Efforts to attain Universal Health Coverage (UHC) in Nigeria encounter considerable obstacles, including systemic issues, slow advancements, and limited public understanding of financial strategies designed to alleviate out-of-pocket healthcare costs.

These challenges were highlighted during a one-day hybrid orientation for media professionals held in Abuja, organized by Breakthrough ACTION Nigeria and the Local Health System Sustainability Project (LHSS), both supported by the United States Agency for International Development (USAID).

The purpose of the event was to enhance awareness of UHC and the vital role of government entities, particularly the National Health Insurance Authority (NHIA), in fostering equitable access to healthcare.

Bolanle Olusola-Faleye, Chief of Party for the LHSS, recognized the progress made in UHC initiatives but pointed out ongoing deficiencies in financial risk protection, equitable healthcare delivery, and access to essential services.

“Our health insurance coverage stands at approximately 80%, which is still short of the 90% target. Out-of-pocket expenses, a significant barrier to UHC, account for as much as 76%,” she stated.

She stressed that the path to achieving UHC becomes more apparent when considering out-of-pocket payments.

According to her, paying for healthcare at the time of need is not ideal and should ideally be limited to no more than 30%, as such expenses impose a heavy burden on individuals during critical times.

Discussing the current landscape of health insurance in Nigeria, she pointed out that only around 19 million individuals are covered nationwide, with merely 2.4 million enrolled in the Basic Health Care Provision Fund (BHCPF), primarily due to a lack of awareness.

She underscored the urgent need to significantly increase enrollment to meet the 2030 UHC objectives while encouraging other states to adopt the successful model implemented in Kwara State, which has made significant strides in promoting UHC.

Olusola-Faleye highlighted the inefficiencies arising from disjointed efforts within the health sector, stating, “While our intentions are good, the absence of coordination results in wasted resources. It is vital to adopt strategic and unified approaches to maximize outcomes with minimal resources.”

In discussing the necessity for enhanced accountability, Faleye commended the government's Nigerian Health Sector Renewal Investment Initiative (HSRII), characterizing it as a framework designed to facilitate universal health coverage (UHC) reforms.

“We must collaborate and utilize our resources effectively to transform the health system and guarantee quality care access for all Nigerians,” Faleye remarked.

Prof. Chima Onoka, a community physician and health systems economist with the NHIA, pointed out significant challenges, such as a lack of awareness and trust in the health insurance system.

“Many Nigerians perceive health insurance as a loss if they remain healthy, rather than as a means of social solidarity to mitigate risks. Additionally, low trust in government and institutions hampers enrollment,” he explained.

Onoka emphasized the importance of rebuilding trust by tackling governance issues, ensuring transparency, and highlighting success stories. “Although negative experiences dominate public discussions, numerous lives have been saved through health insurance. These narratives must be shared to change perceptions,” he added.

He also mentioned that operational inefficiencies hinder progress, citing delays in service delivery, quality deficiencies, and strike actions as factors that erode public confidence.

“These issues deter individuals from enrolling in health insurance and weaken the entire system. It is essential for providers, regulators, and stakeholders to act responsibly to ensure uninterrupted service,” he asserted.

According to Onoka, the current economic environment further complicates UHC initiatives, noting that many Nigerians find it difficult to afford insurance, which makes public subsidies through health insurance essential.

Health insurance serves as a quantifiable means of alleviating poverty. According to him, government investment in insurance represents one of the most effective strategies for easing the financial strain on citizens.

Onoka called on the NHIA to enhance its enforcement mechanisms and ensure accountability among all stakeholders, while also pointing out the common frustrations that enrollees encounter with Health Management Organizations (HMOs) and healthcare providers, especially hospitals, during care delivery.

“The NHIA needs to effectively address complaints and guarantee that providers fulfill their obligations to deliver the care for which they are compensated,” he stated, urging citizens to assert their rights to the services they are entitled to, emphasizing the importance of information and active engagement.

He acknowledged that, despite existing challenges, there are indications of progress, recognizing the NHIA's recent initiatives aimed at improving communication and resolving complaints.

“Enhancing responsiveness and tackling compliance issues are commendable advancements,” he remarked.

He reiterated that the pursuit of Universal Health Coverage (UHC) necessitates a collaborative effort, asserting that “Providers, regulators, and citizens all have essential roles to fulfill.”