Reimagining the Future of Health Financing in Nigeria

Key Takeaways

• Health financing in Nigeria remains heavily dependent on out-of-pocket payments, with over 70 percent of health spending financed directly by households.
• Reducing donor dependence is now a strategic imperative for health financing in Nigeria as external funding becomes less predictable.
• Enforcement of the National Health Insurance Authority Act represents a major structural reform to institutionalize mandatory health insurance and expand financial protection.
• Subnational governments and State Social Health Insurance Agencies are critical to improving coverage and service delivery under Nigeria’s health financing architecture.
• Strengthening public financial management and accountability mechanisms is essential to ensure efficiency and value for money in health financing in Nigeria.
• Evidence-based decision-making, including the use of health technology assessment, can improve prioritization and equity in health spending.
• Private sector engagement is indispensable for mobilizing additional resources and supporting sustainable health financing in Nigeria.
• Macroeconomic and fiscal reforms are creating opportunities to expand domestic health financing, but implementation gaps remain significant.
• Successful execution of reforms will determine whether health financing in Nigeria delivers universal coverage and sets a benchmark for Africa.

Executive Summary

This report summarizes the outcomes of the National Health Financing Dialogue held in Abuja from 1–4 September 2025, a landmark convening focused on advancing health financing in Nigeria. The Dialogue brought together national and subnational government leaders, civil society, academia, private sector actors, media, and development partners to align reforms under the Renewed Hope Agenda. Discussions centered on reducing out-of-pocket spending, expanding health insurance coverage, strengthening accountability, and accelerating Nigeria’s transition from donor dependence toward domestically anchored health financing.

The Dialogue highlighted persistent structural constraints shaping health financing in Nigeria. More than 70 percent of total health expenditure remains out of pocket, exposing households to financial hardship, while donor financing is becoming increasingly unpredictable. Despite rising budget allocations, fiscal pressures and competing priorities continue to limit effective health investment. Participants emphasized the need to integrate domestic and external financing flows into a coherent national framework and to position health financing as a driver of productivity, human capital, and economic growth.

Consensus emerged around priority reforms to strengthen health financing in Nigeria, including enforcement of the National Health Insurance Authority Act, improved public financial management, evidence-based priority setting, and expanded roles for subnational governments. A presidential directive mandating NHIA compliance marked a decisive shift from commitments to implementation. The report concludes that sustained execution will determine whether Nigeria’s health financing reforms deliver equitable coverage and serve as a model for wider African reform.