Nigeria’s Health Financing Dialogue: Promises, gaps and the road ahead

Nigeria’s healthcare system is underfunded and overstretched, with millions of citizens paying directly for services at the point of use.

More than 70 per cent of total health expenditure comes directly from households, one of the highest rates in the world, leaving families vulnerable to high costs and deepening poverty.

Against this backdrop, from 1 to 4 September 2025, the Federal Ministry of Health and Social Welfare convened a National Health Financing Policy Dialogue in Abuja under the theme “Reimagining the Future of Health Financing in Nigeria.”

The theme reflects Nigeria’s aspiration for enhanced domestic and sustainable financing in pursuing Universal Health Coverage (UHC).

For four days, policymakers, civil society leaders, academics, the private sector, development partners, and the media debated moving from repeated policy declarations to strategic implementation.

PREMIUM TIMES followed the deliberations, capturing the key ideas, concerns and proposals that emerged.

Insurance expansion, Out-of-pocket challenges

The most pressing concern for many was Nigeria’s heavy reliance on direct household payments.

Health financing scholar John Ataguba described the dependence on out-of-pocket spending as “really problematic.”

Mr Ataguba explained that Nigerians spend about $70 per person directly on healthcare, compared to only $14 per capita spent by the government.

For him, genuine financial protection can only be achieved when out-of-pocket expenditure drops below 20 per cent.

In response to the concerns, the federal government announced one of the dialogue’s headline commitments, which is to enrol 44 million Nigerians into health insurance by 2030, up from fewer than 20 million today.

This pledge, according to the Minister of State for Health and Social Welfare, Iziaq Salako, is part of a broader effort to reduce health spending and strengthen financial protection for households.

The pledge generated optimism, but many cautioned that it could remain aspirational unless budget releases are consistent and financial management improves.

Also, coverage under the National Health Insurance Authority (NHIA) still falls below 10 per cent, raising doubts about whether the new promises will translate into real access for Nigerians.

Primary Health Care

If health financing reforms are to deliver tangible results, many participants stressed that Primary Health Care (PHC) must be the entry point. Despite repeated pledges, PHC facilities across Nigeria remain under-resourced, poorly staffed, and in many cases, barely functional.

They highlighted structural issues that weaken PHC delivery: health worker migration, fragmented state-level programmes, and poor integration of local government budgets. Even where resources exist, delays in fund release and weak accountability mechanisms mean services often fail to reach citizens.

In response, Mr Salako announced that the ministry was considering approaching the National Assembly to increase the Basic Health Care Provision Fund (BHCPF) from the current one per cent to two per cent of consolidated revenue. Officials argued the increase would help revitalise thousands of PHC centres nationwide.

Experts, however, highlighted that revitalising PHC requires more than additional funding, noting that efficiency, transparency, and stronger community engagement must be at the core.

Reducing donor dependence

Sustainability was another recurring theme during the dialogue. Nigeria continues to rely heavily on donor financing for key programmes in immunisation, HIV, Tuberculosis, and Malaria. Experts cautioned that these vertical funding streams often bypass or even weaken domestic systems.

At the event, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, stressed that the country cannot depend indefinitely on aid to solve its health problems, noting that domestic resource mobilisation is the only sustainable path.

The call resonated across sessions, with participants urging federal, state and local governments to prioritise health in their budgets and ensure that approved funds are disbursed.

Increase Health Budget

Mohamed Janabi, WHO regional director for Africa, urged Nigeria to move beyond communiqués and increase health spending to at least 20 per cent of the national budget, while reducing out-of-pocket payments.

Mr Janabi said this will ensure Nigeria moves towards achieving Universal Health Coverage (UHC).

He also highlighted the need for evidence-based policymaking and accountability in implementation, stressing that sustainable domestic financing does not mean shutting out donor support.

Mr Salako, the Minister of State for Health and Social Welfare, said that to achieve its goal of health financing, Nigeria is prepared to learn from best practices in other countries.

“Ghana and Kenya, for example, demonstrate that successful healthcare financing requires political commitment, innovative funding mechanisms, strong legal frameworks, community engagement, decentralised implementation, and expanded coverage,” he said.

He said Nigeria aims to adapt such models, strengthen regional collaborations, and apply context-specific innovations.

