Global Health 2030: Absence of financial risk protection bane of healthcare delivery in Nigeria- NIPSS




I want to sincerely appreciate the National President and the entire leadership of Nigeria Medical Association (NMA) for inviting the National Institute for Policy and Strategic Studies (NIPSS), Kuru to this very important Annual General Conference and Delegates Meeting taking place in one of the most peaceful state in the country. I bring warm felicitations and best wishes to the delegates at this Conference from the Management and staff of the National Institute.

The theme of this year’s conference, “Nigeria and the Global Health Agenda 2030”, is not only apt, but very significant considering the challenges confronting our health sector particularly under the COVID-19 Pandemic. It is apparent that achieving the 2030 Agenda, will bring radical transformation of our health sector. However, achieving universal health coverage is prerequisite for promoting physical and mental health as well as extending life expectancy in Nigeria. For these to be realized, there must be commitment not only from the health personnel and institutions, but also political and policy actors. Access to quality and affordable health care for all citizens must be the priority not only for government, but all stakeholders. The National Institute has since come to this realization and has been contributing its quota towards achieving universal health care delivery in Nigeria.

As some of you may be aware, the National Institute, Kuru, is Nigeria’s apex think tank and serves as a high-level centre for reflection, research and multi-stakeholder dialogue. It brings together academics of excellence, seasoned policy initiators, civil society and executors and other citizens of mature experience and wisdom, from all walks of life, to meet, reflect and exchange ideas on great and critical issues in the society, particularly as they relate to Nigeria and Africa, within the context of a constantly changing world. In pursuit of its mandate, NIPSS has remained consistent in regularly studying and dialoging on major national issues that pertains to improving the quality of life of the citizens of our great nation. 

It is in this regards that NIPSS had been collaborating with development Research and Policy Centre (dRPC) since 2006 in building organizational and technical capacity of senior government functionaries in the federal and state public service most especially in the areas of health. NIPSS is currently collaborating with the dRPC on the Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) intervention, which is a health accountability project that aims to catalyze action from national and state governments to increase funding for 4 health issue areas such as Family Planning (FP), Routine Immunization (RI), Ending Childhood Killer Diseases and Primary Health Care Under One Roof (PHCUOR). 

 Your Excellences, distinguished Ladies and Gentlemen, concerned by the challenges confronting our health sector, the President of the Federal Republic of Nigeria, Muhammadu Buhari, tasked NIPSS Senior Executive Course 41, 2019 participants to study Funding Universal Health Care Delivery in Nigeria. In 2019, NIPSS and dRPC with support from Bill and Melinda Gates Foundation collaborated in the implementation of the NIPSS Senior Executive Course 41 theme, Funding Universal Healthcare Delivery in Nigeria. The report of this study was well received by President Muhammadu Buhari and his cabinet last November with a pledge to implement the recommendations. 

The National Institute was able to deliver on this Presidential mandate. The report of this study was well received by President Muhammadu Buhari and the Federal Executive Council in November 2019 with a pledge to implement the recommendations. However, in conducting the study and enhancing our understanding of the healthcare situation in Nigeria, we asked some pertinent questions: Why has Nigeria fallen short of meeting critical milestones in attaining Universal Healthcare Delivery (UHCD)? Why have previous efforts yielded limited results? How can Nigeria accelerate its drive towards achieving universal healthcare delivery? 

The study tour took the Participants of SEC 41 to 12 countries in and outside Africa. The Participants also toured FCT and 11 States across the six geopolitical zones of the country as well as some national and international institutions that were relevant to the theme of study. These are in addition to interactions with high-level frontline health policy actors, experienced practitioners, subject-experts and political actors. 

We have come with some copies of the Policy Brief emanating from the study to share with the participants of this Conference. However, permit me to briefly highlight some of the findings which include the followings: 

  1. Funding universal healthcare delivery in Nigeria is characterised by low budgetary allocation, inadequate and untimely release of funds, absence of financial risk protection; 
  2. There is no clear allocation of constitutional responsibility on health to any tier of government leading to confusion, overlaps, duplication and inefficiency in funding universal healthcare delivery;
  3. Nigeria’s high out-of-pocket expenditure is catastrophic and this has pushed many Nigerians into abject poverty;
  4. The NHIS has recorded less than five per cent coverage in years of its existence due to the non-mandatory nature of the Scheme; 
  5. The private sector is the bedrock of public health insurance, there are about 41 million MSMEs operating in Nigeria whose employees have not been captured in the NHIS; 
  6. There is disproportionate focus on funding curative rather than preventive health services; 
  7. Procurement and distribution processes for drugs and medical equipment are not centrally coordinated thereby compromising quality and economies of scale; 
  8. A substantial number of PHCs in Nigeria are in various stages of dilapidation without adequate infrastructure and personnel. Indeed, there are over 30,000 primary healthcare centres in Nigeria but less than 20 per cent have functional infrastructure. 

