Efforts to achieve Universal Health Coverage (UHC) in Nigeria face several challenges, including systemic issues, slow progress, and limited public awareness about financial mechanisms designed to reduce out-of-pocket healthcare expenses.
These challenges were highlighted during a one-day hybrid orientation for media professionals in Abuja, organized by Breakthrough ACTION Nigeria and the Local Health System Sustainability Project (LHSS), both funded by USAID. The event aimed to raise awareness about UHC and the important role of government agencies, particularly the National Health Insurance Authority (NHIA), in ensuring equitable healthcare access.
Bolanle Olusola-Faleye, Chief of Party for the LHSS, acknowledged the progress made in UHC initiatives but pointed out gaps in financial risk protection, equitable healthcare delivery, and access to essential services. She explained that Nigeria’s health insurance coverage remains at about 80%, falling short of the desired 90%, and that out-of-pocket expenses remain as high as 76%, which is a significant barrier to UHC. Ideally, out-of-pocket payments should be reduced to no more than 30%, as high costs place a heavy burden on individuals when they are most vulnerable.
Olusola-Faleye also discussed the limited coverage of health insurance in Nigeria, with only about 19 million people covered nationwide and just 2.4 million enrolled under the Basic Health Care Provision Fund (BHCPF), mainly due to a lack of awareness. She stressed the need for increased enrollment to meet the 2030 UHC target and encouraged other states to adopt the successful Kwara State model.
Prof. Chima Onoka, a community physician and health systems economist with NHIA, addressed key challenges such as limited awareness and trust in the health insurance system.
He explained that many Nigerians view health insurance as a loss if they remain healthy, rather than understanding it as a form of social solidarity to share risks.
Onoka also noted that low trust in government and institutions negatively affects enrollment and emphasized the need to rebuild this trust through transparency and by amplifying success stories.
Onoka pointed out operational inefficiencies, such as delays in service delivery, quality gaps, and strike actions, which undermine public confidence.
He stressed the importance of addressing these issues to encourage the uptake of health insurance and improve the system. The economic climate also complicates efforts, with many Nigerians unable to afford insurance, making public subsidies vital.
He concluded that health insurance is a key tool for poverty alleviation and that government funding for insurance is essential to reduce the financial burden on citizens.
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