Bridging research, policy gap

To achieve Universal Health Coverage, experts agreed that Nigeria must strengthen its health financing systems and build stronger links between research and policymaking.

Chigozie Uneke, a professor of Health Systems and vice-chancellor of the David Umahi Federal University of Health Sciences (DUFUHS), argued that most Nigerian health research is underutilised because it is not aligned with policymakers’ priorities.

Mr Uneke blamed a “publish or perish” academic culture that rewards volume over relevance.

He proposed that government-funded research grants be linked to ministry priorities, ensuring that researchers focus on studies with practical policy impact.

Kamil Shoretire, director of Health Planning, Research and Statistics at the Federal Ministry of Health and Social Welfare, echoed the concern, saying researchers must go beyond academic output and engage directly with decision-makers.

On her part, Susana De, the Gates Foundation’s deputy director for Health and Nutrition in Ethiopia, stressed that success should not be judged by prestigious journal publications but by whether findings influence change.

Prudent use of fiscal gains

At the high-level dialogue, finance leaders warned that rising government revenues must not be allowed to dissipate without impact.

Akin Oyebode, Ekiti State’s Commissioner for Finance, cautioned that sudden fiscal gains risk becoming “numbers on paper” if not matched by executed expenditure.

He flagged weaknesses in fragmented nutrition programmes and noted that health-worker migration, driven by pay disparities across states, is hollowing out primary care.

The Executive Director of the National Primary Health Care Development Agency (NPHCDA), Muyi Aina, echoed a similar concern, saying costs for vaccines and other essential commodities are rising faster than budget adjustments.

He stressed that efficiency, transparency, and accountability must accompany additional resources. “Donors and partners can support,” he said, “but Nigeria must first demonstrate its own commitment.”

State, local govt’s roles

At the event, the Chairman of the House of Representatives’ Committee on Health Care Services, Amos Magaji, called for stronger legislative backing, deeper state involvement, and innovative financing models to strengthen Nigeria’s health system and expand access to quality healthcare.

Mr Magaji stressed that healthcare financing should not be left to the federal government alone, noting that states and local governments are closest to the people and play a pivotal role in mobilising resources.

Aminu Hassan, chairman of Jalingo Local Government in Taraba State, argued that councils must commit more resources at their level, insisting that 25 per cent of local government budgets should be dedicated to healthcare.

Similarly, Samuel Gejere, a former Karu council chairman who represented the Association of Local Governments of Nigeria (ALGON), pressed for an increase in councils’ share of the federation account, from 20.6 per cent to 35 per cent.

He criticised the culture of empowerment projects such as motorcycle distributions and urged that funds be channelled instead toward sustainable health investments.

Diaspora, private sector roles

At the event, Mr Pate highlighted the potential role of the diaspora and the private sector in achieving a reliable health system in Nigeria.

He encouraged Nigerians abroad to move beyond ad hoc remittances and pay directly into insurance schemes for relatives at home.

“Instead of sending money when an aunt or uncle is sick, you can pay for their insurance. That brings the diaspora closer home,” he said.

Mr Pate also cited new initiatives, including dialysis subsidies, fistula repair programmes, and a planned catastrophic health fund, as signs of reform momentum, stressing that private sector engagement will be central to sustaining progress.

The road ahead

The country is making bold promises on insurance expansion and funding, yet it remains heavily dependent on donors. Revenues are rising, but budget execution and accountability remain weak.

Sub-national governments hold key responsibilities, but their commitment is uneven. Also, plenty of research exists, but they are often disconnected from the policy cycle.

Meanwhile, these challenges are not new to Nigeria’s health system. Nigeria has signed ambitious declarations before, including the Abuja target of 15 per cent budgetary allocation to health and the rollout of national and state-level insurance schemes.

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However, implementation has consistently lagged with the country’s health budget still a little above five per cent of the total annual budget.

Now, with donor contributions declining, particularly as global priorities shift and traditional funders such as the United States scale back support, the pressure on Nigeria to mobilise domestic resources has never been greater.

The health financing dialogue has set a fresh round of promises, but the test will be whether these translate into measurable improvements in health outcomes for all Nigerians.

Until then, the health system will remain overstretched and ordinary citizens will keep paying the price.