The World Health Organisation (WHO) has urged the Nigerian government to move beyond declarations and ensure bold, sustained implementation of reforms to achieve Universal Health Coverage (UHC).
In his keynote address at the National Health Financing Policy Dialogue in Abuja on Thursday, WHO Regional Director for Africa, Mohamed Janabi, noted that reforms must not remain another declaration.
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Mr Janabi praised Nigeria’s recent efforts in improving health care, such as the Basic Health Care Provision Fund (BHCPF), the National Health Insurance Authority Act, and the expansion of state-level insurance schemes, describing them as visionary foundations.
He, however, noted that the government must increase public health spending to at least 20 per cent of the national budget, reduce out-of-pocket payments that recycle poverty, and strengthen pooling and prepayment mechanisms.
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Call for accountability, increased investment
Mr Janabi also highlighted the need for evidence-based policymaking and accountability in implementation, stressing that sustainable domestic financing does not mean shutting out donor support.
Citing Nigerian novelist Chinua Achebe, he said the country’s main challenge has historically been one of leadership.
“Today in this room we are witnessing the opposite. I only wish Achebe was here to see this moment where leadership rises to meet the challenge,” he said.
Beyond institutional reforms, Francis Ukwuije, WHO Health Economist called for the extension of accountability to individuals and communities.
Speaking on the topic “Strengthening Community Accountability Linking CSOs, Communities and Local Governments,” Mr Ukwuije said civil society organisations have used community scorecards to track equity, quality and financial protection in health services.
He, however, said that accountability mechanisms remain the missing link.
“It’s not so much about name and shame. Even in other countries, what CSOs emphasise is how to hold institutions responsible. But they don’t talk much about how to hold individuals themselves responsible for their own health and the health of their communities,” he said.
He urged stakeholders to “design community scorecards in Nigeria to ensure that we hold individuals responsible for their personal behaviour,” alongside the institutions mandated to provide care.
“That is one last thing I want us to note as we design community scorecards in Nigeria. We must ensure that individuals are held responsible for their personal behaviour. Communities and governments cannot carry this alone,” he noted.
He pointed to lessons from other countries, noting that while global experiences show how institutions are held responsible, there is little emphasis on personal behaviour.
Mr Ukwuije argued that accountability will bite only when it is hard-wired into financing channels.
He recommended integrating community scorecards into the BHCPF and the country’s social health insurance systems at national and state levels and leveraging local government reforms to institutionalise the approach.
He added that sustainability could be achieved through existing lines such as the BHCPF, the Vulnerable Group Fund (VGF) and the HIV Trust Fund.
Donor support and sustainability
Maria Kirova, Head of department at the Global Fund, commended Nigeria’s achievements in tackling HIV, Tuberculosis, and Malaria, while pledging continued support for the country’s health sector transformation agenda.
Ms Kirova noted that investments in national disease programmes have also strengthened Nigeria’s health system and pandemic preparedness.
She highlighted contributions such as expanding health insurance coverage in five states, installing oxygen infrastructure in over 60 major facilities, strengthening supply chains, and supporting primary healthcare revitalisation.
According to her, sustainability of these investments is now critical.
Through the organisation’s financing model, she encouraged domestic resource mobilisation by requiring counterpart funding, providing catalytic resources, and fostering partnerships with government, civil society, and the private sector.
“We believe the strong political leadership displayed by the Nigerian government and the momentum so palpably felt in this forum will lead to a positive outcome in mobilising additional health financing and advancing better and stronger health outcomes,” she said.
Call for CSO independence
Speaking at the event, the Director-General of the National Agency for the Control of AIDS (NACA), Temitope Ilori, urged civil society to strengthen their independence through innovative financing models.
Ms Ilori said CSOs that rely solely on government or donor support risk losing objectivity.
“Civil society cannot depend solely on government or donors to survive. Whoever pays the piper dictates the tune. To remain objective and credible, CSOs must strengthen their systems, adopt innovative business models, and position themselves as true watchdogs in governance,” she said.
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Instead, she recommended that CSOs explore social enterprise models including consultancy, training and other services to fund their activities while maintaining credibility.
She also stressed the need for legislation and policies that institutionalise civil society’s role in governance, adding that transparency, trust and technology must underpin future partnerships.
CSOs outline commitments
Delivering feedback on CSOs commitments, Moji Makanjuola, Founder of the International Society of Media in Public Health (ISMPH), outlined practical steps to deepen accountability and push for inclusive health financing reforms.
Ms Makanjuola highlighted four priorities including scaling up community-led monitoring through grassroots scorecards and dialogues; producing clear, multilingual reports accessible to ordinary citizens; promoting participatory budgeting and performance reviews; and harmonising CSOs to act as a cohesive voice.
She also emphasised the need to involve traditional leaders, women and youth in health financing debates, and urged CSOs to move beyond statistics to human-centred stories that capture the realities of Nigerians.
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