Assessing Health Financing Progress Towards Universal Health Coverage in Nigeria (2015-2022)
Universal Health Coverage (UHC) is vital to achieving Sustainable Development Goals. It ensures that everyone has access to quality healthcare without financial hardship. Though the reliance on public health expenditure is the gold standard to achieve UHC, however, out-of-pockets payments dominates health financing in low-income countries including Nigeria. Against this backdrop, the present study assessed the drive towards UHC in Nigeria using the newly launched World Health Organisation-Health Financing Progress Matrix (HFPN) 2.0. The result showed that Nigeria's drive towards UHC is hindered majorly by the double whammy of poor governance and inadequate public health financing. While the Abuja Declaration of 2001 mandated African countries to devote at least 15% of government expenditure to the health sector, however, on average, Nigeria spends 4%. It was observed that the large proportion of the informal sector-put at 65% of GDP poses a huge fiscal challenge to the government in raising revenue. More worrisome is the catastrophic and impoverishing out-of- pockets payments hovering around 70% as against the SDG3.8.2 indicator of at most 25%. Again, the national health insurance only covers less than 7% of the population, mainly government and private employees in urban areas, thus leaving behind a sizeable proportion of the rural population. There is also the problem of technical inefficiencies as evidenced in a plethora duplication, overlaps, and misalignments of core health system functions across health programs. As things stand, the goals of UHC i.e., Utilization relative to need, financial protection, and quality health care may not be realized if the national and subnational governments do not only scale up public spending but also strengthen the health system by improving; governance, public finance management, amongst others reforms. Thus, framing the drive towards UHC in Nigeria within the context of "development bargain," as Stefan Dercon puts it, holds promise to accelerate the drive towards UHC in Nigeria.