By Racheal Abujah
For 32-year-old Mr Chinedu Okonkwo, a teacher, from rural Enugu state, a routine check-up for high blood pressure became a nightmare.
Okonkwo local primary healthcare centre, meant to be the first point of care, lacked basic equipment, clean water, and reliable power.
With no insurance coverage and limited access to affordable medication, he faced a harrowing choice: skip treatment or spend months’ savings out-of-pocket.
Not far away in Kano state, 28-year-old Mrs Aisha Ishaka, a mother of three and a housewife, travelled more than 30 kilometres to a functional PHC for her youngest child’s vaccinations.
Ishaku said that the journey, exhausting and costly, is one she has had to make multiple times.
“Sometimes I have to borrow money just for transport and medicine,” She said.
Meanwhile, in Lagos state, a young doctor, Dr Ifeanyi Okoro, battles daily shortages of staff and equipment.
“Even when patients have insurance, delays and lack of resources mean we can’t always deliver timely care. We want to help, but the system makes it difficult,” Okoro said.
These stories illustrate the reality for millions of Nigerians. Despite the government’s commitment to Universal Health Coverage (UHC), most Nigerians still pay for healthcare themselves, with 69–76.6 per cent of spending coming directly from patients at the point of service.
Some households spend over 40 per cent of their non-food income just to stay healthy.
Only 5–10 per cent of Nigerians have health insurance coverage, leaving informal sector workers, rural dwellers, and the poor most vulnerable.
Stakeholders in the healthcare sector said Nigeria’s healthcare system is hampered by poor infrastructure, workforce shortages, and uneven service distribution.
Rural communities often lack functional facilities, forcing patients to travel long distances.
Even where facilities exist, PHCs are underutilised because of perceived low-quality care, long wait times, and insufficient staff, putting pressure on secondary and tertiary hospitals.
The shortage of healthcare professionals is acute: in some states, there is one doctor per 5,000 patients, far below the World Health Organisation’s recommendation of one per 600.
“Brain drain” is widespread, with many Nigerian doctors, nurses, and specialists relocating abroad for better pay and working conditions
Stakeholders have urged urgent reforms to strengthen quality, affordability, and equity in Nigeria’s health system.
Speaking at the 2025 UHC Day High-Level Convening, themed “Unaffordable Health Costs? We’re Sick of It!”, Dr Njide Ndili, President of the Healthcare Federation of Nigeria (HFN), warned that slow policy implementation and high out-of-pocket costs are pushing millions of Nigerians into poverty.
“People will only prepay for health insurance when they know they will receive good quality care when they need it,” Ndili said.
She emphasised that quality is the arrowhead of UHC and called for frontline implementation across institutions and local governments, warning that Nigeria is unlikely to meet the global 2030 UHC targets without drastic action.
Dr Funke Fasawe, Country Director of the Clinton Health Access Initiative (CHAI), described Nigeria’s health inequities as “unfair and deadly,” stressing that access should not depend on purchasing power.
Fasawe urged stronger policy implementation and citizen engagement to ensure accountability in the health system.
Healthcare providers also shared stories of facility-level quality improvement journeys, such as upgrading PHCs to meet national standards through programs like the AGIA Community Health Care Programme, emphasising that safe care is central to achieving UHC.
Dr Saheed Ogunme, Chief Medical Director of Federal Medical Centre Ebute-Metta, highlighted the financial strain on hospitals absorbing losses from patients unable to pay, and called for a decisive policy direction, whether a tax-funded system like the UK or insurance-driven like the US, to guarantee that no citizen is denied essential care.
The convening brought together national and sub-national leaders, policymakers, health financing experts, development partners, civil society, private sector health leaders, and champions of quality care, underlining the urgency for renewed commitments toward equitable, high-quality, and financially accessible healthcare.
The discussion emphasised reducing financial hardship, strengthening domestic health financing, and ensuring coverage is matched by improved service quality, signalling a national push to move beyond dialogue toward concrete implementation.
To address systemic challenges, the Nigerian government is implementing the Nigeria Health Sector Renewal Investment Initiative (NHSRII), focusing on governance, funding, infrastructure, and accelerated UHC progress.
Dr Iziaq Adekunle Salako, Minister of State for Health and Social Welfare, highlighted several key initiatives driving Nigeria’s health sector reform in 2024 and 2025.
Salako noted that mandatory health insurance is now being enforced across government agencies, pushing national coverage to over 11 per cent, or 21.1 million enrollees, and expanding access to essential services.
