Nigeria faces severe public healthcare challenges, with over 90% of the population relying on out-of-pocket payments, leading to substantial financial hardship and high rates of preventable illnesses and deaths. Despite the establishment of the National Health Insurance Authority to mitigate these costs, less than 5% of Nigerians are insured, highlighting the urgent need for expanded insurance coverage and increased public healthcare funding to improve access to quality care.
Nigeria faces significant public healthcare challenges, exacerbated by a high poverty rate, with over 56% of the population living below the poverty line. This economic situation forces citizens to bear the burden of escalating out-of-pocket (OOP) healthcare costs, leading to severe financial hardship and perpetuating a cycle of poverty and poor health outcomes. According to statistics from the World Health Organization (WHO) and the World Bank, more than 90% of Nigerians rely on OOP spending for healthcare, one of the highest rates globally. This reliance results in millions of families being pushed into poverty annually, as catastrophic health expenses consume a large portion of household budgets. The consequences of this situation are grave.
Nigeria accounts for 12% of global maternal mortality, with about 95% of these deaths being preventable. The lack of access to affordable and quality healthcare leads to untreated chronic diseases and exacerbates acute medical emergencies, ultimately deteriorating the overall health of the population. The WHO advocates for Universal Health Coverage (UHC), aiming to ensure that everyone can access quality health services without financial hardship.
In response to the financial risks associated with OOP payments, Nigeria established the National Health Insurance Authority (NHIA) in 2005, intending to provide access to quality healthcare and protect households from financial burdens. However, nearly two decades later, evidence indicates that less than 5% of Nigerians, primarily government workers, are insured under this scheme. Furthermore, only about 3% of the population has private health insurance, typically provided through employers. Despite the government’s efforts to mitigate the impact of OOP spending, the statistics reveal a persistent problem.
Several determinants contribute to the high levels of OOP healthcare spending in Nigeria. OOP expenses often involve user fees at public health facilities and payments to private healthcare providers. The public health system’s effectiveness relies heavily on government budget allocations, which have historically been inadequate. As a result, households frequently find themselves paying for healthcare services directly, increasing their OOP expenditures. Research also indicates that poorer households are more likely to seek care from informal providers, such as traditional healers, rather than higher-level healthcare facilities.
Hallmark Health Services Limited, a prominent Health Maintenance Organization (HMO) in Nigeria, emphasizes the need to break the cycle of OOP spending and move toward UHC. The organization believes that innovative solutions can empower Nigerians to access healthcare without the fear of financial ruin.
To address Nigeria’s OOP healthcare challenges effectively, several progressive strategies can be implemented. First, expanding social health insurance coverage is vital. Increasing enrolment in the NHIA is crucial, with a goal of making insurance mandatory for all citizens, supplemented by subsidized premiums for low-income families. This would enhance the risk pool and improve financial sustainability while ensuring equitable access to essential healthcare services. Additionally, increasing public healthcare funding is essential to eliminate user fees, which contribute to OOP spending. By improving the quality of care in public health facilities, the government can ensure that services remain affordable, particularly for low-income households. Implementing these strategies is crucial for progressing towards a more equitable and effective healthcare system in Nigeria.
