By Chioma Obinna

Health sector leaders have issued an urgent warning that Nigeria risks deeper crisis unless sweeping reforms are implemented to strengthen primary healthcare, overhaul financing and improve the quality of services.

Speaking at the 2025 Universal Health Coverage Day commemoration in Lagos, experts said millions of Nigerians are being pushed into avoidable suffering and preventable death because the health system remains weak, underfunded and heavily dependent on out-of-pocket spending.

Speaking, the Director of Standards and Quality Assurance at the National Health Insurance Authority, Dr. Yakubu Abadie, who spoke at the event organised by the Nigeria UHC Forum in collaboration with PharmAccess Foundation, with the theme “Unaffordable Health Costs? We’re Sick of It” said the current system is failing those who need it most.

“Out-of-pocket payment of 70 to 75 percent is simply unacceptable. People are selling their homes, losing everything, and still dying because health care is unaffordable. In a country as rich as Nigeria, this should never be heard.”

He warned that government spending on health, currently around 0.5 to 0.7 percent of GDP, is far too low to sustain a functional system.

He explained that when the Basic Healthcare Provision Fund was introduced in 2014, nearly 30 percent of PHCs were non-functional and maternal and child mortality indicators were among the worst globally. He said the expansion of BHCPF from a minimum of 1 percent to 2 percent of the Consolidated Revenue Fund is a step forward, but the fund must remain predictable.

“If inflow declines, the fund declines. We must build a system that is resilient even when national revenue fluctuates,” he said.

Abadie highlighted improvements under BHCPF 2.0, noting that PHCs supported by the fund have grown from about 8,800 to more than 11,000 nationwide. Facilities now receive ₦600,000 to ₦800,000 quarterly, tied to performance indicators aimed at strengthening accountability and quality.

He said infrastructure upgrades, electricity improvements and basic equipment have been provided in several centres as part of a national push to establish 17,600 fully functional PHCs by 2027. Staffing gaps are also being addressed through deployments of midwives and community health workers.

He further cautioned that quality remains a major concern, with only 36.1 percent of facilities fully accredited. “This kind of story where families abandon treatment because they cannot afford it should never happen.  We must build a system where people can access the care they need, not the care they can afford.”

Speaking, the President of the Healthcare Federation of Nigeria, Dr. Njide Ndili, said Nigeria cannot achieve universal health coverage without fully integrating the private sector. “The private sector is often left out, and government as regulator is always in the lead, but it is one system and one goal.”

 Ndili who is also PharmAccess’s Country Director warned that shrinking development funding and limited government resources make private participation unavoidable.

She noted that at least 50 percent of hospitals lack stable power supply, describing infrastructure weakness as a core barrier to quality. She highlighted successful public–private partnerships in Delta State where collapsed PHCs were restored, resulting in safer deliveries and zero maternal deaths, saying the model shows what is possible when partnerships are sustained.

Ndili added that all Nigerian governors recently signed an Efficiency Compact committing to UHC benchmarks, and for the first time the private sector is a co-signatory. “This is a major milestone. We finally have a way to measure private sector contribution to UHC,” she said.

Representing the Gombe State Primary Health Care Development Agency, Mrs. Joy Daudu Bako said the goal is to ensure that no Nigerian is left behind. “Everybody should have access to quality healthcare—the poor, the vulnerable, the downtrodden,” she said. She appealed for stronger collaboration among government, private sector, civil society, philanthropists and political leaders to increase insurance enrolment. “All hands must be on deck, because a large part of our population is not enrolled,” she said.

Speakers agreed that achieving universal health coverage will require sustainable financing, strengthened primary healthcare capacity, improved quality of care and accountability across institutions. They warned that unless urgent reforms are made, the growing burden on families and the worsening health crisis could undermine national development.