REIMAGINING THE FUTURE OF HEALTH FINANCING IN NIGERIA

Building Sustainable Public Finance Systems in Africa: Insights from the Live Transmission Panel

The video titled "Live Transmission - REIMAGINING THE FUTURE OF HEALTH FINANCING IN NIGERIA" from NTA Network presents a compelling panel discussion focused on strengthening public finance systems across African nations, with a particular emphasis on Nigeria.

The conversation opens with a call to prioritize domestic financial responsibility over reliance on foreign aid. The speaker emphasizes that African countries must develop taxation systems rooted in equity, where every citizen contributes according to their means. Nigeria’s tax-to-GDP ratio, currently at a low 11–12%, is highlighted as a concern, especially when compared to Southern African averages. This discrepancy signals that many Nigerians are not participating in the tax system, which undermines national development efforts.

The panelist outlines three foundational principles for effective public finance: equitable taxation, responsible borrowing, and efficient service delivery. Health, education, and security are identified as the core pillars of development. Within the health sector, the speaker introduces the “Four A’s” framework, Availability, Accessibility, Affordability, and Accountability, as essential criteria for delivering meaningful public services. These principles are illustrated with examples of how services may be declared free but remain inaccessible due to lack of infrastructure, personnel, or resources.

The conversation transitions to the importance of protecting vulnerable populations through targeted subsidies. The speaker argues that any financial system that fails to support the weakest members of society is inherently unjust and unsustainable. He advocates for pooling risks across federal, state, and local entities, as well as private actors, to build robust national health insurance schemes. This approach, he notes, is not merely technical but a strategic method of resource mobilization.

Another key point raised is the necessity of saving for economic downturns. The panelist warns that resource scarcity, whether due to falling oil prices or environmental challenges, requires proactive financial planning. He refers to these principles as the “iron rules” of public finance, asserting that adherence to them will reduce dependence on foreign aid and foster self-sufficiency.

Following this, Dr. Harry Banigo addresses legislative strategies to expand health insurance coverage from 20 million to potentially 100 million Nigerians. She acknowledges the existing funding gap and proposes increasing the Basic Health Care Provision Fund allocation from 1% to 2% of the national budget. She stresses the importance of efficient fund utilization and the implementation of accountability frameworks to prevent waste and ensure that resources reach their intended beneficiaries.

The discussion also touches on the “One Health” approach, which integrates human, animal, and environmental health to combat zoonotic diseases such as Ebola, SARS, and COVID-19. The panelists advocate for interdisciplinary collaboration and data-driven strategies to manage outbreaks and improve public health outcomes.

However, while the panel discussion in the video offers a robust framework for strengthening public finance systems in Africa, several critical perspectives appear underrepresented or entirely absent:

Citizen Engagement and Budget Transparency

The conversation emphasizes technical reforms and policy frameworks but overlooks the role of public participation in budgeting and financial oversight. According to the CABRI Seminar on public financial management (PFM), open budgets and citizen engagement are essential for legitimacy and accountability. Without mechanisms for public input, reforms risk being top-down and disconnected from grassroots realities.

Political Economy and Governance Dynamics

The panel lightly touches on legislative efforts but doesn’t fully explore how political incentives, patronage systems, and governance structures shape fiscal decisions. The IMF notes that weak legislative oversight often leads to executive dominance in budget allocation, resulting in wasteful spending on “white elephant” projects. A deeper dive into how political will and electoral competition influence financial priorities would enrich the discussion.

Institutional Capacity and Skills Gaps

While the panel calls for efficient service delivery, it doesn’t address the chronic skills shortages in budgeting, forecasting, and financial management across ministries. The ACCA report highlights that outdated systems and lack of technical expertise undermine reform efforts in many African countries. Without investing in human capital within public institutions, even well-designed policies may falter.

Gender and Equity Considerations

The discussion mentions protecting vulnerable populations but doesn’t explicitly address gender disparities in access to public services. Women, especially in rural areas, often face unique barriers to healthcare, education, and financial inclusion. Integrating gender-responsive budgeting could ensure that reforms are equitable and inclusive.

Environmental Sustainability and Climate Finance

Although the “One Health” approach briefly touches on zoonotic diseases, the broader implications of climate change on public finance, such as disaster preparedness, green infrastructure, and sustainable development, are missing. Given Africa’s vulnerability to environmental shocks, integrating climate resilience into fiscal planning is increasingly vital.

Diaspora Contributions and Remittances

Dr. Banigo alludes to diaspora engagement, but the potential of remittances and diaspora bonds as alternative financing mechanisms is not explored. These can be powerful tools for mobilizing resources and fostering transnational accountability.

In short, the panel lays a strong foundation but could benefit from a more multidimensional lens, one that includes political realities, institutional challenges, citizen voices, and global trends.

In the closing drive, the coordinating minister underscores the role of health in building social capital, especially in post-conflict societies. Public health spending, he argues, benefits the collective by preventing disease and enhancing human capital. The panel concludes with a call to action for policymakers, civil society, and citizens to work together in creating resilient and equitable public finance systems that serve all segments of society