current concerns 2-005 (special edition) THE IMPERATIVE OF THE 2025 NATIONAL HEALTH FINANCING DIALOGUE IN NIGERIA

 current concerns 2-005 (special edition)

THE IMPERATIVE OF THE 2025 NATIONAL HEALTH FINANCING DIALOGUE IN NIGERIA

-by Dr. Uzodinma Adirieje / +2347015530362 (WhatsApp) / druzoadirieje2015@gmail.com

CEO/PD, Afrihealth Optonet Association (AHOA) – CSOs Network and Think-tank

As Nigeria convenes the 2025 National Health Financing Dialogue (1–4 September 2025), the country faces a decisive moment to redesign how health is financed, governed, delivered, and accessed. The Dialogue—convened by the Federal Ministry of Health and Social Welfare under the theme “Reimagining the Future of Health Financing in Nigeria”—is intended to bring government, parliamentarians, development partners, the private sector, civil society and academia together to agree concrete, time-bound steps that will move the nation toward achieving Universal Health Coverage (UHC).

 

THE URGENCY OF THIS DIALOGUE

Nigeria’s health financing profile is both stark and unsustainable. Recent reporting indicates households still carry the lion’s share of health spending: out-of-pocket payments account for roughly three quarters (about 76–79%) of current health expenditure—one of the highest ratios globally—exposing millions of Nigerians to catastrophic spending and impoverishment.

Public spending on health remains low. National budget analysis shows health allocations at roughly 5% of the federal budget in recent proposals, well below the 15% Abuja Declaration benchmark, while total health expenditure as a percentage of GDP has hovered around 3–4% in recent years. These financing shortfalls translate into under-resourced primary health care, uneven state-level service provision, shortages of personnel and medicines, and weak readiness to respond to shocks and epidemics.

 

OUR EXPECTATIONS FROM THIS DIALOGUE

We expect this Dialogue to convert political commitments into operational financing reforms across four interlocking priorities as shown below.

 

I. Mobilize Progressive Domestic Resources: With the recent withdrawal of USAID support, uncertain donor flows, and high fiscal pressures, Nigeria must identify and protect sustainable domestic revenue streams for health: earmarked “sin” taxes (tobacco, alcohol, sugar-sweetened beverages), strengthened tax administration to reduce leakages, and ring-fencing of and increased budgetary proportion for the Basic Health Care Provision Fund (BHCPF), to protect primary health care (PHC) financing. These measures should be accompanied by explicit fiscal-space analyses to show how revenue can be mobilized without regressive impacts.

 

II. Operationalize and Scale-Up Social Risk-Pooling through the NHIA: The National Health Insurance Authority (NHIA) Act 2022, which replaces the fragmented voluntary scheme with a statutory framework for mandatory insurance and integrated risk pools, is a critical legal foundation for better health care financing. This Dialogue must produce a clear operational roadmap for NHIA implementation, including enrollment pathways for informal workers, benefit-package prioritization, provider payment reforms, and transitional financing guarantees for vulnerable groups. Without rapid operationalization, the promise of statutory reform may never be translated into financial protection for households.

 

III. Increase Efficiency, Transparency and Accountability: More money alone will not guarantee better health. This Dialogue should commit to measurable reforms that improve value for money such as digital public financial management for health, open procurement, performance-based financing for priority services, and routine public reporting of subnational expenditures. CSOs (civil society organizations) must be given structured roles in monitoring, auditing, and feedback to ensure that funds reach frontline facilities.

 

IV. Prioritize Equity and Primary Health Care (PHC): Financing reforms must protect the poor, women, children, the elderly, persons with disability, vulnerable and rural populations. This requires progressive financing instruments and deliberate allocation formulas that direct financing to primary health care and underserved states. Strengthening PHC will reduce preventable morbidity, lower dependence on expensive tertiary care, and improve the system’s resilience.

 

DATA-DRIVEN, POLITICALLY SAVVY REFORM

The political economy of health financing in Nigeria is complex and characterized by competing fiscal demands (security, debt service, infrastructure), state–federal fragmentation, and limited implementation capacity, all of which stall reform. To succeed, this Dialogue must be both data-driven and politically realistic. It must present costed, phased reforms, identify short-term wins - such as protecting BHCPF and launching enrollment pilots for informal workers, and set medium-term targets for public health spending and insurance coverage expansion. Providing the evidence that investments reduce tertiary care costs and increase workforce productivity will help persuade finance ministries and legislators.

