The recent decision by the United States government to cease foreign development aid and assistance is a wake-up call for sustainable and self-reliant financing for health. Based on this, the Nigeria Universal Health Coverage (UHC) Forum organized a webinar on the 6th of February 2025. The webinar was geared towards expounding on the impact of donor dependence and charting a sustainable financing pathway for Nigeria’s health sector.
The webinar was moderated by Dr. Gafar Alawode (Managing Partner/CEO, DGI Consult), featuring eight erudite speakers who are experts in the health sector. These include:
- Chief Mrs Moji Makanjuola, MFR (Chair, Nigeria UHC Forum/Executive Director ISMPH)
- Dr. Magda Robalo (Chair, UHC2030)
- Professor Rob Yates (Visiting Professor in Practice at The London School of Economics)
- Dr. Muhammed Mustafa Lecky (Chairman, Health Sector Reform Coalition)
- Dr. Amina Aminu Dorayi (Country Director, Pathfinder International)
- Dr. Anne Adah-Ogoh (Director of Policy, Private Sector Health Alliance of Nigeria)
- Professor Obinna Onujekwe (Professor of Health Economics, University of Nigeria)
- Dr. Chinekwu Oreh (Senior Health Specialist, Nigeria Governors Forum)
The webinar was heralded with a welcome remark by Chief Mrs Moji Makanjuola, who highlighted the impact of the decision on the health sector. This serves as a wake-up call for low—and middle-income countries, especially Nigeria, to deploy strategies for mobilizing domestic resources from innovative sources to sustainably transition from donor financing through significant budgetary allocation and judicious utilization. She acknowledged the reform efforts of the current health administration towards institutionalizing transparency and accountability in the health system.
“We should not let the crisis go to waste.”
Dr Magda Robalo identified the importance of mobilizing political leadership to get “more money for the health and more health for the money”. She highlighted that the numbers on progress in health are alarming, with major gaps in service coverage and a worsening trend of financial hardship caused by catastrophic health expenditures. Despite the commitment to universal health coverage by member states during the United Nations High-Level Meeting in 2019 and 2023, there is still insufficient action to deliver on the promise of health for all. In low- and middle-income countries, as out-of-pocket expenses remain the primary funding source for health. She further noted that most donor countries have announced major cuts in their overall budgets, translating to a decline in external resources availability for health funding. The prospects for future improvement are grim, as many low- and middle-income countries have struggled to return to pre-coverage economic growth and government spending trajectories. She highlighted a need for novel strategies, committed leadership and decisive action in the health financing sector also restating that “we should not let the crisis go to waste.”
‘’The key driver of UHC and a sustainable health system is domestic financing’’
Speaking on the implication of the current crisis for sustainable financing for health, Professor Rob Yates acknowledged the profound impact of the crisis on middle- and low-income countries, cautioning that the situation might worsen over time. Looking ahead, he emphasized that financing UHC in Nigeria cannot rely on aid funding, as such funding would be insufficient given the scale of the challenge with the need to embrace domestic public financing to accelerate progress towards UHC. Professor Yates identified examples of countries that successfully implemented publicly financed UHC reforms successfully amidst crises because of strong political commitments, emphasizing the need to mobilize strong commitments from leaders who truly understand the significance of healthcare for their populations. He emphasized the importance of mobilizing political commitment to dedicate at least 1% of the country’s GDP to health, which can guarantee access to a basic healthcare package of healthcare for every resident, urging leaders to take responsibility for funding healthcare to ensure free and accessible services for all.
‘’Transitioning from donor to domestic financing requires strategic planning with involvement of all critical stakeholders’’
Dr. Amina Aminu Dorayi expatiated on how donor-funded programs can be strategically designed to catalyse domestic and public financing. She advocated for sustainability from the outset, emphasizing that programs must be aligned with national and subnational policies rather than imposed based on external assumptions. She highlighted the importance of designing interventions based on a country’s felt need-issues identified as priorities by the nation itself. Dr. Amina stressed that donor-funded initiatives should complement government development objectives to ensure continuity beyond the funding lifecycle. Strong stakeholders’ engagement and partnerships are crucial, starting with robust environmental and stakeholder mapping. She recommended practical, context-specific smart advocacy, which is a collaborative and transformational process that brings together advocates and allies from different backgrounds to create change and sustain progress. She also reinforced the importance of domestic financing as a sustainable solution. Stressed the need for accurate data to drive decision-making and effective resource allocation. Dr Amina emphasized the need for effective mobilization of critical stakeholders including governments, health professionals, media, the academia etc. to move for policy changes towards domestic financing in this critical juncture of donor freeze. She explained further that transitioning from donor funding should be carefully planned to involve all critical stakeholders. Further emphasized the need to improve research by tracking health system interventions to understand the models that works best in the context of Nigeria’s health system. Domestic funding could also be significantly improved by strengthening tax collection, improved allocation to health, strengthening health insurance schemes, and leveraging the expertise and resources of the private sector to improve healthcare delivery.
