Healthcare on a budget: The untold cost of accessing primary healthcare in Nigeria

Nigeria’s healthcare system is currently at a critical point in its pursuit of achieving universal health coverage for its citizens. Access to affordable, accessible healthcare is a major concern for individuals and families, especially for those on tight budgets. While the Primary Healthcare Centres (PHCs), which form the bedrock of health care (and were designed to provide essential services at an affordable rate in the nation), have faced a lot of challenges in achieving basic coverage at the grassroots/community level, many care seekers have faced hidden or unprepared expenses that make access more difficult.

As established frontline facilities, PHCs provide essential services, including preventive care through routine checks, screenings and immunisation; treatment of minor illnesses and injuries; health education and disease prevention; and early diagnosis and management of chronic conditions such as hypertension and diabetes.

BudgIT, a civic tech organisation in 2021, expanded its program offering to include “Strengthening Health Systems” with a core focus on health accountability, primary healthcare service delivery and capacity building program for a confluence of community and state actors. This was in addition to providing a technological structure for improved data information systems via a feedback mechanism for citizens.

The phctracka, a carefully built and contextualised tech tool, provided easy access to tracking the Basic Health Care Provision Fund (BHCPF), monitoring Primary Health care service delivery across the Nation and citizen engagement through a feedback mechanism, which is further analysed for community and government engagement.

In Q3, 2025, BudgIT Foundation assessed 5,092 PHCs across the 36 states and the FCT. 64% of these facilities required some form of renovation, while 36% required reconstruction. In line with service delivery, 48% were not connected to the national grid, while 38% lacked an alternative power supply.

Human resources for health remain a challenge, with stark disparities across states; only 29% of these PHCs have medical doctors. Nurse/midwife distribution is uneven, with many facilities failing to meet the National Primary Health Care Development Agency (NPHCDA) minimum staffing standards requirement. Community Health Extension Workers (CHEWs) make up the bulk of the workforce, especially in the northern states, highlighting an overreliance on lower-level cadres. Supply chain weaknesses undermine trust and service quality; 81% of patients report the unavailability of prescribed drugs, forcing them to rely on private vendors.

However, a more looming challenge persists with health financing, as out-of-pocket payments by poor Nigerians make a strong case for increased health insurance coverage. The Director General of Nigeria’s Health Insurance Authority (NHIA), Dr Kelechi Ohiri, in an interview session conducted in September 2025, highlighted gaps in Nigeria’s fragmented health systems and discussed the measures to be taken to reform healthcare financing through mandatory health insurance and scalable coverage through innovative policies aimed at achieving universal health coverage.

A major highlight from the interview was that 70% of health expenses were paid out of pocket. This finding poses a big concern in a nation, following the World Bank, Nigeria Poverty and Equity Brief that revealed 75.5% of rural Nigerians were living below the poverty line, with 30.9% of Nigerians living below the international extreme poverty line of $2.15 per person per day in 2018/2019 (before the COVID-19 pandemic).

Although designed as low-cost facilities, patients still incur out-of-pocket expenses that can quickly add up. Even when insurance schemes or performance-disbursements from the BHCPF (ranging from N600,000 to N800,000) are available, co-payments remain a challenge for patients who need frequent visits. Medication costs are an even greater burden, especially for those managing chronic diseases, especially when drugs are unavailable or only partially covered, and laboratory services are limited.

Beyond direct medical expenses, indirect costs significantly affect care-seeking behaviour. Transportation costs can deter patients who live far from PHCs, leading to delayed presentation. Time spent attending appointments often means lost income, especially for those in informal employment without paid leave. For caregivers, especially women, childcare responsibilities further complicate access to care, sometimes pushing families toward unregulated medical stores or traditional remedies, which increases the risk of misdiagnosis and severe complications.

Unexpected costs also arise when patients are referred from PHCs to higher-level facilities because of limited services or specialist care. These referrals often come without ambulance support, leaving patients to bear the costs of sudden transportation and treatment or abandon care altogether. Follow-up visits for unresolved health issues further increase the overall cost of treatment.

Despite these challenges, adopting value-based healthcare approaches can help manage costs. Health insurance remains one of the most effective tools for reducing out-of-pocket spending when patients understand and select coverage that aligns with their needs. Many PHCs also offer subsidised services and medications, which patients can access by seeking information at the facility.

Emphasising preventive care through regular check-ups and immunisation helps detect illnesses early and avoid costly complications. Prescribing generic medications rather than brand names also significantly reduces drug costs without compromising effectiveness. Community medical outreaches, often organised by governments and non-profit organisations, provide free screenings and health education to support patients requiring long-term care.

Equally important is the relationship between healthcare providers and the communities they serve. Through community engagement initiatives such as the SCEAP and SCAPP Projects implemented by BudgIT, patient feedback has been incorporated into facility and town hall meetings, strengthening trust, improving continuity of care, increasing service utilisation and participation in health-related activities at PHCs.

Policy frameworks remain central to improving access and affordability. Increased government funding for PHCs would enhance service quality, expand the range of services, and provide essential equipment. Expanding insurance coverage for low-income earners can further reduce financial barriers, while local production of essential drugs and medical consumables would lower costs and cushion patients from economic shocks.

Through community-led initiatives, BudgIT continues to advocate for stronger PHC financing, accountability and citizen participation across Nigeria’s 36 states and the FCT, reinforcing the simple yet profound goal of a more resilient and affordable healthcare system for all.

Dr Biobele Davidson is the Head of the Strengthening Health Systems Unit at BudgIT Foundation