The increasing reliance on out-of-pocket healthcare payments in Nigeria is pushing a growing number of families into poverty, public health physicians have warned. This financial strain forces households to make difficult choices between seeking necessary medical attention and meeting fundamental needs like food and shelter. Experts highlight that the escalating costs of treatment, coupled with limited access to subsidized healthcare services, are disproportionately impacting low-income earners, exacerbating their vulnerability.
These concerns were voiced at the recent Biennial and Scientific Conference of the Association of Public Health Physicians of Nigeria (APHN), Lagos Chapter. The conference centered on the theme: “Global Health Under Workforce Threat: Advancing Sustainable Financing & Workforce Capacity for Equitable Healthcare Delivery in the Global South.”
The Burden of Out-of-Pocket Payments
Professor Yetunde Kuyinu, Chairman of the APHN Lagos Chapter, emphasized that Nigeria’s heavy dependence on out-of-pocket payments is a significant impediment to achieving health equity. In this system, patients are often required to pay directly for consultations, diagnostic tests, and medications, particularly those managing chronic conditions such as hypertension.
Kuyinu pointed out the detrimental consequences of this financial burden, noting that many Nigerians delay seeking medical care due to affordability issues. This often leads to late presentations, when conditions have worsened and treatment becomes more complex and expensive. She stressed that while healthcare cannot be entirely free, adequate financing is crucial for ensuring access. The lack of understanding and affordability of health insurance further compounds the problem, leaving many vulnerable to catastrophic health expenditures.
The Role of Health Insurance
While the federal government has mandated all states to establish health insurance schemes, including Lagos through LASHMA, enrollment rates remain insufficient to significantly alleviate the financial burden on households. Professor Kuyinu argued that strengthening health insurance coverage is essential to ending catastrophic health spending and ensuring equitable access to healthcare for all Nigerians, regardless of their location.
She also emphasized the timeliness of the conference theme, given the global spread of diseases, the strain on Nigeria’s healthcare workforce, and the rising cost of care. The interconnectedness of the world means that diseases can easily cross borders, as evidenced by the COVID-19 and Ebola outbreaks. These emerging diseases, along with the increasing prevalence of non-communicable conditions and emergency situations, are placing immense pressure on the healthcare system.
Flaws in Nigeria’s Health Financing Model
Professor Akin Osibogun, a Professor of Public Health at the College of Medicine, University of Lagos, criticized Nigeria’s health financing model as fundamentally flawed. He stated that an effective system should provide citizens with access to care without causing financial hardship. The current reliance on out-of-pocket spending forces families into impossible choices, often delaying care and leading to poorer health outcomes. He further highlighted that countries with high levels of out-of-pocket payments consistently demonstrate the worst health outcomes globally.
He drew a comparison between Nigeria and Rwanda, noting that both countries initiated their national health insurance programs around the same time, nearly two decades ago. However, while Rwanda has achieved coverage for over two-thirds of its population, Nigeria’s progress has stalled.
The Healthcare Workforce Crisis
Professor Osibogun also addressed the worsening workforce crisis in Nigeria, with doctors emigrating in large numbers in search of better opportunities. He emphasized the need to expand training capacity, employ more trainers, offer incentives, and reduce burnout to retain talent within the country. He lauded the postgraduate fellowship program for equipping doctors with advanced skills, but noted that many fellows still face poor remuneration and working conditions.
Prioritizing People Over Infrastructure
Dr. Sunday Mgbejume, a Management Consultant with PharmAccess Nigeria, emphasized the need for healthcare investments that prioritize impact. He pointed out that over 70% of Nigerians pay for healthcare out-of-pocket, pushing many into poverty. He argued that current investments are disproportionately focused on buildings and equipment, rather than on improving access and affordability. He called for a shift in focus towards prioritizing the needs of the population.
Demographic Pressures and Declining Donor Funding
Professor Adesegun Fatusi, President of the Society for Adolescent and Young People’s Health in Nigeria, warned that demographic pressures, climate change, weak infrastructure, and declining donor funding are placing Africa under significant strain. He noted that per-capita health expenditure in Africa remains among the lowest globally, and donor dependency is high, particularly for HIV, TB, and reproductive health commodities.
He called for stronger domestic financing, improved primary healthcare, expanded workforce production and retention, and community-rooted governance to address these challenges. He emphasized that countries must rethink how health is financed, governed, and delivered to ensure sustainable and equitable access to care for all.
Key Recommendations for Improvement
In summary, the conference highlighted several key areas that require urgent attention to improve Nigeria’s healthcare system:
Reduce Reliance on Out-of-Pocket Payments: Implement policies that shift the burden of healthcare costs away from individuals and towards a more sustainable and equitable financing model.
Strengthen Health Insurance Coverage: Expand enrollment in health insurance schemes to cover a larger proportion of the population, particularly those in vulnerable groups.
Invest in the Healthcare Workforce: Address the workforce crisis by increasing training capacity, offering competitive salaries and benefits, and creating a supportive work environment.
Prioritize Primary Healthcare: Strengthen primary healthcare services to provide accessible and affordable care at the community level.
Increase Domestic Financing: Increase government investment in the healthcare sector to reduce reliance on donor funding.
Improve Governance and Accountability: Strengthen governance structures and ensure accountability in the management of healthcare resources.
By addressing these critical issues, Nigeria can move towards a more equitable and sustainable healthcare system that protects families from financial hardship and ensures access to quality care for all.