He explained that the 2025 proposed health budget allocates 5.15 per cent, ₦2.56 trillion, to strengthen infrastructure, procure equipment, and expand insurance coverage.
According to him, the government is also revitalising primary healthcare, with plans to increase the number of fully functional PHCs from 8,300 to 17,600 within four years, supported by direct facility disbursements from the Basic Healthcare Provision Fund (BHCPF).
He added that the Health Workforce Migration Policy aims to tackle workforce shortages by recruiting over 20,000 frontline health workers, improving incentives, and mitigating brain drain.
He further highlighted major infrastructure investments, including the NSIA Healthcare Expansion Programme, which is building and equipping new diagnostic and oncology centres nationwide.
In addition, he said the government is unlocking the healthcare value chain through the Presidential Initiative on Unlocking Healthcare Value Chain (PVAC), designed to boost local manufacturing of medicines and medical devices and reduce dependence on imports.
Finally, he emphasised the increasing use of digital technologies, such as the national PHC dashboard and online training platforms, to enhance data collection, improve service delivery, and support continuous training for health workers.
The HFN emphasises that the private sector is essential for UHC, especially as donor funding declines. Over 500 members, including hospitals, pharmacies, HMOs, and manufacturers, advocate collectively, ensuring private voices influence policy and planning.
The private sector outlined several key contributions it is making toward Nigeria’s UHC agenda.
First, it is deepening private, public collaboration to help build a unified and efficient health system that works seamlessly with government structures.
Stakeholders also stressed the need for health sovereignty, emphasising increased local production of healthcare services and medical products to reduce Nigeria’s dependence on foreign aid.
To improve equity, the private sector is partnering with national programmes such as the BHCPF and the Maternal and Adolescent Health and Immunisation (MAMI) initiative to strengthen rural primary healthcare centres and expand access in underserved communities.
They further highlighted that quality care remains central to growing public trust and boosting insurance enrolment, noting that Lagos State and a few others have become models for embedding quality systems across facilities.
On regulation, they pointed to the establishment of the National Health Facilities Regulatory Authority (NEPHRA), which is expected to set and enforce national standards for healthcare facilities.
In addition, the private sector is playing a stronger role in policy advocacy, now serving as a co-signatory to the UHC Compact and helping define key performance indicators (KPIs) that will track and measure private sector contributions to achieving UHC.
HFN stressed that collaboration, quality care, innovation, and private sector engagement are crucial for a stronger health system and wider insurance uptake, directly impacting patients like Okonkwo and Ishaku.
In some regions, initiatives are already showing results. Ishaku’s child received timely vaccinations at a recently upgraded PHC.
Okoro documented that new frontline recruits have eased patient loads in Lagos hospitals.
He said that digital tools and quality programmes, such as SafeCare, were helping facilities meet national standards and improve patient outcomes.
Speaking passionately about the future of healthcare delivery in Nigeria, Mrs Moji Makanjuola, Executive Director of the International Society for Media in Public Health (ISMPH), urged “We’re going to take stock of you. Let’s make this a Christmas to remember for healthcare delivery in Nigeria.
“It is a challenging season in the north and south, but together, we can build a resilient, all-inclusive healthcare system, not just the Federal Ministry of Health.
“We need to know what the states are doing so we can bring the true picture into perspective.
“I sincerely thank our partners—PharmXS, HFA, SafeCare, and the Clinton Health Initiative, for collaborating with us and making this happen.
“But we cannot get there if we continue to live in comfort. Next year, we will visit states like Sokoto to identify gaps firsthand. We want everyone to join us until we achieve this vision.
“Healthcare in Nigeria is a shared responsibility, and together we can make it better.”
Her call reinforces the need for collective action, hands-on engagement, and accountability across all levels of government, civil society, and the private sector, inspiring stakeholders that change is possible with cooperation and commitment.
Without accelerated progress, millions of Nigerians will continue to face preventable illnesses and financial hardship.
Families like Okonkwo’s risk debt and poverty; children may miss essential care; rural communities remain underserved.
The story of Nigeria’s healthcare system is not just about budgets or policies, it is about the lives hanging in the balance every day.
Nigeria stands at a critical juncture. Achieving UHC requires political will, smart investments, citizen engagement, and strong partnerships across government, civil society, and private sector actors. Stakeholders warned that the time for action is now, or the human and financial costs will continue to mount.
For Okonkwo, Ishaku, Okoro, and millions more, the promise of UHC is not just a policy, it is the hope of a healthier, more equitable future.
(NANFeatures)
