Geographic constraints, including remoteness and inadequate infrastructure, further hinder the delivery of healthcare services. The shortage of qualified healthcare professionals, lack of essential medical equipment, and corruption within the healthcare system compound these challenges.

Additionally, the rather large socioeconomic gap within these states can exacerbate disparities in access to healthcare, with marginalised populations often bearing the brunt of the burden.

Challenges in healthcare budget allocation 
Nigeria navigates a complex web of issues regarding healthcare funding as its healthcare is grossly underfunded. Nigeria’s annual healthcare budget for over 200 million people is ridiculously incompatible with great well-being. In context, Nigeria’s 2024 budgetary allocation to healthcare, of about $870m, only 15 per cent of Rhode Island’s (the United States smallest state in terms of land size) budgeted spending on healthcare this year. 

Although Nigeria hosted her African Union counterparts in Abuja about 23 years ago to declare their government’s commitment to a 15 per cent budgetary allocation to the health sector, the Nigerian government consistently defied the Abuja Declaration of 2001.

Since 2010, Nigeria’s health budget has not reached half of the 2021 Abuja Declaration percentage’s commitment. The country’s largest budget percentage funding was 6.23 per cent in 2012. This year, only a little over five per cent of the annual budget goes to healthcare funding. The consistently small budgetary allocation to healthcare, comes off as a lack of commitment from the government, according to Development Research and Projects Centre. 

The popular argument within the corridors of government that “there is not enough money,” does not usually resonate with many Nigerians. Many citizens believe the issue with healthcare funding in Nigeria is simply that of will and priority by the political leadership. The decision to spend more money on healthcare is always a tough one for a developing nation, like Nigeria, which is battling insecurity, where over $2.2 billion is earmarked for security alone this year.

The security budget is three times more than the healthcare budget. However, balancing percentages of allocations to critical sectors, including healthcare, holds the key to the overall well-being of the nation and its people. 

Since 2023, the political administration of Nigeria’s health sector has changed, but there seems to be no sign that the government will improve healthcare funding. Nigeria’s economy is at a crossroads and experiencing turbulent moments. It would require some discipline to look beyond the present and see the future benefits of significantly investing in healthcare. 

Nigeria’s primary source of revenue is crude oil, but production continues to dwindle. The Nigerian Upstream Petroleum Regulatory Commission says oil production hovered around 1.5 million barrels daily in September. This volume is over 200,000 barrels per day short of the 1.78 million barrels per day benchmark in the 2024 budget. This fluctuation means projected revenues that fund the healthcare budget are already threatened. For sustainable, adequate funding of Nigeria’s healthcare, it is clear that there is an urgent need to look beyond the money that the government can bring to the table from its current revenue pots. 

Recommendations Public-private partnerships
Public-private partnerships (PPPs) are collaborative arrangements between government entities and private sector organisations aimed at funding, constructing, and managing public-benefit projects, including healthcare infrastructure and services. These partnerships capitalise on the unique strengths of both sectors to boost efficiency, widen access, and elevate the quality of services. By adopting such models, governments can attract additional investments, stimulate private sector participation in healthcare financing, and use public resources optimally, ultimately leading to enhanced healthcare delivery and improved health outcomes.

PPPs create mutual benefits for the public and private sectors and the general public. Healthcare institutions gain the opportunity to strengthen their medical teams’ expertise and provide high-quality care that appeals to citizens across all income levels. They also alleviate financial and operational pressures by sharing these responsibilities with private partners, depending on the chosen PPP structure.

Conversely, private sector participants gain faster market entry through public institutions with existing infrastructure, often benefiting from steady revenue flows and access to higher-income patients due to the public facilities’ established patient traffic.

Scaling up health insurance for Nigerians 
According to a November 2024 report by NOIPolls, only about 19 per cent of adults are covered by health insurance. Alternatively, other Nigerians resort to paying out-of-pocket. The latter option is usually ineffective, inconsistent, and inadequate for caring for many health expenses. Unfortunately, the Nigerian federal government’s goals for transitioning from a voluntary health insurance scheme to a mandatory one are still largely unmet two years after implementation.

The informal sector accounts for more than 65 per cent of the country’s economy, and on boarding members of this sector is crucial to getting the necessary funds to provide quality care and ultimately achieve universal health coverage. As of Q4 of 2024, the director-general of the National Health Insurance Authority (NHIA), Dr. Kelechi Ohiri mentioned that only 1 per cent of the informal sector is captured under the mandatory health scheme. This poor percentage uptake sharply contrasts with about 62 per cent of the formal public and private sectors covered by the NHIA. 

Capturing at least 50 per cent of the informal sector in the mandatory insurance policy can make more money available to fund healthcare, thereby easing pressure on other healthcare funding sources, like the Basic Health Care Provision Fund. To achieve this, state health insurance agencies must be empowered to play their pivotal roles; state governments must financially support their insurance agencies and make counterpart funding available.

At the same time, the NHIA must actively and consistently engage with stakeholders, including state health ministries, the Nigeria Governors’ Forum, labour union leaders, informal sector leaders, civil society organisations, and the media to improve the number of those captured within the insurance scheme. 

Conclusion
Addressing the challenges facing Nigeria’s healthcare system requires a comprehensive and sustained effort. While the correlation between budget allocation and health outcomes highlights the importance of increased funding, it also underscores the need for efficient resource utilisation. The persistent shortfall in meeting the Abuja Declaration’s 15 per cent target for healthcare spending has hampered the nation’s ability to provide equitable, quality healthcare for its population.

Leveraging public-private partnerships and expanding health insurance coverage offers practical pathways to bridge funding gaps and improve access. These approaches can empower the healthcare sector to deliver better outcomes, particularly in underserved regions with formidable socioeconomic and infrastructural barriers.

By adopting innovative solutions and fostering collaboration among stakeholders, Nigeria can gradually overcome its healthcare challenges and build a system capable of meeting the diverse needs of its people, ensuring a healthier future for all.
Concluded.
Dr Adetula is a Dentist and Public Health professional. He can be reached via: [email protected]
Agbontale is a final-year Student of Physiotherapy student at the College of Medicine, University of Ibadan and Odutoye is a passionate Medical Student at Bowen University.