 

ROLE OF CIVIL SOCIETY ORGANIZATIONS (CSOs)

CSOs are indispensable in translating the outputs/outcomes of this Dialogue into results and impact. As a CSOs Network and Think-tank, Afrihealth Optonet Association (AHOA) can contribute in four practical ways:

1. Partnerships, Coalition-building, and Collaboration – work with other Networks/CSOs/NGOs/FBOs/CBOs, professional associations, and media to sustain public attention on implementation;

2. Advocacy, Social Mobilization, and Public Education — advocate to policy leaders/makers and mobilize communities to demand predictable financing and explain how reforms will protect households;
3. Research, Evidence and Policy Inputs - generate locality-level data on OOP impacts, service gaps, and fiscal inefficiencies to inform national decisions;

4. Capacity Development, Training, and Mentoring – develop and strengthen the capacity of civil society and other non-state actors to actively participate in implementing and achieving the outcomes interventions of this Dialogue;

5. Outreaches and Community Engagement – utilize the interface of members of the AHOA Network and other civil society Networks with the communities, to promote health outreaches and community involvements in remote and especially hard-to-reach communities, vulnerable and marginalized groups, persons with disability, and other persons-at-risk; and
6. Monitoring, Evaluation, and Accountability - establish citizen scorecards and social audits to track whether funds reach PHC facilities, and if the services meant to be provided have been accessed by the target populations.

 

RISKS AND MITIGATION

There are risks to achieving the outcome of this Dialogue. They include weak follow-through after the Dialogue, delayed implementation of its recommendations, persistent under-budgeting for health (anything less than 15%) and its several consequences, political influences and/or commercial interests, insufficient fiscal space, etc. To mitigate these, this Dialogue’s final communiqué should include the following:

1. a time-bound National Health Financing Strategy with clear targets and responsible agencies; 2. a public reporting calendar; and

3. an independent multi-stakeholder oversight mechanism - including civil society representation, to monitor implementation and trigger corrective actions once needed.

 

CONCLUSION: A MAKE-OR-BREAK MOMENT

For Nigeria, the 2025 National Health Financing Dialogue is more than a convening; it is a make-or-break moment for Nigeria’s progress to UHC. The country cannot afford continued high out-of-pocket spending, chronic underinvestment, or fragmented schemes that leave the most vulnerable behind. If this Dialogue results in a financing strategy that mobilizes progressive domestic resources, operationalizes the NHIA, strengthens accountability, and prioritizes primary health care, Nigeria will be able to chart a credible path toward equitable health for all. For AHOA and the rest of the civil society, the imperative is clear: engage aggressively, anchor reforms in community realities, and hold leaders to time-bound commitments that turn policy into available, affordable and effective services at the frontline. The health and economic future of millions of Nigerians depend on diligent implementation of the outcomes from this Dialogue. To Nigeria's Coordinating Honourable Minister of Health and Social Welfare Professor Muhammad Ali Pate, CON, who is leading this Dialogue; and the Honourable Minister of State for Health and Social Welfare Dr. Iziaq Adekunle Salako, we thank you for your leadership. Like Oliver Twist, we want some more!

 

 

Dr. Uzodinma Adirieje is a seasoned consultant with extensive expertise in global health, climate change, health/community systems strengthening, development planning, project management, sustainable development goals (SDGs), governance, policy advocacy, and monitoring and evaluation (M&E). He provides high-level consultancy services to governments, UN agencies, international organizations, NGOs, and development partners across Africa, leveraging over 25 years of multidisciplinary experience across Africa and the Global South. He was the Chair of Nigeria’s national World Malaria Day Committee in 2019; National President and fellow of the Nigerian Association of Evaluators (NAE) during 2019 – 2022; President of the Civil Society Organizations Strategy Group on SDGs in Nigeria (CSOSG); and Chair of the Resource Mobilization sub-committee of Nigeria’s national World Tuberculosis Day Committee in 2025, etc. He’s currently President of the African Network of Civil Society Organizations (ANCSO), and Chair of the Global Consortium of Civil Society on Climate Change and Conference of Parties (GCSCCC).