Federal govt to enforce mandatory health insurance as out-of-pocket spending hits 71%

The federal government has made plans to intensify enforcement of mandatory health insurance across ministries, departments and agencies as part of efforts to curb Nigeria’s high out-of-pocket health spending.

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The Minister of State for Health and Social Welfare, Iziaq Salako, disclosed this on Wednesday while delivering an address at the APC Medical Council Health Roundtable Conference held at the State Banquet Hall, Abuja.
Mr Salako said that although national health insurance coverage has grown to between 10 and 13 per cent of the population, out-of-pocket expenditure still accounts for 71 per cent of total health spending, a situation he described as unsustainable.

“These figures underscore the twin challenges of insufficient investment and catastrophic health expenditure that push millions of Nigerians into poverty annually,” he said.

Below the Abuja Declaration target

Mr Salako noted that government health expenditure currently stands at 5.2 per cent of GDP, far below the 15 per cent benchmark set under the African Union’s Abuja Declaration.

Per capita health expenditure from all sources is approximately $43, while external financing accounts for 21 per cent of total health expenditure.

He said the federal government is pushing health financing reforms to guarantee releases under the Basic Health Care Provision Fund (BHCPF), improve capital expenditure implementation and meet obligations tied to the Health Infrastructure Bond.

States, he added, are being encouraged to meet health budget benchmarks and release counterpart funding to match donor-supported programmes.

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Mandatory insurance enforcement

The minister said over 20 million Nigerians have been enrolled into health insurance through formal sector contributions, vulnerable group programmes and BHCPF integration pathways.

He attributed the expected acceleration in coverage to a recent executive order by President Bola Tinubu mandating the implementation of health insurance across federal MDAs, including entities involved in public procurement and the defined benefits scheme for retirees.

He said the government aims to exceed its 2027 target of 20 per cent coverage by expanding enrolment, scaling up the inclusion of vulnerable groups, and broadening benefit packages to cover catastrophic illnesses, non-communicable diseases, mental health, and emergency services.

The convergence of the BHCPF and the National Health Insurance Authority (NHIA) framework, he added, provides a strong mechanism to drive universal health coverage, provided states enforce mandatory subscription.

Wider system reforms

Beyond financing, Mr Salako said the administration is implementing the Nigerian Health Sector Renewal Investment Initiative (NHSRII), launched in December 2023, under a Sector-Wide Approach (SWAp).

The initiative rests on four pillars: governance reform, equitable and quality service delivery, unlocking the healthcare value chain, and strengthening health security using the 7-1-7 framework, seven days to detect a threat, one day to notify authorities and seven days to mount a response.

He acknowledged that Nigeria continues to grapple with workforce shortages, with a doctor-to-population ratio of 1:5,000 compared to the World Health Organisation’s recommended 1:600, and a nurse-to-population ratio of 1:2,000 against the recommended 1:300.

Although over 37,000 health workers have been recruited since 2023, brain drain, urban concentration of personnel and industrial disputes remain challenges.

Persistent health burdens

Citing preliminary results from the 2023 Nigeria Demographic and Health Survey, Mr Salako said maternal mortality stands at 512 deaths per 100,000 live births, down from 576 in 2018, while under-five mortality is 110 per 1,000 live births.

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He said skilled birth attendance has risen to 53 per cent, and full immunisation coverage to 39 per cent.

He added that Nigeria has recorded zero wild poliovirus cases since 2020, and HPV vaccination has reached over 15 million girls aged nine to 14.

Laboratory capacity for PCR testing has expanded from five to 129 laboratories, with emergency operations centres established in 32 states and real-time surveillance systems deployed nationwide.

Call for political commitment

Despite what he described as commendable progress, Mr Salako said reforms are not happening at the pace required for Nigeria’s population of over 230 million.

He called for stronger political commitment to prioritising health in national and subnational budgets, the timely release of allocated funds, improved accountability, and sustained collaboration across sectors.

“The resilient health system we seek is one where every Nigerian, regardless of location or income, can access quality healthcare without financial hardship,” he said.