Constitutional reforms key to sustaining Nigeria’s health sector financing – World Bank

Dr Olumide Okunola, Senior Health Specialist at the World Bank says constitutional reforms and innovative revenue frameworks will be key to sustaining health financing in Nigeria.

Speaking, on Thursday at a policy dialogue on health financing in Abuja, Okunola noted that while Nigeria has made progress since 2023, the current structure of revenue allocation limited states’ ability to invest adequately in health.

He said that additional funding sources, such as increasing allocations from the Consolidated Revenue Fund (CRF) might not be feasible without deeper fiscal reforms.

“Our calculations show that an additional one per cent from the CRF may not necessarily work because the Federal Government will not release another one per cent of its revenues.

“What we need is a stronger constitutional and fiscal framework that allows states to access and deploy resources more effectively,” he explained.

Okunola highlighted the December 2023 signing of Nigeria’s Universal Health Coverage (UHC) compact as a landmark step, positioning the country as a model for global health financing reforms.

“Global conversations now recognise the increasing role of innovative financing for health, and Nigeria’s UHC compact has changed the narrative.

“This is not about a small number, it is about a compact that all governments agreed to. That is the opportunity for the investment we are talking about,” he added.

He urged civil society organisations (CSOs) to push for constitutional amendments that would enable states to generate and retain additional revenues for health, stressing that this would strengthen Nigeria’s journey toward UHC.

Okunola reaffirmed that with the right policy framework, Nigeria could move from fragmented health financing to a sustainable, inclusive system that would benefit all citizens.

He highlighted how reforms in public financial management (PFM) could translate into real-life health benefits, especially for women.

“If NHIA says to states: pile up receipts for safe deliveries and we will reimburse you, we will stop seeing the kinds of tragic cases we see today.

“No woman in Nigeria should suffer or die in childbirth simply because she cannot afford it. That is the nitty-gritty of this reform. PFM is about how you build, implement, and execute a budget.

“If done right, Nigeria can, within five years, become a model that other countries come to study,” he explained.

Earlier, the Permanent Secretary, Ms. Daju Kachallom, Coordinating Ministry of Health, recognised the significance of this dialogue, positioning the High-Level Policy Dialogue as a launchpad for bold, coordinated action to reform how Nigeria financed health.

“Let us move beyond dialogue into decisive action,” Kachallom said.

Our correspondent reports that health insurance coverage in Nigeria got a major boost with the directive mandating all MDAs to implement health insurance with strict compliance monitoring.

This highlighted the urgent need to reduce out-of-pocket payments and ensure more Nigerians are protected from the financial burden of healthcare.

This aligns with the conversations at the Health Financing Policy Dialogue, organised by the NHIA with partners, now in its final day.

Our correspondent recalls that over the past three days, leaders from government, civil society, academia, the private sector and development partners had been rethinking how Nigeria financed health, focusing on sustainable approaches that could expand coverage and ensure quality care for all.