Celebrating Universal Health Coverage In Nigeria

Nigeria is Africa’s most populous nation, with over 200 million people. It’s a vibrant country full of entrepreneurial energy and talent, but it’s also a country affected by poverty and disease. Almost 90 million Nigerians live in extreme poverty. Some 4,000 Nigerians die from malaria every week, mainly small children and pregnant women, 31% of the worldwide total. With close to 2 million people living with HIV, Nigeria has the third highest number of HIV-positive people in the world (after South Africa and India), and the country also has the highest number of people with tuberculosis (TB) in Africa.

as President Bola Ahmed Tinubu launches Nigeria’s Health Sector Renewal Investment Initiative. This is a bold plan to accelerate Nigeria’s journey towards universal health coverage (UHC), bringing better health and care to every Nigerian. Successful implementation of this plan will require unprecedented collaboration – between Federal and State governments and between the government and development partners, including the Global Fund – plus an unrelenting focus on superb execution and on delivering outcomes. The prize is huge. Given the scale of Nigeria’s population, and the weight of the disease burdens, achieving significant progress here could save millions of lives and shift the global trajectory of the fight against the deadliest diseases, particularly malaria.

The Global Fund will invest over US$1 billion in Nigeria over the next three years (out of some US$15 billion in total), more than in any other country, supporting programs to fight HIV, TB and malaria, and build stronger health systems, all aligned with Nigeria’s overall blueprint for delivering UHC.

Countries Must Invest in Their Own Health Systems to Deliver UHC

Yet in Nigeria, as elsewhere, the key to delivering and sustaining UHC is not external funding, but the commitment of domestic financial resources. No country has achieved UHC without substantial mobilization of domestic resources through taxation or various forms of compulsory health insurance. Nigeria is stepping up its budget commitments towards health and will need to do even more. This is why Nigeria’s reform of the Basic Health Care Provision Fund is a crucial element of the plan.

In many low- and middle-income countries across Africa and elsewhere, there remains a disconnect between the ambition of delivering UHC and the political willingness to mobilize and allocate sufficient public funding to make it happen. In 2001, African Union countries set a target of allocating at least 15% of their budget each year to the health sector – but at no point since then have more than 4 countries ever met it. As recently as February 2023, African leaders recommitted to implementing this Abuja Declaration target. Whether funded through general taxation or compulsory health insurance, UHC entails a more redistributive financial underpinning than many political leaders are prepared to contemplate. It also requires robust and effective systems for resource allocation, financial control and accountability.

Gender and Human Rights Barriers Stand in the Way of UHC

In a worrying number of countries, both rich and poor, there’s also a disconnect around the “U” of UHC, the commitment to universality. It’s impossible for a government to deliver UHC while