Leveraging scale to expand access to healthcare

In a country of over 200 million people and abundant natural resources, the right to healthcare should not be a privilege; it should be a right. Yet in Nigeria today, that right remains elusive for the vast majority. For many citizens, falling ill does not just threaten their health; it risks plunging them into financial ruin. Despite the proliferation of healthcare policies, frameworks, and reforms, the sector remains deeply broken, mired in underfunding, poor implementation, and a glaring lack of coordination.

This troubling reality was brought into sharp focus at the recent BusinessDay Media Health Conference held in Abuja under the theme “Bridging the Gap: Advancing Equitable and Affordable Access to Healthcare in Nigeria”. The message from health leaders, policymakers, investors, and development experts was unanimous: unless Nigeria undertakes urgent, systemic, and coordinated reform, its health system may continue to fail those who need it most.

Nigeria’s healthcare indicators remain some of the worst globally. The sector is chronically underfunded, with government health spending at just 0.5 percent of GDP, approximately N6,289 ($4) per person yearly, far below the African Union’s recommended 15 percent budget allocation under the Abuja Declaration. In the 2024 budget, N1.34 trillion was allocated to health, a meagre 4.64 percent of the total N28.78 trillion budget.

These figures are not merely technical; they represent a grim reality for millions of Nigerians who cannot afford even basic care. Over 70 percent of total healthcare spending comes from out-of-pocket payments, a model that is both unsustainable and inequitable, especially as more than half of the population lives in multi-dimensional poverty.

Insurance schemes, one of the few tools designed to cushion citizens from these shocks, are still vastly underutilised. As of 2024, only 9.5 percent of Nigerians are covered by any form of health insurance, leaving the vast majority exposed to financial hardship at the point of care. Meanwhile, public hospitals are overcrowded and understaffed, and Nigeria’s movement (the japa syndrome) of health professionals continues unchecked due to poor wages, working conditions, and infrastructure.

While policies like the National Health Insurance Authority (NHIA) Act of 2022 hold promise, their impact is hindered by weak enforcement and poor follow-through. At the conference, Chineye Ajayi, legal counsel at Olaniwun Ajayi LP, rightly observed, “Policy without implementation is paper.” Despite the frameworks in place, millions remain uninsured, and private sector engagement is hampered by uncertainty and lack of regulatory clarity.

Lekan Ewenla, MD of Ultimate Health Management Services, highlighted the missed opportunity in failing to enforce mandatory health insurance, particularly in the informal sector. Without full participation, the economics of risk pooling, central to successful health insurance models, simply do not work. This is not a flaw of concept but of commitment.

Wiebe Boer, chief growth officer at JIPA Network, offered a global perspective, comparing Nigeria’s situation with more integrated Caribbean health systems. His call for a single national funding pool, consolidating federal, state, donor, and private resources, struck a chord. A unified structure led by NHIA could enhance coordination, reduce waste, and ensure more consistent outcomes.

Yet, Boer warned that mandates alone will not drive enrollment. Instead, incentive-based strategies such as discounts, loyalty rewards, or bundled services could prove more effective in pulling Nigerians into the health insurance net. His broader message was clear: Nigeria must fully leverage its scale, integrate public and private systems, and eliminate duplication if it wants to lower costs and expand access.

Perhaps the most urgent challenge is healthcare financing. According to Mustapha Zakari, executive vice chairman of Masslife Healthcare, “More than half of Nigerians cannot afford care when they need it.” His prescription included direct financial incentives, expansion of targeted subsidies, and better alignment between spending and national priorities.

Adetolu Ademujimi, technical adviser at APIN Public Health Initiatives, echoed this sentiment, calling for investor-friendly policies, concessional loans, and real-time data to guide resource allocation. The government’s recent push to stimulate local pharmaceutical manufacturing is welcome, but it will take more than tax breaks to lure investors into an environment still perceived as high-risk and low-return.

At the heart of healthcare delivery are people: nurses, doctors, and community health workers. But as Brian Deaver, CEO of the Afreximbank-backed Abuja Medical Centre for Excellence, emphasised, “Unsupported and underappreciated workers will not innovate and cannot deliver care.” Nigeria’s chronic health worker movement, driven by poor remuneration, unsafe working conditions, and lack of career progression, is undermining the sector’s future.

Deaver called for massive investment in training, digitally enabled systems, and a supportive work environment. He also pointed out that equitable access is about more than infrastructure; it is about removing systemic barriers for rural populations, women, and persons with disabilities.

Minister of State for Health and Social Welfare Iziaq Salako acknowledged the sector’s failings but pointed to ongoing efforts to scale investments, upgrade primary healthcare, and deepen private sector collaboration. While welcome, his assurances echo decades of similar promises that never materialised. Nigerians have learnt to greet such rhetoric with deep scepticism.

Still, for all the dysfunction, there is cause for cautious optimism. Nigeria loses an estimated $2 billion yearly to medical tourism, money that could be redirected toward building domestic capacity. With coordinated reform, strategic investment, and political courage, that money could finance world-class facilities, generate jobs, and position Nigeria as a regional healthcare hub.

Nigeria’s health crisis is not new, but what is new is the alignment of stakeholders around what must be done. There is a growing consensus: the system cannot be fixed through fragmented, siloed efforts. Reform must be holistic, anchored on financing, enforcement, equity, and workforce support.

What remains is political will. Will this administration seize the opportunity to transform one of Nigeria’s most broken sectors? Or will it allow another cycle of unmet promises and deepened suffering?

Healthcare is not just a moral imperative; it is an economic strategy and a national security priority. The time to act is not tomorrow but today.