…Says health must be placed firmly on political agenda head of  2027 elections

Civil Society Organisations (CSOs) under the Health Sector Reform Coalition have called for timely release of appropriated health budgets, stronger accountability for the Basic Health Care Provision Fund (BHCPF), transparent tracking of funds from allocation to individual facilities and expansion of health insurance and financial-protection mechanisms.

The CSOs also raised concerns over Nigeria’s high out-of-pocket health expenditure and fragmented financing arrangements in the health sector and the continued dependence on external funding.

Meanwhile, the Chair and Co-convener of the Nigeria Universal Health Coverage (UHC) Forum, Moji Makanjuola, has said that health must be placed firmly on the political agenda as the country approaches the 2027 elections

Speaking at a CSO/media-led Mid-year review of Nigeria’s Health Sector reforms and Policy Dialogue on Monday in Abuja, the Chairperson of the Health Sector Reform Coalition, Dr Muhammed Lecky commended the ongoing health sector reforms but warned that Nigeria’s progress will remain fragile unless policy gains are translated into functioning primary healthcare services and measurable improvements in citizens’ lives.

Lecky urged government to adopt functional primary healthcare centres, as a key benchmark for measuring reform rather than the number of renovated facilities,

He argued a functional PHC must have adequate health workers, essential medicines, basic diagnostic services, electricity, water, infection-prevention systems, referral arrangements, maternal and child health services and mechanisms through which patients and communities can provide feedback.

Lecky stated that the country is moving in the right direction adding that the reforms under the Health Sector Renewal Investment Initiative and Sector-Wide Approach (SWAp) represented one of the most significant attempts in decades to tackle fragmentation in Nigeria’s health system.

He said, “Through the Health Sector Renewal Investment Initiative and the Sector-Wide Approach (SWAp), government has created a stronger framework for aligning federal and state governments, LGAs, development partners and communities around shared priorities. The principles of one plan, one budget, one report and one conversation provide an important foundation for improved coordination and accountability”.

Lecky however, warned that the gains must now be institutionalised, adequately financed and targeted at underserved populations.

Lecky stated that the ultimate test of the reforms must be whether a Nigerian woman can safely access maternity care, whether a child receives life-saving vaccines and whether families can obtain healthcare without being pushed into financial hardship.

“A renovated PHC without the staff, medicines, power and systems required to provide care is not yet a fully functioning PHC,” Lecky said

Lecky highlighted the troubling indicators contained in the Nigeria Demographic and Health Survey 2023–24, including the fact that while 79 per cent of women received antenatal care from a skilled provider, only 43 per cent had four or more antenatal visits.

He pointed out that only 50 per cent of live births were assisted by a skilled provider, while just 39 per cent of children aged 12–23 months were fully vaccinated with basic antigens.

Lecky lamented that 14 per cent received no vaccinations at all adding that 40 per cent of Nigerian children under five are stunted, including 21 per cent who are severely stunted, while modern contraceptive use among currently married women stands at only 15 per cent, with 21 per cent reporting unmet need for family planning.

The figures,  according to him, underline the urgent need to move from measuring government activity to measuring health outcomes.

Lecky demanded greater attention to health workers, including timely payment, supportive supervision, rural incentives, safer working conditions, training, career progression and transparent deployment.

Drawing lessons from the Social and Citizen Accountability for Primary Health Care Performance (SCAPP) project implemented by BudgIT and HSRC across the 23 LGAs of Kaduna State, Lecky emphasized that  community participation must become a stronger pillar of health reform.

He called for a comprehensive review to align Nigeria’s expanding health reforms with the National Health Act 2014, warning against a proliferation of disconnected programmes, policies and institutional responsibilities.

Lecky proposed a National Health Act Alignment and Implementation Matrix to identify overlaps and gaps, clarify responsibilities, harmonise policies and guidelines, set implementation timelines and provide for public reporting.

On his part, Minister of Health and Social Welfare, Prof Muhammad Ali Pate  said that the government is making efforts to increase resources for the health sector, including interventions aimed at securing additional financing for healthcare.

Pate highlighted the need to strengthen regulatory and professional institutions responsible for service quality, financing and medical practice, among others, arguing that effective regulation was critical to building public confidence in the health system.

He identified access to medical supplies and infrastructure as major priorities, stressing that improving healthcare would require sustained investment at federal, state and local government levels.

While acknowledging the scale of the challenge, Pate cautioned against expecting years of deterioration to disappear within a few years.

The minister acknowledged that rebuilding Nigeria’s health system will take time, saying the country’s decade-long deterioration in the sector cannot be reversed overnight.
He said, “If anybody comes and says that you have gone through 10 years of health atrophy, and that overnight in three, four, five or eight years everything will disappear, that person is a bit provocative,”

The minister also appealed to development partners and other stakeholders to support Nigeria in a way that would strengthen the country’s own capacity to deliver healthcare, rather than create parallel systems.

He stated that sustained partnerships, improved governance, accountability, adequate resources, stronger institutions and meaningful community participation would be necessary to achieve lasting improvements in Nigeria’s health sector.

The minister stated that the present administration  remained committed to laying the foundation for a stronger and more responsive health system capable of meeting the needs of Nigerians.

Speaking on efforts to reform the health sector, the government stressed the importance of working closely with civil society organisations (CSOs), saying their involvement would help policymakers identify gaps, assess the impact of reforms and make necessary adjustments.

According to the government, civil society provides an important feedback mechanism because government institutions may not always see the “blind spots” in policies and programmes.

He observed that stronger collaboration among stakeholders was essential to improving accountability and ensuring that interventions were properly coordinated rather than duplicated.

Also speaking, Chair and Co-convener of the Nigeria Universal Health Coverage (UHC) Forum, Moji Makanjuola, has said that health must be placed firmly on the political agenda as the country approaches the 2027 elections.

Makanjuola recalled that the Forum had engaged political parties and candidates during the 2023 election cycle with a citizen-led health agenda, which subsequently influenced the health priorities contained in the manifestos of key political parties.

She disclosed that the Nigeria UHC Forum would convene a stakeholder workshop in October to review the citizen-led health agenda and develop an action plan for advocacy before, during and after the 2027 elections.

According to her, health investment is ultimately a political decision.

She also praised Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, for beginning his tenure with engagement with civil society, recalling that he had presented the National Health Sector Renewal Investment Initiative to the Nigeria UHC Forum and acknowledged its recommendations.

But Makanjuola warned that progress remained uneven across the country.

She said evidence from the ongoing Gates Foundation-funded Exemplar Analysis Project showed “pockets of positive shifts” in some health indicators, while other states remained stagnant or were deteriorating.

The challenge, she said, was not merely to identify what works but to establish why it works, where it works, whether it can be replicated and what is required to sustain it.