…Insurance coverage hits 20%; weak referrals, funding gaps threaten gains
The federal government has disbursed N339 billion through the Basic Healthcare Provision Fund (BHCPF) since inception, intensifying pressure on authorities to prove that increased healthcare spending is delivering measurable improvements in access, quality and outcomes for Nigerians.
Muhammad Pate, Coordinating Minister of Health and Social Welfare, said the amount disbursed reflected the government’s renewed commitment to strengthening primary healthcare, expanding financial protection and improving access to basic health services.
Pate, who was represented by Uzoma Nwankwo, a director at the Federal Ministry of Health and Social Welfare, spoke at the BusinessDay Health Conference 2026 in Abuja, with the theme “Building Trust, Building Systems: Strengthening the Basic Health Care Provision Fund for Universal Health Coverage.”
But speakers at the conference warned that more money alone will not deliver Universal Health Coverage (UHC) unless Nigeria closes gaps in accountability, healthcare infrastructure, staffing, medicines, referral systems and sustainable financing.
The BHCPF, established under the National Health Act 2014 and operationalised in 2018, is designed to provide catalytic funding for primary healthcare and essential health interventions, particularly for poor and vulnerable Nigerians.
Pate said the government’s health reforms were ultimately being judged by whether Nigerians could obtain quality care when they needed it, rather than by the size of allocations alone.
“For a family seeking care, choice comes from experience. Whether a health worker is available, whether the prescribed medicine is in stock, whether the cost is explained, and whether a referral leads to treatment, those are the questions against which our financing reforms must be judged,” he said.
He said the Nigeria Health Sector Renewal Investment Initiative, launched in December 2023, was bringing together reforms around governance, equitable and quality healthcare, the health value chain and health security.
According to him, the sector-wide approach was aligning federal and state institutions and development partners around a common plan, budget, reporting framework and implementation strategy.
Pate described the BHCPF as a central financing instrument in the reform programme, but said increased funding also imposed greater responsibility on implementing agencies to demonstrate measurable results.
He explained that the fund operates through four major gateways. The National Primary Health Care Development Agency supports primary healthcare facilities, essential supplies and frontline service readiness, while the National Health Insurance Authority finances a basic package of care for poor and vulnerable Nigerians.
The Nigeria Centre for Disease Control and Prevention handles disease surveillance, outbreak preparedness and response, while the emergency medical treatment gateway supports emergency care and transportation.
“These functions must work together. A patient needs an accessible facility, an affordable service, and a referral that can be completed,” Pate said.
He said direct facility financing had reached 3,109 primary healthcare centres, with revised arrangements providing quarterly payments of between N600,000 and N800,000, depending on facility categorisation.
Pate also disclosed that about 3,150 incomplete primary healthcare revitalisation projects had been identified across the wider sector programme as of around June, while approximately 78,000 frontline health workers had received training.
He attributed the progress to contributions from the federal government, state-level implementation and development partners, but warned that the gains would not be sustained without adequate staffing, functional equipment and reliable supplies of essential medicines.
Pate said there was evidence of increased utilisation of maternal healthcare services, particularly in local government areas with high maternal mortality burdens, with increased attendance beginning to coincide with declining mortality in some targeted areas.
“These results concern the targeted areas, and we must continue to improve the quality of our records and checking programme. Families deserve progress that is sustained and can be verified,” he said.
On health insurance, Pate disclosed that national health insurance enrolment had exceeded 22 million as of July, while BHCPF funding was providing financial coverage for more than two million poor and vulnerable Nigerians. He, however, warned that enrolment must translate into actual access.
“Financial protection must advance alongside service availability,” he said. He stressed that beneficiaries must be able to obtain covered services, understand their entitlements and have complaints resolved.
Pate also disclosed that the National Emergency Medical Treatment and Ambulance System (NEMSAS) had recorded more than 830,000 emergency medical transports.
The minister said the federal government deployed 13 ambulances to states on September 4 as part of efforts to strengthen emergency response. According to him, effective emergency care required a connected chain linking dispatch, transportation and receiving facilities.
“We must assess them against certain standards, address the deficiencies, and verify the improvements,” he said.
The Minister also criticised poor treatment of patients in public facilities, insisting that Nigerians should receive respectful and transparent care irrespective of their financial circumstances.
“People should not have to accept poor treatment because they are receiving publicly financed services,” he said.
Pate stressed that federal government financing could not substitute for the responsibilities of states and local governments, which own and operate most primary healthcare facilities.
On accountability, he disclosed that the Ministry of Health and Social Welfare, in collaboration with the Independent Corrupt Practices and Other Related Offences Commission, inaugurated a joint task team on August 17 to identify weaknesses and prevent misuse of health resources.
Under the PECEF 2.0 framework, Pate said authorities were working to improve traceability of health funds from allocation to utilisation.
“I ask BusinessDay and other media organisations to follow the commitments beyond their announcements. Report good delivery and failure and check whether corrective actions follow,” he said.
Pate backed legislative efforts to increase statutory allocation to the BHCPF from one percent to two percent of the relevant consolidated revenue base and called for stronger fiscal measures on sugar-sweetened beverages, with part of the revenue channelled into disease prevention.
Health insurance coverage rises to 20% – Anas
Salma Anas, Special Adviser to President Bola Tinubu on Health, said Nigeria’s health insurance coverage had risen from less than five percent to about 20 percent in three years, as government reforms seek to accelerate the country’s progress towards UHC by 2030.
Anas said targeted interventions in states and local government areas with high maternal and newborn mortality were also beginning to produce measurable results.
“Public trust, transparency and accountability remain critical to achieving Universal Health Coverage and ensuring that government spending translates into better health outcomes,” she said.
