Damian Duruiheoma (Guest Writer)
One of the key issues of national concern — which any government would be concerned about, is the alarming number of Nigerians who are currently unable to access healthcare. While many have relied on out-of-pocket spending to meet their health needs, some have been completely hampered by the country’s economic realities.
According to a World Bank report in 2023, the poverty rate in Nigeria has reached 38.9%, with approximately 87 million Nigerians living below the poverty line. A further report from the World Health Organization (WHO) in 2022 estimated that about 80% of Nigerians have fallen into poverty as they struggle to pay hospital bills. This is hindering effective progress to achieve Universal Health Coverage (UHC).
The economic stability of the country has been worsened by the high level of inflation, which stands as a contributing factor to the financial struggles of many Nigerians today. Since the removal of the fuel subsidy in 2023, many citizens have been left economically vulnerable, which threatens their ability to access healthcare services when they fall ill due to the rising cost of living.
Currently, Nigeria’s UHC index score is lower than the average for the region and income group. According to Dr. Walter Mulombo, WHO Nigeria representative, “the country’s progress on the UHC Service Coverage Index rose from 25 in 2003 to 44 in 2019” He pointed out that out-of-pocket expenditure still accounts for over 75% of health spending, creating barriers for many Nigerians.
As the global community celebrates World Universal Health Coverage (UHC) Day, the theme “Health: It’s on the Government” calls on every country’s leadership to invest in health for all and protect people from impoverishing healthcare expenditure.
The right to healthcare is a fundamental human right
Achieving UHC is firmly rooted in the 1948 WHO Constitution, which declares health as a fundamental human right and commits to ensuring the highest attainable level of health for all. Therefore, every Nigerian should be able to seek medical care without facing financial ruin or catastrophe, as recognised by various international and national laws and policies.
While there is rural-to-urban migration in Nigeria, about 45.7% of the country’s population still lives in rural areas. For many residents in rural communities, the need for UHC remains an unfulfilled promise. Many rural communities across Nigeria face limited access to quality medical services, inadequate infrastructure and a shortage of skilled professionals. This situation has left most of the population in a precarious situation, with many forced to resort to dangerous alternatives.
Accessing hospital services can often be challenging for rural communities, and those who have access only visit under emergency circumstances where, in some cases, public fundraising is required to enable them to pay for accrued bills. Some patients with no one to assist them financially in accessing healthcare are left to their fate, hoping for a miracle.
According to a recent publication by BusinessDay an estimated 253,000 Nigerians die annually due to insufficient access to healthcare. This is almost double the number of deaths caused by poor quality healthcare services, which cause 123,000 deaths.
The study stated that a majority of these numbers come from rural communities, where preventable diseases, fuelled by socio-cultural factors, including unavailability of skilled medical personnel, persist. This unacceptable reality underscores the need for swift, sustainable solutions.
Some states’ strategies to achieve UHC
Addressing these challenges requires innovative and sustainable solutions that guarantee access to quality healthcare delivery. For instance, in Enugu State, the government, led by Governor Peter Mbah, has taken steps to address some challenges faced by the state’s indigenes, including the construction and equipping of 260 Type-3 primary healthcare centres (PHCs) and announcing the recruitment of 2,220 health workers to address the healthcare deficit across the state. Dr Ifeyinwa Ani-Osheku, the Executive Secretary of Enugu State Primary Health Care Development Agency (ENPHCDA), noted that the aim for this is for patients living in rural areas to have the same opportunities and treatments as their counterparts in urban areas.
In Lagos, the state government has announced that over a million residents have been enrolled in its health insurance scheme, known as ILERA EKO, as part of ongoing efforts to achieve UHC.
In 2023, the WHO and the National Primary Health Care Development Agency (NPHCDA) embarked on an advocacy visit to Zamfara, Sokoto and Kebbi states in the northwest region as a tactical effort to improve access to PHC service delivery, especially vaccination, to inaccessible security-compromised communities in the states. The region, consisting of six states, has been grappling with a severe security crisis, which has greatly hampered the delivery of healthcare services, such as immunisation, resulting in a staggering number of zero-dose children in the country.
Nigeria’s health insurance coverage remains low
Another aspect of the low UHC in Nigeria is that after almost two decades of establishing the National Health Insurance Scheme (NHIS) in 2005, the legislation and the enactment for mandatory health insurance finally came in 2022.
However, while available data shows that out of over 200 million Nigerians, only 5% are covered with health insurance, there has been commendable progress as Dr Kelechi Ohiri, Director-General of NHIA, noted that health insurance coverage rose within the year, growing from 16.7 million to 19.2 million enrolees in Nigeria.
The National Health Insurance Authority (NHIA), in its quest to expand UHC and break barriers to equitable healthcare, is broadening the scope of financial risk protection for the poor and vulnerable, going beyond the Basic Health Care Provision Fund (BHCPF) to include the Vulnerable Group Fund (VGF). Through this initiative, health insurance premiums are subsidized for indigent Nigerians, including low-income families, persons with vesico-vagina fistula, vulnerable pregnant women needing emergency care, and the elderly. There is an urgent need to reduce the burden of out-of-pocket expenses for health services and expand UHC in Nigeria. Enhancing the scheme’s operations can ensure expanded healthcare coverage for the poor and vulnerable.
Moving forward
As the government prepares the budget for the 2025 fiscal year, it is crucial to allocate sufficient funds to cover a broader spectrum of healthcare expenses, especially for those with lower incomes.
The chairman of the Enugu State chapter of the Nigerian Medical Association (NMA), Dr Sunny Okafor, emphasised the need for health insurance and functional primary healthcare centres. He also stressed the importance of regular recruitment and retention of healthcare workers, as quality and access are tied to Human Resources for Health (HRH).
State governments should ensure that the remuneration of state and local government healthcare workers is equal to that of their counterparts at the federal level. This will boost talent retention in healthcare and reduce internal brain drain — a situation where health workers at the state and local government levels see their jobs as transit camps to take up federal jobs.
By taking these steps, Nigeria’s government can help ensure that all citizens, particularly those in rural communities, have access to quality healthcare services without financial hardship.
Investing in UHC enhances equity and social cohesion while benefiting the national economy by improving health and well-being, increasing workforce participation and productivity, and building resilience in individuals, families and communities.