Universal Health Coverage in Nigeria: Why the Private Sector is Key to Sustainability
As global development aid continues to decline, the need for sustainable, locally driven health solutions has never been more urgent.
This trend is particularly concerning in countries like Nigeria, where international donors have long supported large-scale interventions, ranging from immunization programs and maternal health initiatives to HIV/AIDS treatment, malaria prevention, and health systems strengthening.
These efforts have helped drive significant improvements, yet they have also fostered a dependence that leaves health systems vulnerable as aid diminishes.
The recent USAID stop-workorder underscores the urgency of addressing this issue. The freeze in foreign aid has created a significant gap, leaving millions of Nigerians who rely on the services at risk.
While the Nigerian government has allocated funds to offset the loss, it is clear that more robust solutions are needed to ensure continuity in care. Without urgent, strategic action, the collapse of aid-dependent systems could reverse decades of progress, leaving vulnerable populations without essential care.
The pressing question then is this: how can we preserve and build upon past health gains in an era of shrinking global assistance?
One clear answer lies in unlocking the full potential of Nigeria’s private health sector. According to the World Health Organization (WHO), Nigeria’s private health sector delivers over 60%of healthcare services, making it an indispensable force in the country’s health system.
However, despite its crucial role, the sector remains underutilized and fragmented, hampered by regulatory hurdles, policy inefficiencies, and lack of support. While the private sector already provides essential services across preventive, curative, and rehabilitative care, it needs a supportive environment to achieve systemic integration and long-term sustainability.
In other African countries as well, the private sector is already playing a significant role in healthcare delivery. In Egypt (North Africa), over 60% of healthcare services are delivered by the private sector,contributing significantly to the country’s Universal Health Insurance Law aimed at covering all citizens by 2032.
As of 2014, over 90% of the population in Rwanda(East Africa) was covered by community-based health insurance, with private providers fully integrated into the health financing model, thereby expanding access.
Also, South Africa (Southern Africa) has nearly 16% of its population enrolled in private medical aid, with the private sector responsible for almost 50%of national health expenditures.
In Ghana (West Africa), the National Health Insurance Scheme (NHIS) covers approximately 40% of the population, and according to the 2017 Ghana Living Standards Survey (GLSS7), the private health sector accounts for 51.7%of health consultations in the country.
This widespread involvement of the private sector in healthcare across the continent demonstrates its vital role in meeting the healthcare needs of African populations.
In Nigeria, despite the country’s commitment to the Abuja Declaration of 2001, the healthcare sector has consistently received a smaller portion of the national budget, with healthcare spending representing only 5.03% of total expenditure.
This shortfall, combined with increasing out-of-pocket costs, underscores the urgent need for a more robust and equitable health financing strategy to bridge the gap in coverage and improve access to essential services.
The real opportunity now lies in governments tapping into the private sector to fill the gap left by diminishing aid.
Source: World Bank, World Development Indicators & Global Health Expenditure Database
Barriers to Private Sector Participation
For the private sector to meaningfully bridge the widening gaps left by diminishing donor aid, it must be empowered to operate effectively and sustainably. While private providers already play a significant role in delivering care, their capacity to scale and innovate is held back by a challenging operating environment.
Some of the most pressing challenges include:
- Lack of basic infrastructure such as electricity, water and qualified human resources for health due to “Japa syndrome”
- Non-implementation of the National Health Act, which does not provide a pool of insured personnel
- Importation bottlenecks on medical supplies and life-saving equipment
- Delays in product registration with regulatory bodies
- Poor access to foreign exchange, affecting the cost and availability of essential medicines and devices
- Rigid regulatory frameworks built primarily around public sector needs
These challenges create significant barriers to scale, they inflate costs and discourage innovation. The private sector can play a much larger role in healthcare delivery, but it requires intentional government intervention through policy reforms that integrate the sector into national health strategies.
Harnessing Private Sector’s Full Potential – Zero Maternal Deaths and a 99% Drop in Child Mortality
One of the most effective ways to harness the private sector’s full potential is through deliberate, well-structured public-private partnerships (PPPs). These collaborations allow governments to tap into the agility, innovation, and reach of private healthcare providers while ensuring alignment with national priorities.
In Nigeria, successful PPPs have already demonstrated the power of collaboration. A notable example is the Access to Finance (A2F) Scheme, launched by the Delta State Contributory Health Commission in partnership with PharmAccess and the Healthcare Federation of Nigeria(HFN).
This initiative revitalized primary healthcare centres (PHCs) in underserved regions by leveraging private sector investment and expertise, resulting in improved service delivery and
The Impact Evaluationconducted after 3 years of implementation evidenced significant successes, including zero maternal mortality in all the PHCs managed under the scheme, 24-hour availability of clinic personnel, an under-five mortality rate of 0.7 per 1,000 live births—compared to the state average of 53 per 1,000.
The project saved over N211 million as a result of private-sector investments during that period. The A2F Scheme amongst several others showcase the power of the private sector in closing the gap in service delivery both in the urban and rural areas.
However, the appropriate enabling environment and policies need to be put in place to enable scale of proven frameworks.
Connecting the Dots: A Unifying Platform for Private Sector Meaningful Engagement
As a coalition that brings together private healthcare associations, private institutions, development partners and interested individuals, the Healthcare Federation of Nigeria has been at the forefront of advocating for the policy reforms needed to create an enabling environment for the private sector to lead in health system transformation.
Healthcare Federation of Nigeria provides a unifying platform for the private sector to engage meaningfully in the health ecosystem.
These, among many other achievements, are more than just technical milestones—they serve as strategic mechanisms for reducing health inequities and expanding access to care, especially for underserved populations. But more needs to be done. Without bold policy shifts, the fragmentation, inefficiencies, and missed opportunities within the health system will persist. With the right environment, the private sector can deliver far more.
Beyond Advocacy: Medical Tourism, Diagnostics and Patient Tracking
The private sector in Nigeria is already driving progress through innovation, service delivery, and digital transformation. Private hospitals such as Paelon Memorial, EuraCare, Lakeshore Hospital, Iwosan Lagoon Hospital are attracting medical tourism into the country, while private clinics are filling gaps in primary care.
Health tech startups such as Carepay, MobiHealth, and Mymdoc, are improving diagnostics and patient tracking. Health Maintenance Organizations (HMOs) are expanding insurance coverage to low-income earners. These innovations are scalable and can reach more people faster, but they require an environment that fosters collaboration, not competition with public institutions.
Conclusion
The future of UHC in Nigeria hinges on embracing the private sector as a strategic partner—not a peripheral player. As international aid recedes, Nigeria has a unique opportunity to redefine its health system through bold, inclusive reforms that unlock the private sector’s full potential. With over 60% of healthcare services already delivered by private actors, empowering this sector is not just an opportunity—it is essential.
With platforms like HFN leading the charge, Nigeria has a blueprint for how to engage the private sector meaningfully. Through the right policy frameworks, public-private partnerships, and an enabling business environment, the private sector can drive innovation, expand access, and ensure the continuity of care for millions. The groundwork has been laid through advocacy and successful pilot programs, but scaling these efforts requires sustained political will and collaboration across sectors.
