A report by the Nigerian Economic Summit Group Health Policy Commission showed that low health spending by the government and high Out-of-Pocket expenses can limit access to healthcare and increase inequities.
The report titled, “Health financing for Universal Health Coverage in Nigeria: Realities, impediments and recommendations,” noted that despite steady progress, strategic purchasing in Nigeria faces persistent challenges.
“Low health spending by the government and high OOP expenses can limit access to healthcare and increase inequities. Additional barriers include passive purchasing practices, inadequate budget allocations, infrastructure constraints, an inconsistent adherence to accountability standards.
“Recent efforts to address these issues include initiatives such as the legal framework improvement with the recent NHIA Act of 2022. At the subnational level, governments are revamping agencies like the SHISs to strengthen strategic purchasing functions, including benefit design, provider selection, and payment structures. These reforms are gradually fostering more active, data-driven purchasing practices across the country.
“The landscape of strategic purchasing in Nigeria is defined by progress in establishing foundational policies and expanding health financing schemes, yet significant challenges remain,” it stated.
It said to enhance strategic purchasing in Nigeria’s health sector, a comprehensive approach is needed; which includes shifting from input-based to output-based financing models, such as performance-based or blended payments, which would align provider incentives with patient health outcomes.
It highlighted that establishing centralised, interoperable data systems would support evidence-based adjustments to contracting and payment policies by enabling better tracking of provider performance and healthcare utilisation.
The report emphasised that sronger oversight and independent audits of Health Management Organisations and providers, along with greater decision-making and budgetary autonomy for the National Health Insurance Authority, would enhance accountability, efficiency, and public trust in health insurance systems.
“Standardising benefit packages and care standards across states could reduce fragmentation and ensure consistent care quality, while training NHIA and Federal Ministry of Health staff in advanced contract management skills would improve provider agreements and enforce contract terms more effectively.
“Finally, regular stakeholder engagement—including government agencies, NHIA, HMOs, providers, and patients— could foster transparency, policy alignment, and collaboration on health sector reforms,” it said.
The report also recommended investing in local research, and evidence generation, enhancing accountability and transparency, enhancing fund release and disbursement efficiency, ensuring data-driven and decision-making, leveraging innovationand technology to strengthen healthcare performance, and among others.
“Achieving UHC in Nigeria requires a concerted effort to expand health insurance coverage for all Nigerians, which can serve as a basis for strengthening primary care and as a foundation for secondary and tertiary healthcare services. Health financing is critical for any nation to achieve its goals for the health system, particularly UHC, which requires deliberate policies to ensure that the populace is provided with access to quality healthcare that does not expose them to financial hardship.
“Although Nigeria has implemented many policies, these have not yet translated into a health system that provides quality and equitable care when needed. The issues faced at the time of the inception of older policies still exist. These challenges have hampered the nation’s ability to progress faster towards UHC.
“The recommendations in this paper are geared towards addressing some of those challenges, thereby advancing progress towards the goal of UHC, which is also in tandem with many of the current health policies and those that existed in the past. It is hoped that the government and other relevant stakeholders will adopt these recommendations to strengthen the health system and ensure timely, equitable, efficient, and affordable access to healthcare services for the populace,” it concluded.