Consequently, the study puts forward some recommendations that would strengthen the innovative funding of universal healthcare predicated on the realities obtaining in Nigeria. These include the following:

  1. The Federal Government of Nigeria along with other levels of government should expand the revenue base for funding universal healthcare delivery which should include introducing a levy of one kobo per second on all out-going GSM calls for funding universal healthcare delivery;
  2. The Federal Government of Nigeria should amend the Constitution to specify roles for the three tiers of government in healthcare
  3. Governments at all levels should make health insurance mandatory for all citizens and legal residents.
  4. The FGN should create a special intervention health fund to provide loans with single-digit interest rate to private health institutions for procurement of modern equipment and expansion of health facilities in rural areas.
  5. The Federal Government of Nigeria should develop a Public Private Partnership framework for the management of primary and secondary healthcare facilities in the rural areas.
  6. Government at all levels should adopt and strengthen central procurement and distribution systems for drugs and medical equipment.
  7. The Federal Government of Nigeria should address the dearth of human resources for health, especially in the rural areas.


Your Excellences, Distinguished Ladies and Gentle, as I mentioned, earlier, the report of the study was well received by the President of the Federal Republic of Nigeria and the Federal Executive Council. The National Institute also presented the report to the National Assembly. I am glad to informed this Conference that the reviewed National Health Insurance Act reflected some of our recommendations. The National Assembly has also considered some of our recommendations for the current review of National Health Act. 

It is unequivocal, even as the World Health Organization has always emphasized, health is a basic human right and its attainment is anchored on the principles of availability, accessibility, affordability and quality. The universal healthcare delivery is key to attaining these principles. This informed the United Nations Member States in 2015 adopting the Sustainable Development Goals (SDGs), with Goal Three aims to ensure healthy lives and promote wellbeing for all at all ages. 

There is no doubt that sustainable funding in the face of dwindling government finances and shrinking revenues as well as other competing needs have made it a herculean task to adequately make provision for funding the health sector. Consequently, the intended objectives of achieving Global Health Agenda 2030 through universal healthcare delivery in Nigeria and the targets set in the various national health policies are being marginally realised.  

Your Excellences, distinguished Ladies and Gentlemen, although standards have been established to guide the provision of healthcare in Nigeria, enforcement of these standards is weak and directly affects the ability to ensure safe healthcare delivery. This results in the need for people to seek healthcare services in more than one place in search of a second opinion or better care thus, contributing to increase Out-of-Pocket-Expenditure.  Additionally, poor healthcare standards contribute to increasing medical tourism cost to Nigeria estimated at N400 billion annually. This outflow deprives the health sector the much-needed funding for healthcare delivery in Nigeria.

It is apparent that unsystematic coordination of healthcare funding policies in Nigeria has widened the gap between policy intentions and outcomes which has resulted in poor healthcare delivery in the country. This partly explains the ineffectiveness, duplication and failure to achieve the desired results in some national and State healthcare funding policies particularly at the community level.  Coordination in the implementation of health-related policies at various institutional levels is weak across the country. 

In conclusion, Your Excellences, Distinguished Ladies and Gentlemen, there is still substantial ground to cover and tremendous opportunity for further improvements. The process of attaining the Global Health Agenda 2030 through universal healthcare delivery in Nigeria require sustained high-level political commitment and institutional synergy across levels of government. 

It is undisputable that good health is critical to attaining sustainable development and of course the Global Health Agenda 2030. For a developing country like Nigeria, this of course include tackling economic and social inequalities, poverty, social exclusion, insecurity and several other development challenges in order to build good health for all.

Finally, Your Excellences, distinguished Ladies and Gentlemen, I have no doubt in my mind that with the array of professionals, experts, and eminent delegates in this hall, the objectives of the Conference would be fully realized. I wish you a very fruitful deliberation.

Thank you and God bless.