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Chapter 3 of AHOP's Nigeria Health Systems and Services Profile.
Key messages
- The Nigerian health system is primarily funded by government tax revenue, health insurance, donor/external funding and private spending.
- Nigeria spends less on health as a share of gross domestic product (GDP) than nearly every other country in the world. The national health budget remains below 5% of the total government budget and below the Abuja Declaration target of 15%. Current health expenditure across both the public and private sectors was just 4% of GDP in 2021, which is below the global benchmark of 5%.
- Out-of-pocket (OOP) spending accounts for more than 75% of total health expenditure, one of the highest levels of OOP expenditure globally. This exposes the low-income population to catastrophic health spending and impoverishment.
- Only 5% of Nigerians are covered by any health insurance, prepayment or risk-pooling mechanisms. Coverage is limited by weak technical capacity to implement health insurance schemes nationwide, labour unions’ refusal to accept worker contributions to the Formal Sector Social Health Insurance Programme (FSSHIP) and poor public understanding of health insurance. Existing enrolment is primarily through the FSSHIP of the National Health Insurance Authority (NHIA) and state-level health insurance programmes.
- The NHIA Act 2022, the Basic Health Care Provision Fund 2014 and the recently established subnational individual health insurance schemes across the 36 states and the Federal Capital Territory offer potential to improve coverage, with financial risk protection mechanisms and greater equity.