Experts decry weak accountability, demand statutory inclusion in health financing

Health experts have criticised the weak accountability mechanisms in Nigeria’s health sector and called for statutory inclusion of civil society and other non-state actors in key financing structures to ensure transparency and better outcomes.

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The experts made the call during a panel discussion at the ongoing National Health Financing Dialogue in Abuja on Monday.

The panel discussion was focused on “Advancing Accountability in Health Financing: Improving Budget Transparency, Participatory Budgeting and Expenditure Tracking.”

The dialogue brings together health officials, development partners, civil society groups and the private sector to craft new strategies for sustainable health financing in Nigeria.

The four-day event, themed “Reimagining the Future of Health Financing in Nigeria,” is expected to produce commitments to reduce out-of-pocket spending, improve accountability, and strengthen domestic funding for the health sector.

Call for civil society role

Gafar Alawode, Co-Convener of the Nigeria Universal Health Coverage (UCH) Forum, said Nigeria’s health financing framework risks failure without stronger accountability structures.

Mr Alawode noted that civil society organisations (CSOs) are often invited late into health policy conversations, limiting their ability to influence critical financing decisions.

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“We must institutionalise accountability beyond political promises. Citizens should not be waiting for goodwill; there should be structures in place that guarantee transparency in financing and delivery,” he said.

He added that Nigeria’s health financing reform will remain fragile unless CSOs are embedded as watchdogs with power to question allocations and demand transparency.

He also said that a whole-of-society approach where government, private sector, and CSOs play complementary roles is necessary.

Speaking on CSOs moving beyond tokenism, Aminu Magashi, Coordinator of the Africa Health Budget Network, said CSOs themselves must adopt more strategic approaches to remain relevant in policy reform.

Mr Magashi stated that the civil society space is fragmented, with organisations often focusing narrowly on malaria, family planning, or HIV, while the government negotiates reforms with minimal scrutiny.

He also explained that CSOs are often invited as observers rather than as statutory members of oversight structures.

“If we are serious about accountability, we must move beyond token representation. There should be statutory provisions making CSO inclusion in financing boards mandatory, with clear agenda items for civil society to speak on transparency and accountability at every meeting,” he said.

He added that the CSOs need to adopt the whole-of-policy-cycle approach which means being present at the design, implementation, monitoring, and evaluation stages.

Journalism as accountability partner

Moji Makanjuola, Founder of the International Society of Media in Public Health (ISMPH), said the media remains a critical player in strengthening accountability.

Ms Makanjuola noted that most journalists covering health lack training and institutional support to track complex health budgets and financing flows.

“Without capacity building, many journalists cannot follow the numbers, and that creates a gap that allows misuse of funds to go unchecked,” she said.

“They need to ask the right questions. Without strong media scrutiny, health financing reforms will happen on paper only.”

She added that beyond capacity, media houses must prioritise health financing reporting as a public accountability function, not merely as event coverage.

While highlighting the need to strengthen media–civil society partnerships, she added that Nigeria lacks institutional frameworks for digital health at the state level, stressing the need for designated units within health ministries to manage accountability systems.

Youth demand inclusion in financing debates

Semiye Michael, Founder of DEAN Initiative said young people are being sidelined in Nigeria’s health financing reforms.

Mr Michael noted that despite youths making up the majority of Nigeria’s population, they are rarely given space in budget discussions or financing oversight.

He argued that the youths are not just beneficiaries of health services but critical stakeholders.

“But today, our voices are absent when budgets are drafted and when resources are tracked,” he said.

He added that excluding young people from accountability frameworks risks weakening reforms in the long run.

“If the future of health financing is being discussed without the youth at the table, then we are only planning for half of Nigeria,” he said.

Mr Michael also highlighted that youth groups are willing to track expenditure at the grassroots, using digital tools and community networks, but require structured entry points into the process.

Women and community voices in accountability

Hajia Hauwa Adamu, who represented the Association of Wives of FCT Traditional Rulers (AWTR), said accountability in health financing will fail unless women and communities are deliberately included.

Mrs Adamu noted that women, especially at the grassroots, are the first to experience the failures of poor health financing but are rarely consulted in budgeting and monitoring.

“Women know when health centres have no drugs, when children are turned back, and when families cannot afford services. If the government ignores our voices, then accountability is incomplete,” she said.

She added that traditional institutions and women’s associations can serve as watchdogs to ensure health funds reach communities where they are most needed.

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“We must move beyond Abuja conversations. Transparency must be felt in villages, in primary health centres, and by mothers who are struggling every day.”

Mrs Adamu also highlighted the role of traditional rulers’ wives in mobilising feedback from households, stressing that community-driven monitoring can complement CSO and media efforts.

The experts agreed that Nigeria’s health financing reforms risk failure if accountability mechanisms remain weak and civil society continues to play a peripheral role.

They concluded that statutory inclusion of CSOs, strengthening of media capacity, and institutionalisation of digital accountability tools are urgent steps required to ensure that ongoing reforms deliver value for money and protect the health of citizens.