Professor Chima Ariel Onoka (Guest Writer)
Professor of Public Health & Health Systems Economics
There are rare moments in an academic’s life when the steady accumulation of theory and evidence unfolds into real national reforms. After years of studying how financing shapes access, quality, and equity in health systems, I found myself in one of those moments at the recently concluded National Health Financing Dialogue, a four-day crucible that felt like the narrow neck of an hourglass: on one side, decades of ideas and frustrations; on the other, a widening possibility that those ideas might finally be translated into policy, money, and implementation. At the heart of this was Dr. Kelechi Ohiri, Director General of the NHIA and chair of the Technical Working Group, whose daily welcome addresses set the tone, built anticipation, and created an atmosphere where every single day felt rich, purposeful, and nothing short of excellent.
What made the dialogue different was not rhetoric but composition. For the first time in my memory, the conversation about health financing moved decisively out of the health silo. At the Transcorp Hilton were not only clinicians, researchers, and CSOs, but the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate and Dr. Ishaq Adekunle Salako (Minister of State); the Minister of Finance and Coordinating Minister of the Economy, Olawale (Wale) Edun; the Minister of Budget and Economic Planning, H.E. Abubakar Atiku Bagudu; the Director-General of the Budget Office, Mr. Tanimu Yakubu; the Director-General of the NHIA, Dr. Kelechi Ohiri; the Chair of the Senate Committee on Health, Senator Dr. Ipalibo Harry Banigo; Taiwo Oyedele, Chair of the Presidential Fiscal Policy and Tax Reforms Committee; the Executive Director of NPHCDA, Dr. Muyi Aina; WHO’s Regional Director for Africa, Prof. Mohamed Yakub Janabi; AU and Global Fund envoys; and leaders from the Gates Foundation, Gavi, the Vaccine Alliance, civil society organisations, and private finance. This breadth turned a health financing conversation into a national financing conversation, with global insights woven in at every step.
Image credit: Nigeria Health Watch
Below I set out what I heard, why it matters, and the concrete outputs that, if acted upon, will determine whether the dialogue becomes a moment or a movement.
Five Emerging Themes
1) Health Technology Assessment (HTA): urgency over luxury
The first substantive message was simple: Nigeria can no longer adjudicate coverage and benefits on sentiment, precedent or ad hoc decisions. With medical inflation and an explosion of high-cost interventions (dialysis, oncology, complex NCD care), HTA is not just a technical ivory-tower exercise, it is a practical shield against waste and an instrument to buy value for money. This was not abstract: to help manage current concerns in the health insurance industry, a solution is needed urgently to inform actuarial reviews, benefit package design and political interests in high-cost care.
2) Translating evidence into policy and practice: the NHIA is putting skin in the game
Researchers in the room did not come to pontificate; they came to be interrogated and to inform decisions. Day two was remarkable for the intimacy of that encounter: empirical teams sat alongside policy makers and negotiators. That moment crystallized into an announcement from NHIA’s leadership inviting evidence generating research. Dr. Kelechi Ohiri announced that NHIA had for the first time allocated a dedicated research envelope (over US$300,000) to commission policy-relevant research and to catalyse partnerships, an unprecedented step that signals a shift from political posturing to real interest in evidence for policy action.
3) Reimagining national–subnational synergy: a uniquely Nigerian model
A recurring tension in Nigerian health financing is centralisation versus local agency. The dialogue resolved not to choose one over the other but to craft a model that leverages both: national pooling and risk management, with subnational mobilisation and operational delivery. In practical terms this means harmonising the national risk management with robust operational work amongst State Social Health Insurance Agencies (SSHIAs), and clearer fiscal transfers to local primary care, a sequence that places the political and technical work where it can be implemented. Governor Chukwuma Charles Soludo of Anambra State reinforced this point in his address, underscoring that sustainable health financing will only materialise when states exercise true fiscal creativity and political will to mobilise domestic resources for health.
4) Unlocking Private Sector Participation: Bridging Health and Finance
A defining shift at the Dialogue was the deliberate merging of health and finance actors, unlocking pathways for private sector engagement at a scale not seen before. The leadership of the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) anchored this conversation, while contributions from the Bank of Industry (BOI), Iwosan Investments, and the Health Federation of Nigeria (HFN) highlighted that Nigeria’s journey to Universal Health Coverage (UHC) cannot rest on public finance alone.
The presence of these actors signalled a broadening of the coalition for health financing, from ministries and donors to banks, investors, and private health innovators. Discussions went beyond rhetoric, focusing on blended finance models, targeted investments in infrastructure and equipment, and the creation of dedicated health investment funds. The BOI committed to expanding concessionary credit facilities for health sector actors, while Iwosan Investments and HFN emphasised private capital’s role in deepening service delivery and innovation.
