mrs Adebowale-Tambe said the push for universal health coverage (UHC) must now meet the realities of limited resources.

For years, she noted, Nigeria has aimed to ensure that every citizen can access quality healthcare without financial hardship, yet data continues to tell a different story.

“Out-of-pocket spending still accounts for over 75 per cent of all health expenditure, one of the highest in the world,” she said.

“This means that many families still bear the full cost of care even as donor support continues to decline.”

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Mrs Adebowale-Tambe added that as foreign aid shrinks, particularly following shifts in US global health priorities, Nigeria must strengthen its domestic financing systems.

One of the government’s major commitments at the 2025 National Health Financing Dialogue, she said, is to enrol 44 million Nigerians into health insurance by 2030, a target that reflects both the urgency and opportunity of this moment.

Sector-wide approach

The Senior Programme Director and Country Director for Results for Development (R4D), Felix Obi, said the Sector-Wide Approach (SWAp) under the health renewal initiative has created an opportunity for better coordination between the government and development partners.

According to him, for the first time in years, Nigeria now has a unified plan, budget, and monitoring framework for health spending, following the signing of the Health Sector Renewal Compact in December 2023.

“The compact brought together governors, the federal government, and donor agencies under one common framework,” he said.

“It represents a new level of alignment and coordination that can make every naira count.”

He explained that before now, most donor agencies operated independently, funding projects based on their own foreign policy interests rather than Nigeria’s strategic priorities.

The new approach, he said, will help address duplication and improve efficiency across the health system.

Mr Obi said Nigeria must now focus on translating the national framework into concrete state-level actions.

He stressed that implementation remains the weakest link in Nigeria’s health financing efforts, urging state governments to align their budgets with the national compact and prioritise accountability.

Beyond philanthropy

The Chief Executive Officer of the African Business Coalition for Health (ABCHealth), Mories Atoki, said Nigeria’s limited fiscal capacity calls for a fresh perspective that views health not merely as a social obligation but as a strategic economic sector.

Ms Atoki emphasised that Nigeria must begin to see health as an investment that drives productivity, employment, and national growth, adding that businesses should move beyond philanthropy and take deliberate steps to co-invest in the health ecosystem.

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She identified three key areas where private sector involvement could make the most impact: innovative financing, operational efficiency, and local production.

She explained that mechanisms such as health bonds, blended finance, and impact investment funds can help de-risk investments and attract capital into high-priority areas like diagnostics, pharmaceutical manufacturing, and digital health infrastructure.

Beyond financing, Ms Atoki stressed the importance of building local manufacturing capacity for essential medicines and consumables.

She noted that such investments would reduce import dependence, create jobs, and strengthen Nigeria’s health security.

About the webinar

Amid growing concerns over Nigeria’s health financing gaps, Nigeria Health Watch, in collaboration with PREMIUM TIMES and the Punch newspaper, hosted a high-level dialogue on sustainable health financing.

The dialogue highlighted the need for coordinated action and innovative financing mechanisms to ensure that every naira spent on health translates into measurable impact and progress towards universal health coverage.