According to her, maternal deaths declined by about 17 percent, while newborn deaths dropped by 12 percent in affected local government areas following the implementation of high-impact interventions. She said attendance at BHCPF-supported primary healthcare facilities increased from about 10 million visits in the first quarter of 2024 to 45 million by the second quarter of 2025.
“That increase is more than a statistic. It suggests that Nigerians are increasingly willing to use primary healthcare facilities when those facilities are functional, accessible and responsive to their needs,” she said.
Anas said more than 8,000 primary healthcare centres were being upgraded, alongside investments in cancer care, diagnostics and specialised services.
“Nigeria does not have one health system; it has 36 different health systems. Most healthcare delivery responsibilities lie at the sub-national level, which is why state ownership and alignment are critical,” she said.
She said all 36 states had aligned their annual operational plans with the federal government’s health sector blueprint through a compact signed with the Presidency. But Anas acknowledged that infrastructure, financing, service quality and access remained major challenges.
“We still have huge gaps. We have not reached where we want to be, but we have laid important foundations for transformation,” she said.
She said the success of BHCPF should be measured through skilled personnel, essential medicines, diagnostics, financial protection and quality care rather than budgetary allocations.
“The Basic Health Care Provision Fund will not build public trust simply because money has been appropriated. Trust is built when Nigerians can see where the money goes, when they can feel the impact in their communities and when they experience better services,” she said.
Broken healthcare links threaten UHC ambition – Deaver
Brian Deaver, Chief Executive Officer of the African Medical Centre of Excellence, said Nigeria’s UHC ambition would remain difficult to achieve unless the country fixed weak referral systems, accountability gaps and shortages of skilled healthcare workers.
Deaver said increased funding would have limited impact if primary healthcare centres, laboratories, pharmacies, emergency services and specialist hospitals continued to operate as disconnected components.
“Trust is created when the entire circuit works, not merely when one component performs well,” he said.
He cited World Health Organisation data showing that out-of-pocket payments accounted for 71.9 percent of current healthcare expenditure in 2023, arguing that illness remained both a medical and financial burden for Nigerian households.
“The true test is whether a patient in a primary health setting can obtain an accurate and timely diagnosis, appropriate treatment and, when necessary, a seamless referral to a higher level of care,” Deaver said.
He likened the health system to an electrical grid, warning that even excellent hospitals would struggle to deliver maximum value if the facilities feeding into them remained dysfunctional.
“A brilliant hospital disconnected from the rest of the system is like a power station without a transmission line. Impressive, but unable to deliver its full value to people who desperately need it,” he said.
End fragmented funding of HIV, TB, family planning – SFH
In his remarks, Dayyabu Mahmud Yusuf, Group Director, Impact and Partnership, Society for Family Health, said Nigeria must move away from fragmented, project-based financing of HIV, tuberculosis and family planning and integrate the services into a sustainable domestic health financing system.
Yusuf, who represented Omokhudu Idogho, Managing Director of SFH, said the proposed expansion of the National Health Insurance Authority’s benefit package to include the three services presented an opportunity to redesign healthcare financing.
“For too long, some essential health interventions have been financed through vertical programmes, donor-supported initiatives or fragmented arrangements,” he said.
He said integrating HIV, TB and family planning into the NHIA benefit package could reduce Nigeria’s dependence on unpredictable donor and project financing.
“The success of the Fund must ultimately be measured not simply by how much money is disbursed, but by what changes for the Nigerian family,” Yusuf said.
He warned that sustaining gains in HIV treatment and prevention required predictable financing, while TB demanded continued investment because delays in diagnosis and treatment could affect entire communities.
Nigeria must target medicines, devices it can produce competitively – Govila
On his part, Dr Anshul Govila, chief operating officer, African Medical Centre of Excellence (AMCE), urged Nigeria to adopt a demand-driven strategy for local production of medicines, medical consumables and devices, rather than pursuing blanket self-sufficiency.
Govila said Nigeria could not yet compete with India and China in mass production, particularly given its high energy costs, but could identify high-demand products that local manufacturers can produce competitively.
He cited AMCE’s importation of 100ml saline from Turkey despite local production of larger sizes as evidence of the need to align manufacturing with hospital demand.
Healthcare funding must produce visible results – Aigbogun
Earlier in his welcome address, Frank Aigbogun, publisher of BusinessDay Media Limited, said Nigeria needed stronger systems for tracking healthcare resources from allocation to impact if public investment was to translate into better services and greater trust.
Aigbogun, who was represented by Oghenevwoke Ighure, managing director, BusinessDay Media Limited, said the BHCPF could become a major instrument for improving access to healthcare, but its success depended on transparency and administrative accountability.
“At its core, healthcare is about trust; trust that citizens will receive quality care, that public resources will reach those for whom they are intended, that health workers have the tools and support to do their jobs, and that the systems we build today will continue to work tomorrow,” he said.
He said healthcare systems must track resources from allocation to impact, equip facilities and provide reliable data for decision-making.
“Strengthening the BHCPF must therefore go hand in hand with transparency, accountability and measurable outcomes,” Aigbogun said.
He said the private sector had a major role in healthcare delivery and financing, including technology, pharmaceuticals, insurance, diagnostics, infrastructure, manufacturing and innovation.
“Universal Health Coverage is ultimately about people, the mother who should not have to choose between feeding her family and paying for healthcare, the child who deserves quality primary healthcare regardless of where they are born, and the healthcare worker who needs a functioning facility and the resources to save lives,” he said.
Aigbogun said healthcare was not merely a social issue but an economic imperative.
“A healthy population is more productive, a stronger healthcare system creates jobs and investment, and affordable, quality healthcare strengthens the foundation for sustainable economic development,” he added.
He urged government, businesses, development partners, healthcare professionals and communities to build partnerships capable of delivering healthcare reforms at scale.