5) High-level commitments: enrolment, mandates and fiscal reforms
The final day moved from principles to pledges. Two announcements matter immediately. First, NHIA opened a self-enrolment portal, an operational tool that lowers a real barrier to mass registration and signals a shift to active enrolment campaigns. Second, and more consequential, President Bola Ahmed Tinubu issued a set of binding directives for all federal MDAs to enrol into the NHIA scheme, all entities participating in public procurement to present a valid NHIA-issued Health Insurance Certificate as part of their eligibility documentation, applicants for licenses, permits, and other official approvals from MDAs to show valid Health Insurance Certificates before issuance or renewal, and the NHIA to establish a digital verification platform for Health Insurance Certificates to ensure transparency and authenticity. These directives collectively move the conversation beyond aspiration into the domain of implementation, accountability and the public budget.
Leadership that Bridges Theory and Practice
Complex reforms are intensely political. The appointment of Dr. Kelechi Ohiri to lead NHIA and the visible support of Prof. Muhammad Ali Pate created the rare combination of technical leadership and political support. Equally important was the Senate’s engagement, Senator Ipalibo Harry Banigo’s and Honourable Magaji’s presence signalled legislative buy-in needed for statutory and budgetary reforms. Just as vital was the anchoring role of Nigeria’s economic managers: H.E. Abubakar Atiku Bagudu placed health financing squarely within national development priorities while Mr. Wale Edun linked commitments to the fiscal envelope and broader macroeconomic strategy. Together with international and continental voices, from the African Union, World Health Organization, UNICEF, West African Health Organization, Global Fund and figures like Dr. Donald Kaberuka, Dr. Mark Dybul, these actors did more than lend prestige: they helped frame Nigeria’s choices in an African and macro-fiscal context (responsible domestic resource mobilisation, better taxation and targeted fiscal instruments). In combination, these alignments converted conversations into constrained, achievable action.
Image credit: Nigeria Health Watch
Practical Next Steps
- Fast-track Health Technology Assessment (HTA): Medical inflation is not waiting. NHIA needs to urgently act on HTA, at the least, for high-cost interventions in the existing and proposed benefits included in health insurance plans. Stakeholders need to identify priority topics for evaluation and design a capacity-development plan to anchor evidence-based purchasing.
- Scale up mobilisation of citizens for enrolment: Optimise the self-enrolment portal by supporting digital self-enrolment with funded outreach campaigns, strong community mobilisation, and transparent KPIs (e.g., monthly enrolment growth, validated beneficiary data).
- Strengthen federal–state alignment on pooling and purchasing: Develop a harmonised framework for financing rules, benefit entitlements, and risk adjustment that goes beyond NHIA, State Social Health Insurance Agencies (SSHIAs) to include other actors in primary health care and subnational financing.
- Translate Presidential directives into binding instruments: Circulars, budget instructions, and implementation guidelines need to be issued to translate compulsory MDA enrolment to predictable financing flows.
- Activate the NHIA Research Fund (and other mobilised funds) for policy impact: Launch short, targeted research calls on health financing and purchasing reforms, publish results through public dashboards, and ensure findings are explicitly tied to policy decisions.
- Develop a national health financing strategy: It is one thing to have a Health Financing Policy, and another to develop a National Health Financing Strategy. The momentum from the Dialogue should be leveraged to frame a forward-looking strategy that integrates fiscal reforms, private sector participation, and sector-wide alignment to create a coherent roadmap for sustainable financing.
A Collective Moment
As someone who has studied the impact of catastrophic household spending, the political economy of insurance, and the translation of evidence into policy, I left the Dialogue convinced that theory had finally met a set of practical conditions: leadership, fiscal actors, legislators, organised private sector engagement, and a public institution (NHIA) prepared to commission and use evidence. That guarantees, as we convert words into budgets, processes and measurable reforms, a fighting chance to expand financial protection at scale in Nigeria.
This epoch dialogue was a collective opening act. The hardest part begins now: consistent, accountable execution. If we get the next six to twelve months right, action on HTA, enrolment scale-up through civil society action, MDA mandates translated into budget lines, and a demonstrable research programme that informs purchasing, then the hourglass will tip, and the sand will start to pour. For those of us who have argued, written, studied and waited, this is another moment in Nigeria’s history. The Dialogue has laid the foundation for a health financing system that can truly protect households, expand coverage, and serve as a model for Africa and beyond.