“A lack of medical solutions does not primarily constrain Nigeria’s health outcomes; instead, they are constrained by financial barriers to access. The absence of financial protection forces families into impossible choices, stigmatises those unable to pay, and entrenches reliance on unsafe alternatives.
Protecting people from financial hardship is central to safeguarding their dignity, autonomy, and right to quality healthcare.”
Danjuma Adda, Founder/Executive Director of the Centre for Initiative and Development (CFID), Nigeria
On the occasion of UHC Day 2025, under the theme “Unaffordable Health Costs? We’re Sick of It!”, Danjuma Adda – Founder/Executive Director of the Centre for Initiative and Development (CFID), Nigeria and member of the CSEM Advisory Group – shared why advancing financial protection is crucial in Nigeria and what actions leaders must take now.
From your perspective, why is financial protection essential for advancing UHC in your context or area of work?
Across various communities in Nigeria, healthcare financing is considered the strongest determinant of health equity.
In most of our communities, healthcare financing decides who lives and who dies, among patients with chronic disease conditions. It determines who gets quality care and who is left behind. It influences who receives care, the quality of services available, and the conditions under which people access them. In most healthcare facilities where costs are high and borne directly by patients, the system becomes stratified: those with resources move through the system quickly, receive comprehensive care, and benefit from respect and attention. Those without resources face delays, limited services, and – too often -avoidable complications.
This dynamic erodes trust, fuels inequity, and undermines the principle of UHC.
Financial protection serves three essential policy functions:
- Equity: ensuring access is based on clinical need, not ability to pay.
- Efficiency: promoting early care-seeking and reducing expensive late-stage complications.
- Dignity: protecting patients from the shame, stigma, and loss of self-worth that arise when they cannot pay for basic tests or medicines.
For many Nigerians, especially women, youth, informal sector workers, and people living with chronic conditions like HBV and NCDs, financial protection is not an abstract concept – it determines whether they can enter the health system at all.
How does the lack of financial protection affect people’s access to health in your region? Can you share an example or observation that illustrates this human impact?
I would like to share a story that illustrates how financial barriers forced one family into difficult decisions with devastating consequences.
Wisdom, a young farmer and primary school teacher, was on his farm with his wife when he felt a sharp pain on the upper-right side of his chest. He left the farm work to return home. This pain persisted, and after much persuasion from his wife, Wisdom visited the nearest primary healthcare facility, where a Community Health Extension Worker attended to him. He was given some pills and asked to take some rest from farm work. Wisdom’s health deteriorated with persistent fever, and later he developed jaundice. He decided to visit the general hospital in the local government capital. After running some diagnostic tests, Wisdom was informed he had hepatitis B and was referred to conduct further diagnostic tests in the state capital, 200 km away from his home town of Kumbo.
Wisdom had to wait for his monthly salary to be paid before travelling to Jalingo, the state capital. At the Federal Medical Centre, Jalingo, Wisdom, after spending three days, was attended to by a doctor and asked to run further diagnostic tests that cost over $150 (three times the amount of his monthly salary), while the drugs he was prescribed cost him about $55. He managed to buy half of the medicines and was barely left with his transport to return home. He was unable to pay for the tests that would have determined his eligibility for therapy. He returned home and received care using alternative herbal medicines.
Twelve months later, Wisdom had repeated, persistent fever, jaundice and his stomach started swelling, until one fateful day when he fainted and was rushed to the tertiary hospital in Jalingo. The doctors resuscitated him and conducted some blood and imaging. The results came out-he had liver cancer, he was discharged after nine days in the hospital and referred to another tertiary hospital to see a liver expert. Five months after the liver cancer prognosis, Wisdom passed away, leaving behind his young wife and a three-year-old daughter and lots of medical debts to pay.
High out-of-pocket costs drive many people living with HBV, hypertension, diabetes, and other chronic illnesses toward self-care, unregulated herbal treatments, or complete disengagement from the health system.
What are the most urgent actions world leaders / national leaders must take to protect people from catastrophic and impoverishing health costs?
World and national leaders must commit to eliminating out-of-pocket payments for essential health services by increasing domestic financing, strengthening primary healthcare, expanding insurance coverage, and guaranteeing access to critical medicines at all levels of care.
Priority actions include:
- Fully funding a national benefits package that covers diagnostics, medicines, and chronic disease management.
- Removing point-of-care fees for maternal, newborn, and child health services.
- Expanding prepayment and pooling mechanisms, especially for the informal sector and rural populations.
- Financing hepatitis B, NCD, and other neglected service areas, where patients currently bear nearly all costs.
- Investing in primary healthcare systems that deliver equitable and affordable care close to communities.
These policy shifts are necessary to prevent catastrophic expenditures, reduce preventable mortality, and ensure that UHC becomes a lived reality – not a political aspiration.
