With limited fiscal resources and competing national priorities, stakeholders have called for a fundamental rethink of how Nigeria finances its healthcare system.
They urged policymakers to recognise health expenditure as a driver of economic growth rather than a social burden.
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The call was made during a webinar titled “Investing in Health in a Limited Fiscal Space,” hosted by the Nigeria Health Watch in partnership with PREMIUM TIMES and The Punch.
The discussion examined how Nigeria can sustain healthcare financing amid a tightening fiscal environment.
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Focus on results, not allocations
The Senior Programme Director and Country Director for Results for Development (R4D), Felix Obi, said Nigeria must move from routine budget allocations to performance-based spending if it hopes to achieve universal health coverage.
Mr Obi explained that most health budgets in Nigeria are not tied to measurable outcomes, meaning funds are allocated without clarity on what services or results they are expected to deliver.
“Our budgets are not performance-based or outcome-based. We allocate money to capital or recurrent expenditure without asking what health service that money is supposed to buy, how many women it will provide antenatal care for, or how many children will be immunised,” he said.
He noted that as donor funding declines, Nigeria must treat public health spending with the same level of accountability expected from development partners and private investors.
“When donors give you money, it’s always tied to specific results. We have not been doing that in our public financial management system,” he added.
Mr Obi recommended that a significant share of government health budgets be channelled through the National Health Insurance Authority (NHIA) and state insurance agencies, so that public funds pay directly for services instead of being allocated to hospitals without oversight.
“When funds go through insurance, we know we are buying results and outcomes. That way, we can use our limited fiscal space more efficiently while expanding coverage.”
He also pointed to opportunities for public-private partnerships and blended financing, citing Nigeria’s COVID-19 response as proof that collaboration between the public and private sectors can mobilise resources effectively.
“We saw how the public and private sectors partnered closely during COVID to mobilise resources. We can do the same for long-term health system financing,” he said.
Private capital as catalyst
Mories Atoki, CEO of the African Business Coalition for Health (ABCHealth), said attracting private investment to healthcare requires repositioning the sector as an economic enabler.
Ms Atoki said to attract private capital, Nigeria must stop seeing health as a social expenditure as healthy populations drive productivity and sustain national growth.
She explained that preventive health and insurance programmes can yield measurable returns if backed by reliable data and predictable systems.
“Investors respond to value and predictability. Employer-based health programmes and digital preventive care solutions can make health an investable market,” she added.
Accountability at community level
Speaking on accountability and transparency, Biobele Davidson, Programme Lead at BudgIT, emphasised that open data and citizen participation are critical to ensuring that health spending, particularly through the Basic Health Care Provision Fund (BHCPF), reaches communities in need.
Ms Davidson explained that evidence-based monitoring remains one of the strongest tools for improving transparency in the health sector.
“Evidence itself speaks. Accountability tracking begins when citizens can clearly see where funds go, how they are utilised, and what impact they make,” she said.
She noted that BudgIT had previously tracked over 8,000 primary healthcare (PHC) facilities to determine which had received allocations under the BHCPF and whether the funding translated to improved service delivery.
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She added that Ward Development Committees (WDCs), local accountability structures recognised by government, should be strengthened and better integrated into tracking mechanisms.
“Community members must be part of the process. They should know how much their facilities received, participate in planning, and monitor service delivery.”
According to her, linking PHC data with service outcomes such as maternal health, immunisation coverage, and equipment availability can help identify funding gaps and drive targeted interventions.
“The citizens are at the centre of this process. They are the reason these facilities exist, and their involvement ensures that no one is left behind,” she stressed.
Towards sustainable health investment agenda
The webinar, moderated by PREMIUM TIMES Health and Development Editor, Nike Adebowale-Tambe, revealed the urgency of reforming health financing as Nigeria works to enrol 44 millioThe panellists stressed that health spending should be treated as an economic investment, not a social cost, with stronger accountability mechanisms to ensure that funds reach communities in need.n people in health insurance by 2030.
The speakers agreed that achieving universal health coverage will depend not only on expanding fiscal space but also on improving efficiency, accountability, and private-sector participation.
Ms Atoki noted that healthy populations drive productivity which reduces business losses and sustains national growth.
“So, investing in health, especially preventive care and insurance, by a lot of yards, yields measurable economic returns,” she said.
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