Sept. 2, 2025
Prof. John Ele-Ojo Ataguba, Executive Director of the African Health Economics and Policy Association (AfHEA), has warned that Nigeria’s weak health financing structure and high out-of-pocket payments are deepening inequalities.
Ataguba, who is also a health economist, made this known on Tuesday in Abuja, at the National Health Financing Policy Dialogue.
The event themed “Reimagining the Future of Health Financing in Nigeria”, was organised by the National Health Insurance Authority (NHIA) and partners.
The dialogue seeks to reimagine financing models that make healthcare more equitable, sustainable and accessible for all Nigerians.
It comes at a critical time as African countries grapple with fragile health systems, fiscal pressures and the realities of donor transitions.
He added that uneven health insurance coverage across states was worsening maternal and child health outcomes.
He said that Nigeria spends only about 30 dollars per person on primary healthcare, while government spending per citizen stood at a dismal 14 dollars per person, far below the 86 dollars benchmark required to deliver essential services.
He said that the country is still spending less than eight per cent of its total budget on health, in spite the 15 per cent Abuja Declaration target and its tax-to-GDP ratio of less than 12 per cent which leaves the government with limited fiscal space to fund healthcare.
“When government contribution is weak, the private sector dictates the pace, but healthcare cannot be left entirely to market forces.
“Out-of-pocket spending is pushing households into poverty and driving inequality,” he said.
He noted that inequalities in health financing are stark across states. Some, such as Delta and the Federal Capital Territory, were performing well in terms of health insurance coverage, while others such as Borno, Sokoto, Zamfara and Bauchi, lag significantly behind.
“Fewer than 10 per cent of Nigerians are covered by health insurance, though some states have moved beyond this average.
“We need to scale coverage to at least 80 per cent of the population if we want to protect households from financial catastrophe,” he said.
On child health, he observed that less than one-third of Nigerian children are fully vaccinated, with states such as Sokoto, Zamfara, Kebbi and Niger recording up to 50 per cent of children under two years who had not received even a single dose of vaccine.
“Maternal health indicators are equally grim. Nigeria’s maternal mortality ratio is close to 1,000 deaths per 100,000 and live births, one of the highest in the world.
“Only about 52 per cent of pregnant women attend at least four antenatal visits and family planning uptake remains low at 21 per cent.
“The WHO now recommends eight contacts during pregnancy, but Nigeria is struggling even with half the recommendation,” he added.
He stressed that regional inequalities are widening, with the South-west performing relatively well on financial protection while the South-east remains among the worst.
Calling for reforms, he urged the Federal Government to scale up domestic funding through improved tax mobilisation.
He also recommended expanding innovative financing models to support access to medicines and essential services.
In addition, he stressed the need to strengthen health insurance schemes to reduce out-of-pocket spending.
He, further, called for empowering local governments, where most primary healthcare services are delivered, to directly manage health resources, in line with the recent Supreme Court ruling on local government autonomy.
He said that cutting inefficiencies, reducing redundancies and aligning state and federal health financing would be critical in putting Nigeria back on track toward Universal Health Coverage (UHC).
The dialogue brought together policymakers, development partners, civil society organisations, commissioners of health and other health stakeholders to chart a course for sustainable health financing in Nigeria. (NAN)
