Ibukun Oguntola and Kenneth Ibe (Lead writers)
Nigeria is at a critical juncture in advancing health financing reforms to achieve Universal Health Coverage (UHC). Despite recent progress, public spending on health remains insufficient, out-of-pocket (OOP) payments account for approximately 75-76% of total health spending which is among the highest in the world, continuing to pose significant risks to households.
Conversations around the need for increased investments for the health sector is not something new. In Nigeria, the conversation about strengthening the health system has often centred on increasing funding. However, in a period marked by inflationary pressures, competing national demands, and slowed global growth, the urgent question today is not only about securing more resources but ensuring that every naira invested delivers visible and measurable value for citizens.
At the same time, the global funding landscape for health has undergone significant changes. Cuts in official development assistance (ODA) from tradition donors, notably the United States, which contributes a large share of health financing in Nigeria, has constrained available resources and directly impacted health spending.
These shifts are compounded by the “America First” Global Health Strategy, which will reshape U.S. engagement in Africa. The strategy moves away from broad multilateral commitments towards more bilateral relationships, while concentrating investments in specific areas such as disease programmes, surveillance and epidemic preparedness.
For Nigeria, this evolving donor approach points out the urgency of accelerating the transition from aid dependency to a more self-sufficient, sustainable health financing model. Meanwhile, regional platforms such as the Africa Health Sovereignty Summit and Accra Reset are pushing for stronger continental ownership of health financing and industrialisation, reframing health not as charity but as a sovereign investment.
As a follow-up to the Nigeria Health Financing Dialogue (NHFD), Punch, Premium Times, and Nigeria Health Watch convened a webinar titled “Investing in Health in a Limited Fiscal Space,” aimed at consolidating and amplifying the Dialogue’s key insights and commitments.
The webinar had in attendance, Felix Obi, Country Director, Results for Development (R4D); Dr Mories Atoki, CEO, Africa Business Coalition for Health (ABCHealth); and Dr Biobele Davidson, Health Systems Strengthening Lead, BudgIT Nigeria.
Below are some of the key takeaways from the conversation:
- More Money for More Health, and More Equity
According to Felix Obi, increasing health spending is meaningless if it does not translate into better service delivery and improved population wellbeing. He highlighted the need for clarity and accountability in how public resources are allocated, noting that budgets must be linked to specific service delivery outcomes.
Too often, Nigeria allocates resources without asking, “What health service is this money supposed to buy?” Strengthening health financing, he argued, requires not only more money but smarter spending that delivers real value for citizens.
This is particularly urgent given Nigeria’s persistently high maternal and child mortality rates. Without reforms that promote transparent, evidence-based allocations and result-oriented expenditure, increased budgetary figures will not yield the progress that citizens expect and deserve.
Nigeria’s financing challenge is as much as its about equity as well as scarcity, Felix Obi, stated. Effective spending must reflect the real burden of disease and prioritise the most vulnerable groups: rural communities, low-income households, women, young people, and persons with disabilities.
- Private Sector Confidence Grows Where Value Is Clear
Beyond government spending, the role of the private sector emerged as a critical theme. As global health priorities evolve and domestic resource mobilisation becomes more pressing, Nigeria must create an enabling environment that attracts private investment into health systems strengthening.
Dr. Mories Atoki, noted that “markets respond to predictability and measurable value.” Healthy populations, she explained, drive labour productivity, reduce absenteeism, and boost national competitiveness. Investing in health, therefore, is not an act of corporate charity but a smart economic strategy that benefits businesses operating in healthy, thriving societies.
She explained that, building private sector confidence requires policy clarity, transparent procurement systems, and collaborative planning models that welcome private investment, without diminishing the state’s primary responsibility for health.
- The Bridge Between Spending and Impact
A recurring theme was accountability, how to ensure that health funds translate into tangible impact. Dr. Biobele Davidson, stressed that accountability begins with visibility. Citizens and civil society, she argued, must be able to track health funds from budget approval to implementation. “When expenditure is transparent and its results are tracked,” she said, “trust builds, leakages reduce, and institutions strengthen.”
Strengthening accountability also requires citizen participation. Communities must be empowered to monitor health facilities, engage in budgeting processes, and access open data. Without transparency, even the best-designed policies struggle to deliver meaningful change.
- Leadership and Collective Accountability
While fiscal constraints are real, they cannot serve as an excuse for inaction. Transformative leadership is essential to translate policy discussions into tangible reforms. Nigeria must adopt performance-based health budgeting frameworks that reward efficiency and measurable improvement.
States should align with national priorities while adapting implementation to local realities. Development partners, meanwhile, must shift from running parallel systems to strengthening domestic institutions and capacity.
Ultimately, achieving sustainable health financing will depend not only on new resources but on a renewed commitment to governance, accountability, and shared responsibility.
Health must be recognised not merely as a social service, but as a national investment in human capital, productivity, and resilience.