Nigeria’s health sector financing remains critically low at 5.2% of the national budget, far below the 15% Abuja Declaration target, despite notable advancements in maternal and child health indicators, Minister of State for Health and Social Welfare Dr. Iziaq Salako has disclosed. Speaking at the 2025 African Health Financing Forum in Abuja, Salako highlighted persistent challenges like high out-of-pocket expenditures and workforce shortages, while outlining reforms under the Nigerian Health Sector Renewal and Investment Initiative (NHSRII) to build a more resilient system.
Current State of Health Financing
Nigeria’s per capita health expenditure stands at approximately $43 (about ₦67,000) as of 2024, with out-of-pocket payments accounting for a staggering 71% of total health spending—one of the highest rates globally. Health insurance coverage hovers at just 10-12% of the population, leaving over 200 million Nigerians vulnerable to catastrophic costs. Salako described this as a “twin challenge of insufficient investment and catastrophic health expenditure that push millions into poverty annually.” The 2001 Abuja Declaration’s 15% benchmark, aimed at bolstering African health systems, remains unmet, with Nigeria’s average per capita spending over the past decade stuck between $40-$50—deemed inadequate for a nation of 230 million facing heavy disease burdens.
Progress Amid Persistent Gaps
Encouraging strides have been made in key areas. The maternal mortality ratio fell to 512 deaths per 100,000 live births in 2023, down from 576 in 2018, according to the Nigeria Demographic and Health Survey (NDHS). Similarly, under-five mortality dropped to 110 deaths per 1,000 live births from 132 over the same period. Over 20 million Nigerians are now enrolled in health insurance through formal sector schemes, the vulnerable group programme, and the Basic Health Care Provision Fund (BHCPF). Primary healthcare quality scores have improved from 42% to 67% in recent assessments.
Salako noted, “While these figures show some improvement, they remain not complimentary enough for a nation of our stature, resources and ambition.” Despite these gains, Nigeria accounts for 14% of global maternal deaths and 9% of under-five deaths—disproportionate for its 2.6% share of the world’s population—leaving the country off track for Sustainable Development Goals (SDGs), with under-five mortality unlikely to dip below 25 per 1,000 by 2030.
Key Challenges Hindering Resilience
The minister outlined multifaceted obstacles: funding shortfalls, systemic fragmentation, coordination issues, workforce brain drain, supply chain disruptions, and infrastructure deficits. High out-of-pocket costs impoverish families, while low insurance penetration exacerbates inequities. “Too many mothers still die in childbirth, too many children don’t reach their fifth birthday, and too many families are impoverished by healthcare costs,” Salako lamented. These gaps undermine efforts to create a shock-proof system, especially amid emerging threats like climate change and pandemics.
Reforms and Commitments Under NHSRII
Aligned with President Bola Tinubu’s Renewed Hope Agenda, the NHSRII serves as a collaborative framework to accelerate health investments. Priorities include:
- Guaranteed releases from the BHCPF to enhance primary care access.
- Boosting capital expenditure and honoring Health Infrastructure Bond obligations.
- Scaling up human resources, digital health systems, and climate-resilient infrastructure.
- Ensuring supply of essential medicines and expanding insurance via the 2024 NHIA Act.
Salako pledged accountability at federal and state levels: “We will continue to ensure transparent and judicious use of allocated health resources.” He called for states to meet budget benchmarks, release counterpart funds for donors, and foster cross-sector innovation. “A resilient health system we seek is one where every Nigerian, regardless of location or income, can access quality healthcare without financial hardship,” he affirmed. “Accelerating forward requires strong political commitment to prioritise health in our national budget, financial discipline, technical excellence, collaboration across sectors, and innovation to leapfrog traditional development pathways and accountability.”
Implications for Nigerians and the Health Sector
Low financing perpetuates a cycle of poverty and poor outcomes, with millions facing barriers to care that could prevent routine illnesses from becoming fatal. In a nation where health shocks like floods or outbreaks disproportionately affect vulnerable groups, these reforms could foster equity and resilience. However, without sustained increases—potentially through diversified funding like taxes or public-private partnerships—the sector risks stagnation, hampering economic productivity and national security.
While the forum spotlighted national trends, no specific Niger Delta references emerged, though the region’s oil-related environmental hazards and rural access issues mirror broader infrastructure and equity challenges Salako addressed.
Niger Delta Herald will follow NHSRII implementation and budget updates. Health is wealth—Nigeria’s progress demands bolder fiscal steps to save lives and secure futures.