‘’The NGF secretariat leverages peer comparison to stimulate the commitment of governors to improve health spending’’
Dr Chinekwu Oreh spotlighted mechanisms being deployed at the Nigeria Governors’ Forum (NGF) Secretariat towards ensuring health reflect as a primary priority on the agenda of the state governors. The NGF Secretariat uses accountability frameworks, guidelines and mechanisms for tracking the commitments of the governors across different sectors, including health, keeping the governors on their toes concerning their commitments and promises towards the health sector while deploying allocative efficiency in the utilization of allocated health resources to advocate for more funds from the governors. Similarly, the secretariat uses peer-comparison by tracking government to partner spending for nutrition programs to stimulate the commitment of the governors to spend more on health. Dr Chinekwu also shared the ongoing technical support efforts by the NGF secretariat to the state to develop a sustainable financing framework for nutrition, which is scalable to the entire health sector programs. Examining the next frontier by the NGF, Dr Chinekwu highlighted the tax-for-service mechanism being proposed with the potential for generating additional revenue for the states through tax collection, which in turn provides the fiscal space to expand health insurance coverage to more poor and vulnerable population. Similarly, the governors are being engaged to release the state equity fund which will further increase the number of the state residents in the health insurance pool.
‘’Effective communication with the non-health private sector actors is key towards harnessing private sector contributions for health’’
Dr. Anne Adah-Ogoh highlighted the contributions of the private sector in the health ecosystem and mechanisms for stimulating the interest of the private sector in improving health outcomes in Nigeria. She shared lessons from the PSHAN’s ‘’Adopt a Health Facility Per LGA’’ model. In this approach, private companies and high-net-worth individuals contribute funds and resources, directly benefiting the community by improving the quality and efficiency of healthcare services. They not only provide financial support but also offer valuable expertise that helps upgrade the infrastructure and management practices at these centres. This infusion of private capital and knowledge helps bridge the gap in public healthcare, ensuring that facilities are better equipped to serve local populations. In addition to direct investment, Dr. Anne highlighted the importance of public-private partnerships, involving joint efforts between the government and private entities to build, operate, or lease healthcare facilities. By working together, both sectors can share responsibilities and risks, leading to more sustainable management and maintenance of healthcare infrastructure. She further stressed the need to communicate clearly and effectively with the private sector through evidence-based advocacy to understand the importance of investing in health while deploying the resources to areas with the greatest need to demonstrate impact at scale. In addition, the engagement of the private sector should be timely and consistent.
Innovative financing sources through taxes from SSBs, alcohol and tobacco hold the potential for generating substantial resources for health through appropriate legislation
Dr. Muhammed Mustafa Lecky expounded on how Civil Society Organizations (CSOs) have been at the forefront of leading health reform advocacies in Nigeria, demonstrating a major impact of the establishment of the BHCPF through the National Health Act. To guarantee sustainable financing for health, there is a plan underway by the Health Sector Reform Coalition (HSRC) to leverage the findings of the fiscal space analysis conducted by DGI Consult with funding from the USAID Local Health System Sustainability (LHSS) Project to explore innovating financing sources identified by the analysis. The study identified additional fiscal space from taxes on alcohol with the potential of generating approximately ₦134 billion, and taxes from tobacco generating about ₦52 billion. Additionally, about ₦13.2 billion can be accrued from sugar and beverages taxes. Altogether, these sources amount to nearly ₦200 billion that could be strategically allocated to the healthcare sector. However, harnessing these innovative revenues requires strong political will and pressure from the coalition of CSOs. He stated that the HSRC is in the process of drafting required bill for the national assembly to harness the taxes for financing health.
Professor Obinna Onwujekwe expatiated on the need to leverage the Sector Wide Approach (SWAp) to improve efficiency of government financing.
The webinar provided a basis for further conversations and actions towards achieving a self-reliant and sustainable financing for Nigeria’s health sector through political commitments to improve domestic financing for health at all levels. “We must not let a good crisis go to waste.”
Watch the full Webinar Recording