Investing in Health in a Limited Fiscal Space

By Cynthia Umeh

As Nigeria continues its journey toward achieving Universal Health Coverage, the need for sustainable, domestically driven health financing grows more urgent. On October 29, 2025, Nigeria Health Watch, in partnership with Premium Times and The Punch, hosted a high-level virtual dialogue titled “Investing in Health in a Limited Fiscal Space.” The event brought together government leaders, policymakers, development partners, civil society, media, and private sector stakeholders to sustain momentum from the National Health Financing Dialogue and explore actionable steps to strengthen Nigeria’s health financing system.

Shades of Us joined the webinar to amplify conversations on public health, accountability, and sustainable development in Africa. The discussion reflected a shared urgency: as donor funding declines and fiscal pressures increase, Nigeria must accelerate the transition toward a self-reliant, transparent, and efficient health financing model.

The event took place at a time of growing fiscal constraints and declining donor support, highlighting the need to reimagine how Nigeria funds its health system. With out-of-pocket payments accounting for more than seventy-five percent of total health expenditure—one of the highest rates globally—millions of households remain vulnerable to catastrophic health costs. Against this backdrop, participants examined how the country can strengthen domestic resource mobilisation, improve accountability, and align stakeholders under the Nigeria Health Sector Renewal Investment Initiative (NHSRII) and its Sector-Wide Approach (SWAp) framework.

Nike A. Tambe, Editor of the Health and Development Desk at Premium Times, moderated the discussion and brought together a distinguished panel of experts: Dr. Felix Abraham Obi, Country Director, Results for Development; Dr. Mories Atoki, Chief Executive Officer, African Business Coalition for Health (ABCHealth); and Dr. Davidson Biobele, Head, Strengthening Health Systems, BudgIT Nigeria.

Framing the Challenge: Health as an Economic Investment

Nike A. Tambe opened the discussion by underscoring the importance of addressing Nigeria’s limited fiscal space and the urgency of aligning advocacy, policy, and financing reforms to sustain progress toward Universal Health Coverage.

Dr. Felix Abraham Obi delivered the first presentation, focusing on the Basic Health Care Provision Fund (BHCPF) and domestic resource mobilisation as key enablers of sustainable financing. He explained that although Nigeria has institutionalised the BHCPF, the country still needs stronger fiscal accountability, improved monitoring at the facility level, and greater citizen engagement through Ward Development Committees and community scorecards. He emphasised that community participation and transparency ensure that resources reach the facilities and people who need them most.

Domestic Resource Mobilisation and Budget Efficiency

Dr. Obi also addressed the issue of declining donor funding, urging Nigeria to view this challenge as an opportunity to reform its public financial management systems. He called for a shift from input-based to results-based budgeting, where allocations tie directly to measurable outcomes such as antenatal coverage, immunisation rates, and maternal health improvements.

He further argued that channelling more health funds through insurance mechanisms—rather than through direct institutional subventions—would enhance efficiency and accountability. By allowing the National Health Insurance Authority and state insurance agencies to purchase services directly from providers, the system can ensure that spending links to verified results and health outcomes.

Private Sector Engagement and Health Investment

In the second segment, Dr. Mories Atoki explored how Nigeria can position health as an attractive investment opportunity for the private sector. She urged stakeholders to reframe health not as a social expenditure but as an economic enabler that drives productivity, business continuity, and national growth.

According to her, healthy populations strengthen economic resilience, reduce productivity losses, and attract long-term investment. She noted that private capital responds to value and predictability; therefore, health financing must become an investable market supported by clear data, performance metrics, and predictable returns. She also highlighted the potential of employer-based health programs, digital health innovations, and preventive care models as scalable avenues for private sector engagement.

Data, Evidence, and Accountability in Financing

In the final presentation, Dr. Davidson Biobele focused on the role of data, evidence, and transparency in strengthening accountability across Nigeria’s health system. He explained how data-driven advocacy ensures that funds allocated under the BHCPF reach the communities and facilities most in need.

He shared examples of how civil society organisations, including BudgIT, have used open data and Freedom of Information requests to track allocations to more than 8,000 primary health care facilities across the country. By linking financial flows to service delivery and health outcomes, these evidence-based monitoring mechanisms empower citizens and policymakers to demand accountability and improve system performance.

Dr. Biobele also reiterated the importance of strengthening collaboration between federal and state governments under the SWAp framework to align priorities, prevent duplication, and maximise impact.

Cross-Cutting Reflections and Call to Action

Throughout the discussion, speakers agreed that achieving Universal Health Coverage requires a mix of domestic resource mobilisation, efficient spending, private sector collaboration, and data-driven accountability. They emphasised that health financing reforms must follow clear performance metrics, robust oversight, and a long-term vision that links health investment to economic development.

The panel also highlighted broader continental trends toward health sovereignty, which position health as a national investment rather than an aid-dependent sector. In alignment with initiatives such as the Africa Health Sovereignty Summit and the Accra Reset, speakers called on Nigeria to prioritise locally driven, sustainable financing mechanisms that build resilience and reduce dependency on external funding.

The session ended with a reaffirmation of Nigeria’s potential to lead Africa’s transition toward self-reliant health financing. Participants urged policymakers to match ongoing dialogues with tangible action plans, measurable timelines, and stronger legislative support. They also recognised the role of civil society, the media, and citizens in monitoring progress and ensuring accountability at every level.

The webinar reinforced a collective understanding that investing in health—even within a limited fiscal space—is a strategic imperative for Nigeria’s future. By aligning financing reforms with economic and governance priorities, the country can build a health system that protects every citizen and promotes inclusive growth.

As Shades of Us, we remain committed to amplifying these critical policy dialogues through storytelling, advocacy, and evidence-based communication that inspire change across Africa.