Universal Health Coverage (UHC)

 Nigeria can use to move toward Universal Health Coverage (UHC), written so you can use it in a briefing or presentation. I’ll start with a short executive summary, then a step-by-step plan, financing options, governance and monitoring indicators, and quick wins you can pursue immediately. I’ve cited the strongest sources for the major points.

Executive summary

Nigeria can reach UHC only by

(1) putting primary health care (PHC) at the center, 

(2) shifting from out-of-pocket fees to prepaid pooled financing, 

(3) consolidating and reforming health insurance (NHIA / state schemes), and 

(4) strengthening governance, workforce and supply chains. Political leadership, a clear legal framework, and predictable domestic funding are non-negotiable. 

10-point roadmap (practical steps)

1. Make PHC the delivery hub (PHCUOR model).
   Build, staff, equip and fund local PHC facilities to deliver the essential package (maternal & child care, immunization, basic NCD care, common infections). PHC reduces costs, improves equity, and is the foundation for UHC.  
2. Scale and unify health financing under mandatory, pooled schemes.
   Move from fragmented out-of-pocket payments to compulsory, progressive prepayment (taxes + social insurance + targeted subsidies) and consolidate schemes so funds are pooled and risk-shared. Nigeria’s NHIA/NHIS reforms and state Social Health Insurance Schemes (SSHIS) are the platform to do this—but they must be reformed and expanded.  
3. Introduce progressive, sustainable domestic revenue streams.
   Increase domestic financing through general taxation, sin/earmarked levies (carefully designed), and budget reprioritization (health share of GDP). Experience shows countries that reach UHC mobilize major domestic resources rather than relying on donors.  
4. Define and fund an essential benefits package.
   Decide what services are guaranteed at no point-of-service charge (e.g., antenatal care, childbirth, immunizations, basic surgical care, and first-line NCD management). Match the package to available funding and scale it over time.  
5. Remove user fees for priority services and protect the poor.
   Gradually remove direct fees for high-impact services (maternal care, childhood illnesses) and use vouchers or subsidies for the poorest to prevent catastrophic spending.  
6. Fix governance: transparency, buying not just paying, and public accountability.
   Separate purchaser and provider roles, use strategic purchasing (pay for outcomes, not only inputs), publish budgets and audits, and involve citizens/parliamentarians in oversight.  
7. Invest in health workforce and supply chains.
   Train and retain more primary care clinicians, nurses, community health workers; ensure regular drug supply and functioning labs. Workforce shortages and stockouts undermine insurance and coverage.  
8. Use data & digital systems for enrollment, claims, and monitoring.
   National ID linkage, e-claims, and a simple population register enable targeting, reduce fraud, and allow performance monitoring.  
9. Phased, geographically sequenced rollout with pilots.
   Start with a few states/regions (or selected districts) to demonstrate models (PHC + pooled financing + benefits), learn, then scale nationally. Countries that achieved UHC used staged expansion.  
10. High-level political commitment and legal backing.
    Make UHC a presidential/ministerial priority, backed by law (e.g., NHIA Act and clear regulations), with multi-year budget commitments to reduce policy reversals.  

Financing options (how to pay for it)

• Reallocate and protect health budgets — bump up health’s share of the national budget.
• Progressive taxation — increase general revenues from taxes (with protections for the poor).
• Earmarked taxes — small levies on telecom, alcohol, airline tickets can be ring-fenced (used carefully to avoid regressive effects).
• Mandatory social health insurance — contributions from formal sector salaries + government subsidies for the informal and poor.
• Performance-based transfers to states — use incentives to improve coverage and outcomes.
  Evidence: countries that progressed toward UHC combined several of these mechanisms rather than relying on a single source.  

Governance & implementation design (what to change)

• Consolidate fragmented insurance schemes into a single purchaser or interoperable purchasers that pool risk. (NHIA + well-designed SSHIS.)  
• Strategic purchasing — pay providers for defined packages (capitation for primary care; DRG for hospitals; fee-for-service only where justified).  
• Transparency & anti-fraud systems — open contracting, digital claims, audits, and community scorecards.  

Key performance indicators (KPIs) to track progress

• % population covered by prepayment/pooling (insurance enrolment).
• Out-of-pocket spending as % of total health expenditure (should fall).
• Coverage of essential services (e.g., % facility births, DPT3 immunization).
• Financial protection: % households with catastrophic health spending.
• PHC facility functionality score (staff, drugs, equipment, 24/7 service).
  (These are measurable and used by WHO/World Bank to benchmark UHC progress.)  

Quick wins (3–12 months)

1. Remove user fees for maternal and child services in selected states and fund PHCs to compensate.
2. Launch public information campaigns on state Social Health Insurance Schemes (raise awareness and demand).  
3. Standardize and supply essential medicines kits to PHCs to reduce stockouts.
4. Pilot digital enrolment & e-claims in a few local government areas to iron out fraud and administrative issues.  

Common pitfalls to avoid

• Relying solely on voluntary, fragmented insurance (it leaves many behind).  
• Underfunding PHC while building tertiary capacity—this increases costs and inequity.  
• Weak governance and rapid, unfunded benefit expansion (promising services without money).  

Short country lessons (what to copy/adapt)

• Thailand: strong political commitment + mandatory coverage plus phased benefits.
• Rwanda: heavy investments in community health workers and a cross-subsidized insurance model.
• Ghana: national health insurance with challenges on sustainability—useful lessons on provider payment and fraud control.
  Adopt the principles (domestic funding, PHC focus, strategic purchasing), but tailor the model to Nigeria’s federal structure and large informal economy.  

One-page ask you can use in a briefing

1. Commit multi-year funding increase to PHC (ring-fenced).
2. Fast-track consolidation of insurance schemes under NHIA with clear mandate to expand coverage to informal sector via subsidies.
3. Remove fees for maternal & child services in 10 pilot states and monitor impact.
4. Invest in digital enrolment, e-claims and audit systems.
5. Launch national campaign explaining benefits & enrollment steps.