Despite consistent efforts by government and its development partners, Nigeria continues to record minimal gains in health indicators, majority of which continue to fall short of national and international targets. More dismal is the fact that the highest contributors to morbidity and mortality particularly amongst the most vulnerable groups are health conditions that are either preventable or can be effectively managed at the primary health care (PHC) level. Nigeria remains the second largest contributor to maternal and child mortality in the world, losing an estimated 2,300 children and 145 women every day. Declines in maternal and under-5 mortality has been slower than comparable countries, such as including Kenya, Uganda, Senegal, and Tanzania, with Nigeria’s weak health financing system being a major driver of poor health outcomes.

The situation is further compounded by a constraint fiscal space, dwindling revenues from fledging global oil prices and persisting mismatch between domestic resource allocation and burden of disease. Expenditure from all tiers of government amounts to less than 6% of total government expenditure (a far cry from the Abuja Declaration) and less than 25% of total health spending in the country. This challenge has resulted in significant out-of-pocket spending (70%) among Nigerians, many of whom live on less than one dollar per day.

And while donor funding continues to bridge some gaps, this too remains unsustainable — particularly with project closeouts often requiring significant additional funding to preserve gains.

The National Health Act (NHAct 2014) presents a valuable opportunity to address these health financing challenges and promote equitable service utilization. It earmarks 1% of Consolidated Federal Revenue (CFR) for a Basic Health Care Provision Fund (BHCPF), which makes supply- and demand-side investments for PHC…more