Integrating family planning into Nigeria’s public health insurance: Challenges, opportunities, and feasibility for enhanced primary health care

In Nigeria, integrating family planning (FP) into essential benefits package under public health insurance is pivotal to improving reproductive health and combating poverty. The government’s commitment to achieve 90% health insurance coverage by 2030 presents a timely opportunity to expand FP access and affordability. Through policy analysis, stakeholder interviews across 11 states, and a multi-stakeholder roundtable, we identified key barriers including inadequate and inefficient public financing, donor over-reliance, weak procurement, and workforce shortages. While some states have integrated FP, coverage remains fragmented with variations in services offerings. Key stakeholders advocated for comprehensive integration of FP services into primary healthcare and public health insurance, ensuring access to education, counseling, and a full range of contraceptives. Services were proposed to be tiered as primary (for all facilities) and secondary (for advanced facilities). Sustainable integration shall require a phased approach with necessary insurance premium adjustments. A blended payment model combining capitation and fee-for-service was recommended for provider compensation. Addressing the shortage of skilled FP providers, particularly for long-acting reversible contraceptives, requires training programs like the Community-Based Health Research Innovative Training and Services Program to equip frontline health workers. These actions can support integration, ensure equitable contraceptive access, and advance Nigeria’s health sector reforms.