Technical Assistance on Health Care Financing to the Government of Nigeria

Nigeria’s health care financing system is characterized by high out-of-pocket expenses, low budget allocations and expenditures at all levels of government, and limited coverage through health insurance and other demand-side financing mechanisms. R4D is working with the Government of Nigeria and local and international partners to improve health financing to expand coverage of basic primary care services for the poor and most vulnerable.

The Challenge

The National Health Act of 2014 (NHA) presents a valuable moment of opportunity in Nigeria to fast track progress towards Universal Health Coverage. It earmarks a portion of federal revenues for a Basic Health Care Provision Fund (BHCPF) to make supply- and demand-side investments for primary health care, helping to implement more equitable and efficient health care financing on the path to UHC and provide essential services to the most vulnerable members of the population. Such federal policies have also translated to reform efforts at the state level. Multiple state governments have passed, or are in the final stages of passing State Sponsored Health Insurance Bills (SSHIS) to provide financial risk protection and access to quality care for their residents. States have also started implementing the Primary Health Care Under One Roof (PHCUOR) policy, which aims to integrate all PHC structures and programs at sub-national levels, under one State level body, and in the process, improve the implementation of PHC.

Despite such progress, significant challenges remain and threaten to slow advancement on the implementation of UHC. These include inadequate funding for health and the need to align the health budget with sector priorities; a need to harmonize federal and state level roles with respect to key health financing functions; limited state-level evidence and a variable level of understanding on where each state is in the reform process; and a need for tools and resources that states, local technical organizations, and CSOs can utilize to drive health care financing reform.

The Opportunity

It has become increasingly evident that for reform efforts to prove successful in implementation, the Federal government will need to provide strong, aligned leadership and support to the states. This will include designing policies that are responsive to states’ needs, implementing effective capacity development programs, ensuring the necessary budgetary allocations, and providing overall guidance and oversight. State governments will also need support in their efforts to strengthen their PHC systems and improve financing for health. This period of high momentum for UHC in Nigeria is a vital opportunity to build capacities.

Our Work

R4D is working with public actors and a consortium of local and international development partners in Nigeria to erect a federal and state level technical assistance program for health financing policy development and implementation. By improving the design and implementation of health financing policies at the federal and state level, this partnership aims to improve Nigeria’s performance on key dimensions of universal health coverage—namely, increased provision of priority (primary) health care services to more Nigerians (especially vulnerable populations) via prepaid-pooled health financing mechanisms to reduce the financial burden of utilizing those services.

Activities include:

  • Supporting coordination between federal government agencies on prioritizing health in the national budget, including BHCPF budgeting.
  • Providing technical assistance to align the Federal Ministry of Health’s budget process with its strategic priorities.
  • Providing support to federal and state governments on BHCPF tools and guidelines.
  • Creation of a UHC self-assessment tool for Nigerian states (to be piloted in Niger and Kaduna states).
  • Co-creation and facilitation of a sub-national joint learning network on universal health coverage to share knowledge and disseminate evidence among federal and state stakeholders (an activity co-supported by the Bill & Melinda Gates Foundation and USAID, through the Health Finance and Governance Project).
  • Capacity building for civil society organizations engaged in health financing and budget advocacy work at the federal level.




Bill & Melinda Gates Foundation


World Bank Group, Solina Group, Nigerian Federal Ministry of Health, Nigeria National Health Insurance Scheme (NHIS), National Primary Health Care Development Agency (NPHCDA), Health Strategy and Delivery Foundation, University of Nigeria-Nsukka, Health Systems Consult Limited, Government of Niger State



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