Transforming lives through health policies

BY WILAN GLOBAL

Women in Leadership Advancement Network (WILAN) Global is a Nigerian-based global organisation focused on advancing women’s leadership across all levels of political, economic, and public life. Our vision is to inspire a shift to gender-balanced leadership across all levels of political, economic, and public life globally. WILAN’s mission is to ease access to the community, knowledge, resources, opportunities, and support women need to become effective and thriving leaders. With a firm commitment to our mission, we firmly believe that gender-balanced leadership is crucial for achieving sustainable development and building an inclusive society.

Introduction

A healthy country is a productive country, and accessing quality and equitable healthcare is crucial for overall national development. Despite the enactment of the National Health Insurance Authority (NHIA) Act in 2022, which was designed to expand coverage and ensure equitable access to healthcare, only about 7% of Nigerians are currently enrolled in health insurance. As a result, healthcare access remains predominantly out-of-pocket, with approximately 80% of Nigerians bearing the financial burden themselves. This makes Nigeria one of the worst-performing countries in Africa in terms of financial protection, in stark contrast to Rwanda, where 90% of the population is covered by health insurance. The low enrollment in health insurance schemes exacerbates healthcare inequities, limits access to essential services, and pushes millions into poverty due to catastrophic health expenditures. To achieve universal health coverage and improve national well-being, there is an urgent need for stronger policy implementation, increased public awareness, and sustainable financing mechanisms to make health insurance more accessible and affordable for all Nigerians..

Nigeria has a multitude of health policies, but their implementation is weak due to poor funding, governance challenges, and a lack of public understanding of how these policies affect their lives. To advocate effectively for better healthcare services, Nigerians must first be aware of the available policies, their implications, and who is responsible for healthcare provision in their communities. For example, primary healthcare centres, which should serve everyone, continue to be underused and largely non-functional. Our National Health Infrastructures and systems continue to deteriorate amid the following challenges;

Current Challenges in Nigeria’s Health Sector

• Limited Health Insurance Coverage: Although health insurance enrollment has increased to 19.1 million individuals in 2024, a significant portion of the population remains uninsured. The reliance on out-of-pocket payments creates financial barriers to accessing healthcare services.
• High Maternal and Child Mortality Rates: Despite some improvements, neonatal mortality remains high at 41 per 1,000 live births, and under-five mortality is 110 per 1,000 live births. Low healthcare facility utilization (43% of births occurring in medical facilities) contributes to this issue.
• Shortage and Migration of Healthcare Workers: Nigeria has only 2.9 doctors per 10,000 people, significantly below the WHO-recommended 17 per 10,000. The migration of healthcare workers continues to deplete the workforce, disproportionately affecting rural areas.
• Healthcare Disparities: Healthcare facilities and personnel are heavily concentrated in urban areas, leaving rural populations underserved. Disparities also exist along regional and gender lines. In certain regions, women must obtain permission from their husbands before seeking medical care. Additionally, although women make up a significant portion of the healthcare workforce, they are underrepresented in leadership positions. This systemic exclusion affects policy decisions on issues such as maternal health and reproductive rights.
• Inadequate Infrastructure and Medical Supply Chain: While progress has been made in pharmaceutical production, the healthcare sector still suffer from inadequate infrastructure, substandard equipment, and inconsistent medical supply chains. Although there is a policy stating that every ward should have a hospital, however, implementation remains ineffective, with many facilities lacking electricity, medical supplies, and security.
• Emerging Health Threats and Pandemic Preparedness: The country remains vulnerable to disease outbreaks, with gaps in surveillance systems and emergency response frameworks.

Policy Recommendations

In light of these challenges, here are some short-term and long-term recommendations.

• Expand Health Insurance and Financial Protection: Increase funding for the National Health Insurance Authority (NHIA) and the Basic Healthcare Provision Fund (BHCPF) to extend coverage to vulnerable populations and reduce out-of-pocket spending.
• Invest in Healthcare Workforce Development: Implement retention policies for healthcare workers, expand training programs, and incentivise professionals to work in underserved areas.
• Enhance Maternal and Child Health Services: Strengthen antenatal and postnatal care programs, improve access to skilled birth attendants, and ensure availability of family planning services and essential maternal health commodities.
• Strengthen Healthcare Infrastructure and Local Production: Invest in the construction and rehabilitation of healthcare facilities, increase local production of pharmaceuticals and medical supplies, and enhance distribution networks for essential medicines.
• Improve Disease Surveillance and Emergency Preparedness: Establish a robust public health emergency response system, integrate digital health solutions for real-time disease monitoring, and enhance collaboration with private and international health organisations.
• Leverage Digital Technology for Healthcare Improvement: Expand the use of telemedicine, electronic health records, and mobile health applications to enhance healthcare access, efficiency, and data-driven decision-making.
• Promote Gender Equity in Healthcare Leadership: Increase the representation of women in decision-making roles within the healthcare sector. Policies affecting maternal health and reproductive rights must be shaped by those who experience these challenges first hand.
• Public Awareness and Advocacy: Strengthen civic engagement in healthcare policy implementation. Nigerians must be informed about existing policies and demand better healthcare services. Investing in community awareness campaigns through media, advocacy groups, and educational programs will help build a collective voice for change.

Call to Action

To achieve a resilient healthcare system, all stakeholders—including government agencies, private sector actors, and civil society must collaborate to drive sustainable health reforms. Policymakers must prioritise funding, streamline governance, and promote policies that ensure equitable access to healthcare. Additionally, advocacy for functional primary healthcare centres, gender equity in healthcare leadership, and financial protection for all.

Investing in Nigeria’s health sector is not just a moral imperative but an economic necessity for national development. By collectively analysing the healthcare structure and continuously expressing our voices, we can drive real change.

This policy brief is part of an ongoing series exploring critical policy interventions for Nigeria’s sustainable growth. Join us in future editions as we continue to advocate for impactful health policies.

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