An Appraisal of National Healthcare Financing in Nigeria: A Narrative Review

Abstract: Nigeria’s healthcare financing system has undergone several reforms aimed at advancing universal health coverage, yet persistent structural weaknesses continue to undermine equitable access and quality of care. Fragmented funding sources, chronically low public expenditure, and heavy reliance on out-of-pocket payments have sustained financial barriers and poor health outcomes. This narrative review appraises the current landscape of healthcare financing in Nigeria by examining its structure, major funding sources, operational effectiveness, and the policy constraints that limit access and service quality. Using a narrative synthesis of academic literature, policy documents, and institutional reports published between 2000 and 2024, relevant evidence was retrieved from databases including PubMed, Google Scholar, and Scopus with search terms related to healthcare financing, the National Health Insurance Scheme, out-of-pocket payments, and universal health coverage. The review reveals a system dominated by direct household payments, limited insurance coverage, and underdeveloped pooled financing mechanisms. Key challenges include weak governance structures, inadequate political commitment, insufficient budgetary allocation to health, and low public awareness of insurance schemes, alongside a persistent emphasis on curative rather than preventive services. These dynamics perpetuate inequity and expose households to catastrophic health expenditure. Strategic restructuring is therefore required to achieve equity, efficiency, and sustainability, with priorities including increased government investment, expanded insurance coverage, and context-sensitive financing innovations supported by strong policy enforcement, stakeholder collaboration, and public health education. Keywords: Healthcare financing, Nigeria, NHIS, Out-of-pocket payments, Universal health coverage, Health policy,