Special Adviser to the President on Health, Dr Salma Ibrahim Anas, has said that the health and prosperity of Nigeria must no longer be predicated on external benevolence, but on robust domestic ownership and accountability.

She noted that while Nigeria’s healthcare spending per capita has increased from approximately $67.91 in 2020 to $90.92 in 2022, this increase masks a critical, systemic flaw: the overwhelming majority of our Total Health Expenditure is financed by high Out-of-Pocket payments, which push millions of Nigerians into poverty every year.

Speaking at the 9th Annual Health Conference of the Association of Nigeria Health Journalists (ANHeJ), on Friday in Abuja, Anas observed that outside of out-of-pocket spending, a significant portion of the remaining financing comes from external grants, adding that this precarious balance creates a severe vulnerability to risks and slows the attainment of the Universal Health Coverage in Nigeria.

She stated that for decades, development partners and foreign donors have been indispensable allies in Nigeria’s fight against infectious diseases, maternal mortality, and infrastructure deficits; however, the global landscape is changing, accompanied by donor fatigue.

Anas noted that, considering the risk of the dwindling donor aid, experts project a 15 per cent to 20 per cent reduction in foreign grants to Nigeria, a scenario we face, which immediately creates a financial chasm that threatens to unravel decades of progress.

She said, “Donor funds typically target key vertical programs: HIV, Tuberculosis, Malaria, and routine immunisation. The moment this funding stream slows, services break down, stock-outs occur, and the most vulnerable communities suffer immediate and catastrophic consequences”.

Anas observed that dwindling aid directly undermines the country’s drive towards Universal Health Coverage, given the vast quantities of preventive commodities and services made possible by donor aid at the PHC level.

She emphasised that UHC is not possible if basic services are not free at the point of need for the poor, adding that without filling the gap through DRM, Primary Health Care (PHC) facilities, the very foundation of UHC, will stagnate.

Anas observed that under the Renewed Hope Agenda of President Bola Ahmed Tinubu, the target is to build a resilient, equitable, and integrated health system. The cornerstone of this mission is Domestic Resource Mobilisation (DRM).

According to her, the expansion of financial protection under the NHIA is built around pooling resources through mandatory health insurance, as the new NHIA Act aims to drastically reduce out-of-pocket payments by bringing over 50 million new enrollees under financial protection within the next four years.

Also speaking, Minister of State for Health and Social Welfare, Dr Adekunle Salako, highlighted fiscal constraints, including macroeconomic pressures, rising debt service obligations, and competing social priorities, that compress the fiscal space available for health.

Salako stated that Nigeria’s public finances are undergoing necessary rebalancing, adding that we cannot rely on simply substituting foreign grants for unfunded domestic promises, and that the response must be strategic, evidence-based, and audacious.

He said, “Therefore, our responses to this dwindling donor support and the challenge for sustainable domestic resource mobilisation must leverage existing successful approaches with ambitious plans to expand the finance base while learning from the rest of the world, which has been successful with such issues in the past. First, we must accelerate domestic resource mobilisation through sustainable and equitable fiscal instruments. The Nigerian government at both the Federal and state levels has been proactive in developing innovative domestic resource mobilisation strategies”.

The minister noted that the Basic Healthcare Provision Fund, which has disbursed over N260 billion to states and the Federal Capital Territory since its inception in 2018, and the signing into law of the National Health Insurance Authority Act in 2022, making health insurance mandatory for all Nigerians are two novel examples of innovative domestic resource mobilization response among several others, these represents a paradigm shift in our approach to health financing.

In his welcome address, ANHeJ President, Joseph Kadiri, said the conference theme, “Domestic Resource Mobilisation in the Face of Dwindling Foreign Grants and Aid,” underscores the urgent need to strengthen domestic financing, partnerships, and resilient health institutions.

Kadiri called on journalists to track government commitments, highlight gaps, and amplify the realities faced by Nigerian families.

He identified key conference sub-themes, including cancer research funding, maternal and newborn health advocacy, the media’s role in public health emergencies, and the fight against substandard and counterfeit drugs.