The Africa Centres for Disease Control and Prevention (Africa CDC) has called on Nigeria to accelerate the rollout of a robust national health insurance system to reduce the country’s high out-of-pocket healthcare spending, warning that the current model is pushing millions into financial hardship.
Speaking at Nigeria’s Joint Annual Review (JAR) organised by the Ministry of Health and Social Welfare in Abuja, Jean Kaseya, Director-General of Africa CDC, said Africa’s reliance on direct household payments remains a major threat to equitable healthcare access, noting that out-of-pocket expenditure accounts for up to 75% of total health spending across the continent.
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“What is the status of Africa? Colleagues, when we are talking about health financing in Africa, the main source of funding in our system is out of pocket. This out of pocket moved from almost 25% to 75%, it means poor people pay.
“Poor people are paying the most. You cannot deal with out-of-pocket with donor assistance. You deal with out-of-pocket by putting in place a national health insurance scheme,” Kaseya said.
He stressed that Nigeria would only reduce the burden through large-scale health insurance coverage. “You cannot deal with out-of-pocket with ODA. You deal with out-of-pocket by putting in place a national health insurance scheme,” he said, urging Nigeria to draw lessons from Rwanda experience, where community-based health insurance has significantly expanded coverage.
“They moved to around 88% of people covered and 88% of out-of-pocket gone,” he added.
He added that a comparable achievement in Nigeria would “gladden the world”, given its population size and economic influence.
The Africa CDC chief further said the biggest challenge facing African health systems is not merely a shortage of money, but the inefficient use of existing resources. He highlighted evidence showing that fragmentation, weak governance and poor planning are costing African countries between 20 and 40% of their health budgets.
Kaseya also warned that “ghost workers” remain a major drain, citing examples from his native Democratic Republic of Congo where $800 million is lost annually to fraudulent payroll entries, with some regions recording 40% ghost staff.
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He commended Nigeria for its recent reforms, noting that the digitalisation of the federal payroll system has already helped the government save ₦220 billion.
He further urged Nigeria to push ahead with pooled procurement and regional collaboration, noting that smaller neighbouring countries with populations below five million struggle to negotiate adequate supply or fair prices.
“Nigeria is a blessed country of 200 million people. What Nigeria manufactures is not just for Nigeria, but for the entire continent,” he said, citing the commitment of private-sector leaders such as Aliko Dangote to expand local production of health commodities including bed nets.
