The Imperative of Equity and Financing in Nigeria’s Health System
At the 66th National Council on Health (NCH), a clear message emerged: health in Nigeria must be viewed as a fundamental right, not a privilege. This sentiment was strongly emphasized in the opening remarks by the Honourable Minister of State, Dr Iziaq Adekunle Salako, who positioned equity as the cornerstone of the nation’s pursuit of Universal Health Coverage (UHC). He stressed that governments at all levels must ensure that the most vulnerable groups—pregnant women, children under five, the elderly, persons with disabilities, and those facing catastrophic health conditions—are not left behind.
By aligning equity with bold health financing reforms, the minister underscored a critical truth: rights are meaningless without adequate resources. Achieving UHC will depend less on declarations and more on Nigeria’s willingness to confront difficult questions about how health is funded, who is covered, and how quickly the country can reduce its heavy reliance on out-of-pocket spending. Currently, approximately 21 million people have health insurance coverage.
Equity and financing together set the tone for the council’s deliberations. They also provided the most transparent lens through which discussions on topics like Primary Health Care (PHC) revitalisation, digital transformation, subnational performance, and memo quality could be understood. If equity defines the destination, financing will determine whether Nigeria has the political courage, fiscal discipline, and institutional capacity to reach it.
From 17 to 21 November 2025, the council highlighted how bringing health leaders together can shape effective policies, accelerate progress towards UHC, and reinforce the need for equitable access, resilience, and innovation in the health sector.
Progress and Gaps in PHC Revitalisation
Updates were provided on the revitalisation of Primary Health Care. With 88% of states establishing Primary Health Care Boards, and 2,127 PHCs revitalised, significant progress has been made. However, gaps remain in validation, and there is a need for standardised and transparent tracking of PHC upgrades.
While structural reforms are advancing, many state-level commitments remain uneven and fragmented. The Technical Session’s review of previous NCH resolutions exposed deep disparities across states. Although areas with strong federal direction have recorded notable progress, such as human resource for health (HRH) institutionalisation at 67.6% progress; warehouse upgrade budgeting at 63.9% progress, emergency transport at 66.6% progress and Vital Registration integration, gaining 57.1%, key social protection and public health areas continue to lag far behind.
These low-scoring areas reflect the most vulnerable segments of Nigeria’s health landscape. National averages mask uneven progress, although several states, including Lagos, Kaduna, Enugu, Cross River, Delta, Kano, Ogun, Bauchi, Niger, Kwara, Edo, and Anambra, were recognized for their innovative approaches to health insurance enrolment, digital health integration, and equity-driven interventions.
Digital Innovation and Health Security
Cross River, for instance, reported 28% health insurance coverage, surpassing the national average of 17%, and established a digital UHC Coordination Centre. Edo State has become a national reference point for digital health, achieving 850,000 biometric registrations, reducing vaccine wastage by 23%, and delivering telemedicine to 12,000 patients monthly.
These models show that subnational leadership is the true engine of UHC and that progress is possible when states align political will, financing, and systems strengthening.
The Council also benefited from a compelling health security presentation by Prof. Akin Abayomi, Lagos State Commissioner for Health. Drawing on Lagos’s experience with Ebola and COVID-19, he reminded delegates that universal health coverage (UHC) cannot be realized without a resilient biosecurity architecture. As Nigeria’s busiest port of entry, receiving over 70% of all international arrivals, Lagos has historically been the country’s first point of exposure to global disease threats.
Prof. Abayomi used the Lagos containment of the 2014 Ebola outbreak to demonstrate how rapid contact tracing, coordinated emergency response, and courageous frontline decision-making prevented a national catastrophe and laid the foundation for the state’s biosecurity achievements during the COVID-19 pandemic.
He further highlighted the rising complexity of outbreaks driven by climate change, megacity expansion, antimicrobial resistance (AMR), and synthetic biology, warning that Nigeria must prepare for the inevitability of Pathogen X.
Lagos’s investments in advanced surveillance systems, biocontainment laboratories (Bio Safety Levels 2 and 3), digital monitoring tools, and the new Infectious Disease Research Institute were presented as models that other high-traffic states, such as Kano and Rivers, should adapt. His central message to the Council was unequivocal: a rights-based health system must be anchored on strong subnational preparedness and fortified border-health defences, or Nigeria will remain vulnerable to the next major outbreak.
Leveraging the Diaspora for Health System Strengthening
Alongside these security-focused insights, the Council was also introduced to a forward-looking national initiative that leverages global Nigerian expertise. The Diaspora Health Impact Initiative (DHII), presenting on behalf of international diaspora medical associations, outlines how more than 50,000 Nigerian-trained doctors abroad across the UK, US, Canada, Germany, Australia, and South Africa are mobilizing to support domestic health system strengthening.
Launched in March 2025 by the Federal Ministry of Health and Social Welfare, the DHII outlines a coordinated approach where diaspora associations align their specialty training, mentorship programmes, and capacity-building missions with the specific needs of Nigeria’s geopolitical zones.
The programme’s design is both ambitious and pragmatic: from obstetrics and neonatal care in the North-West to sickle cell management in the North-East; surgical ultrasound training in the North-Central; Biosafety Levels and management of childhood killer diseases in the South-East; laparoscopy and endometriosis care in the South-South, and interventional radiology and neurosurgery in the South-West.
The initiative aims to train 5,000 health workers, scale clinical competencies, and foster sustained mentorship networks across federal and state systems. The presentation urged national and subnational leaders to actively engage with the programme ahead of the 2026 Diaspora Health Week, arguing that diaspora-led technical expertise represents one of Nigeria’s most underutilized assets for accelerating UHC, strengthening the health workforce, and driving system-wide improvements in quality of care.
Financing the Next Phase of UHC
The Minister’s financing proposals signal a strategic pivot:
- Mandatory health insurance domestication.
- Doubling BHCPF coverage to 15-20 million in 12 months.
- Ring-fenced state basic healthcare funding.
- Expanded Public-Private Partnerships.
- Innovative financing mechanisms, including fuel levies, sin taxes, and a $500m Diaspora Health Investment Bond.
These ideas reflect fiscal realism: government budgets alone cannot fund Nigeria’s UHC aspirations. The challenge, however, lies in ensuring these mechanisms do not burden the poorest Nigerians or widen urban-rural inequities.
From Reform to Rights: The Work Ahead
Despite evident progress, the 66th NCH showed that Nigeria’s health system still struggles with:
- Weak state-level implementation
- Poor coordination across ministries and agencies
- Limited capacity to translate policies into scalable programs
- Gaps in data quality and accountability
- Underinvestment in the most vulnerable groups
The Minister’s closing remarks resonated with those of Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation, who stated that “UHC is a political choice.” This encapsulated the essence of the Council’s mandate.
A Call for Bold, Coordinated Leadership
This year’s Council demonstrated ambition but also exposed the structural constraints that continue to limit Nigeria’s ability to translate commitments into tangible improvements for citizens. If Nigeria is to transform health from a privilege to a right, the post-NCH agenda must focus on three imperatives:
- Strengthening state implementation capacity, especially for neglected areas like mental health, Gender-Based Violence, food safety, and palliative care.
- Locking in financing reforms, from mandatory insurance to innovative funding streams to protect the most vulnerable.
- Institutionalising accountability, ensuring that resolutions do not fade into annual rituals but drive measurable, equitable progress.
The 66th NCH has offered a clear blueprint. What happens next in state budgets, legislative chambers, PHC governance structures and facilities, as well as community systems, will determine whether Nigeria truly delivers on the promise: My Health, My Right.
