……says families bear 70% of healthcare costs
AKOR SYLVESTER, Abuja
State governments and actors in the private sector have been urged to leverage the Federal government’s increased investments and contributions in health financing to commit more funds in the sector in order to reduce the burden of out-of-pocket spending, driving millions of Nigerians into poverty.
The coordinating Minister of Health and Social Welfare, Prof. Muhammad Pate, who gave the charge at the National Dialogue on Health Financing in Abuja on Monday, themed Reimagining the Future of Health Financing in Nigeria, lamented that for decades, the health sector has been underfunded, with families bearing nearly 70% of healthcare costs out-of-pocket.
He said, for over two decades, Nigeria’s health system has been dominated by out-of-pocket spending by households and communities, a structure that has left millions vulnerable to financial hardship whenever illness strikes.
Pledging stronger investments as the country moves to overhaul it’s health financing architecture, the minister emphasised that to achieve a transformed health sector, there must be synergy between the federal government, civil society, development partners, private investors, and subnational governments.
According to him: “In the last two years of this administration, the Federal Government has significantly increased its contribution to health financing.
“What we now expect from this dialogue is for state governments to commit to matching up, for private sector actors to work with the National Health Insurance Authority (NHIA) to organise private spending through bigger risk pools, and for regulators to ensure the purchase of quality services for Nigerians.
“We cannot continue to build a healthcare system on someone else’s taxpayer resources.
We must mobilize our own funds, invest more, and make every naira count. Good healthcare anywhere in the world is not cheap, it must be paid for.”
The minister highlighted the four-pillar strategy to include; governance and accountability, improved health outcomes, unlocking the health value chain as well as resilience and health security, stating that they were a “roadmap to a health system that listens to its people, protects its most vulnerable, and eases financial hardship for every Nigerian.”
Maintaining what he termed as unprecedented progress in the enrollment of four million Nigerians under the National Health Insurance Authority (NHIA) framework in 18 months, the minister noted that if such momentum had been sustained over the past two decades, over 60 million Nigerians would have already been covered.
Pate, however, underscored the transformative potential of the 2022 Health Insurance Act, which mandates universal coverage and strengthens NHIA reforms.
He said: “The direction has changed. Health insurance is now mandatory, and we are building a national risk pool to ensure no Nigerian is left behind.
This shows we are beginning to see a shift in direction. The challenge now is to sustain it and ensure that mandatory health insurance becomes a reality for every Nigerian.
“Employers must find ways to enrol their workers, and individuals must also find ways to join. Only then can we build a large enough risk pool to protect citizens from catastrophic health costs.”
Stating recent interventions such as free caeseraean sections and expanded fistula care, the minister said they were targeted at protecting the vulnerable and those who were financially incapacitated.
He noted that: “Making obstetric complications reimbursable is one of the most dramatic interventions introduced under President Tinubu.
The resources are available, but the bigger question is how states will complement what the federal government has already put in place.”
Talking on identity barriers to access health insurance in the country, the Minister disclosed that the NHIA was working with relevant agencies to ensure enrollees, including pregnant women requiring emergency services, were issued National Identification Numbers (NINs) as part of the process to further strengthen digital health records but most importantly, to ensure no one was left behind.
On his part, Minister of State for Health, Dr. Iziaq Salako noted that the ministry was committed towards the evolution and implementation of legislations, regulations and policies that would address inadequate budgetary allocations, systemic inefficiencies, fragmented programming and dearth of reliable data.
Salako who highlighted the need for regional cooperation, noted Nigeria must learn from the health financing models adopted by Ghana and Kenya, which he insisted were recording significant strides in health care financing.
“Ghana’s National Health Insurance Scheme (NHIS), established in 2003, is a prime example. It is Funded by a 2.5% levy on goods and services and social security contributions.
“Kenya has also reformed its healthcare financing, replacing its National Health Insurance Fund (NHIF) with a new framework under the Social Health Insurance Act 2023.
This act introduced three funds: the Social Health Insurance Fund (SHIF), funded by mandatory contributions; the Primary Healthcare Fund, government-financed for basic services; and the Emergency, Chronic, and Critical Illness Fund, also government-financed for catastrophic illnesses.
“These 2 examples demonstrate that successful healthcare financing requires political commitment, innovative funding, strong legal frameworks, community engagement, decentralized implementation, expanded benefits and coverage.
“Nigeria aims to learn from these models, adapt best practices, and strengthen regional collaborations. It is my hope that this policy dialogue will leapfrog a nationally supported reform agenda, focusing on increased domestic health financing, exploring innovative mechanisms, optimizing resources, and ensuring transparency.”
Speaking, the Director-General of the National Health Insurance Authority (NHIA), Kelechi Ohiri said Nigeria must confront longstanding challenges of high out-of-pocket spending, weak financial protection, and fragmented coordination between federal, state, and local governments.
Ohiri stressed that people and not just systems must be placed at the heart of health financing reforms, calling for renewed collaboration between government, civil society, and the private sector to strengthen Nigeria’s health financing system and accelerate the journey towards universal health coverage (UHC).
He said:”Nigeria is people. People must be at the centre of the health system, and people must be at the centre of what we are financing.”
The NHIA boss stated that the world was currently experiencing multiple transitions from changes in development assistance for health to shifting disease patterns and demographic realities.
He said: “We are witnessing the end of an era in which official development assistance largely drove health financing. The new reality is one where countries, including Nigeria, must increasingly rely on domestic resources to fund health systems.”
While noting that Nigeria was simultaneously grappling with an unfinished agenda on infectious diseases, maternal and newborn health, and the rapid rise of non-communicable diseases such as diabetes and hypertension, he cited the upward review of tariffs and service fees, nearly doubling capitation and tripling fee-for-service payments to ensure hospitals were properly reimbursed and patients could access drugs and services covered under their plans.
He said: “Our health system does not have the luxury of choosing one transition over another. We are dealing with the double burden of disease, which requires smarter financing and stronger systems.”
Ohiri made reference to new mandates requiring hospitals to treat patients even if referral codes from Health Maintenance Organisations (HMOs) were delayed, as he explained that, “these reforms are designed to rebuild confidence in the system.”
He maintained that the current administration
has made equity a cornerstone, revealing that “in less than one year, over 10,000 women have benefited from the programme on emergency obstetric care, about 3,000 women with obstetric fistula have so far been treated across 20 centers nationwide.”
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