Nigeria is at a defining moment in its development journey. With a rapidly growing population, vast human capital, and abundant natural resources, the country possesses not only the capacity but also the moral obligation to guarantee affordable healthcare for all its citizens. Universal Health Coverage (UHC) is no longer an abstract aspiration; it is an achievable goal. Yet, despite laudable policies such as the National Health Act and the Basic Healthcare Provision Fund (BHCPF), persistent gaps in financing, infrastructure, manpower, technology, and governance continue to limit access, quality, and affordability. The task before Nigeria is therefore to harness national resources strategically, wisely, equitably, and sustainably, while learning from countries that have made progress.
International experience shows that progress is possible, even in resource-constrained settings. Countries such as Ghana, Indonesia, and Rwanda have expanded coverage through sustained political commitment, disciplined financing, and gradual system building. In Rwanda, insurance coverage rose significantly alongside investments in community health workers and primary care, contributing to measurable improvements in maternal and child health outcomes. Ghana’s National Health Insurance Scheme (NHIS) improved access to care for vulnerable populations, although it continues to face financing and sustainability challenges. These examples are instructive, but they are not templates. Nigeria’s scale, federal structure, and political economy demand solutions rooted primarily in domestic realities.
At the heart of any functional health system lies sustainable financing. Nigeria’s health budget has grown, with allocations approaching ₦2.48 trillion in 2025. However, this still represents only about 5 to 6 per cent of total government expenditure, far below the 15 per cent target enshrined in the Abuja Declaration. In contrast, Ghana’s NHIS combines tax-based revenues with mandatory contributions and strong political backing to create a broad risk pool that protects the poor, children, and the elderly. Similarly, countries such as Indonesia, Turkey, and Costa Rica have unified fragmented financing streams into single national pools, enabling cross-subsidisation and more equitable access.
For Nigeria, the path forward is clear. First, the National Health Insurance Authority (NHIA) Act must be fully implemented and enforced, with mandatory enrolment across both formal and informal sectors. Second, the BHCPF must be strengthened and protected to ensure that every ward in the federation has at least one functional primary healthcare centre delivering a defined minimum package of services. Third, innovative financing mechanisms such as taxes on tobacco, alcohol, and sugary beverages, alongside a dedicated digital health levy, should be introduced, with proceeds ring-fenced for health workforce development and essential medicines.
Financing alone, however, cannot deliver UHC. Nigeria faces chronic shortages and an uneven distribution of health workers, particularly in rural and underserved communities. Countries such as Rwanda tackled this challenge by aggressively expanding training, formalising community health workers, and linking workforce deployment to insurance coverage, resulting in insurance coverage of nearly 90 per cent and significant improvements in health outcomes.
Nigeria must similarly scale up health professional training through federal grants and partnerships with universities and teaching hospitals, while implementing its Health Workforce Migration Policy to recruit over 20,000 frontline workers and stem brain drain. Proven initiatives such as the Midwives Service Scheme, which significantly increased antenatal care uptake and reduced maternal and neonatal mortality, should be institutionalised and expanded. Continuous professional development, supported by digital training platforms, will help keep Nigerian health workers aligned with global standards.
Equally critical is infrastructure. Healthcare facilities in Nigeria are unevenly distributed and often poorly equipped, especially at the primary level. Nigeria can leverage BHCPF and World Bank financing to rehabilitate the more than 17,600 primary healthcare centres nationwide, expanding laboratories, maternal waiting centres, solar power systems, and basic surgical capacity. Public–private partnerships, including those supported by the Nigeria Sovereign Investment Authority, should be scaled up to establish diagnostic and treatment centres that decentralise specialised care from congested tertiary hospitals and reduce patient travel costs. Interoperable health information systems, from electronic medical records to mobile outreach data, must also be expanded to enable real-time monitoring of services, disease outbreaks, and resource utilisation.
One major omission in national health debates is traditional medicine. Millions of Nigerians rely on traditional healers due to cost, access, and cultural familiarity, and ignoring this reality is counterproductive. A regulated national framework, backed by research, quality control, and careful integration with orthodox care, could expand access and reduce pressure on formal facilities, as seen in China and India. Alongside this, technology and local production matter. Nigeria should prioritise basic digital systems, logistics, and referral networks, while incentivising local drug, vaccine, and diagnostic manufacturing to strengthen reach and resilience.
Ultimately, UHC succeeds when communities are empowered. Nigerian state-level innovations such as the Osun Health Insurance Scheme and Ondo State’s Abiye Safe Motherhood Project, which reduced maternal mortality by over 80 per cent, show that local solutions can deliver national impact. Nigeria must therefore expand community health programmes, place trained community health workers at the frontline of prevention, and reward community ownership through performance-linked financing.
Nigeria has all the ingredients for a health revolution: people, policies, resources, and a growing awareness that health is central to development. What remains is execution, anchored in accountability, data-driven decision-making, and political will. If national resources are harnessed with precision, purpose, and equity, affordable healthcare for all Nigerians will no longer be a dream deferred, but a transformation realised.
Sunday Ene-Ojo Atawodi, a Fellow of the prestigious Africa Academy of Sciences, Nigeria Academy of Science, and Academy of Medical Sciences of Nigeria, is a Professor of Biochemistry at Federal University Lokoja, Kogi State. He is also Fellow of the Alexander von Humboldt Foundation (AvH), and the International Union Against Cancer (UICC), Switzerland, and alumnus of the German Academic Exchange Service (DAAD) of Germany, Email:atawodi_se@yahoo.com
