Achieving Healthcare Reform in Nigeria — Learning from PharmAccess’ Initiatives

Nigeria Health Watch
5 min readApr 25, 2024
Image credit: Nigeria Health Watch

Nigeria’s health indices remain an issue of concern. The life expectancy rate is one of the lowest in the world, maternal mortality rate is 512 deaths per 100,000 live births which remains one of the highest globally and non-communicable diseases, such as hypertension, diabetes, cancer, and malnutrition, caused nearly a third of all deaths in the country.
Many challenges underpin these statistics, including:

  • The three tiers of government allocate inadequate funds to the health sector, resulting in out-of-pocket expenses for patients,
  • Under utilisation of primary health care centers nationwide, with many not functional
  • Healthcare professionals are migrating in high numbers
  • Reduced public access to health insurance

Another government, another reform
Last year, the country’s newly elected Federal Government pledged to revive the health sector by introducing the Health Sector Renewal Investment Initiative. In theory, this health sector initiative contains all the right ingredients to turn Nigeria’s poor health indices around. The initiative provides for increased investment and allocation of funds to the health sector, increased health research, and a total ramp up of local production of health products to improve health security through a Healthcare Industrialisation Programme.

It also provides for a more efficient and effective Basic Health Care Provision Fund (BHCPF) to enhance access to essential health services and advance Nigeria’s progress in achieving Universal Health Coverage. In addition to unveiling the initiative, the federal government, state government and development partners signed a Health Renewal Compact.
But many rightly ask: What makes this reform different from previous attempts?

The missing link
This renewed attention presents an opportunity for positive change in the health sector and requires a galvanising of resources, including financial and technical resources, by everyone involved. Financial resources include a budget that meets Nigeria’s commitments to the 2001 Abuja Declaration (15% of the national budget dedicated “to improve the health sector”, compared to about 5% in Nigeria’s latest budget) and releasing funds for the BHCPF.

In addition, technical resources are critical as they include the expertise of role-players such as PharmAccess, who have created pockets of change in the healthcare sector and gained valuable insights along the way.

This is a missing link in the push for such reforms — without a critical review of lessons learned over time and across interventions, the same stumbling blocks will keep tripping us up.

PharmAccess’ track record
Health insurance — PharmAccess partnered with the governments of Lagos and Kwara States to improve access to health through health insurance. During the pilot phase (2007–2016), Kwara State was the first to digitise its claims process enabling the state to successfully transition from a community-based health insurance scheme to a state social health scheme.

Image credit: Nigeria Health Watch

Training. — In collaboration with the prestigious Enterprise Development Center of the Lagos Business School, PharmAccess has provided training for healthcare providers through the Healthcare Management Programme.

Refurbishing health facilities — The Access to Finance initiative enabled the private sector to refurbish 15 dilapidated primary healthcare facilities in hard-to-reach communities in Delta State where the project was piloted. These facilities have provided quality care to an estimated 200,000 people in the surrounding communities.

Digital solutions. PharmAccess developed and deployed a mobile app for TB screening (called the Mobile Application for Tuberculosis Screening, or MATS) in collaboration with the National Tuberculosis and Leprosy Control Programme. Though Nigeria is estimated to have the sixth highest number of TB cases worldwide, the country accounts for 6.2% of the 3.1 million cases thought to be missed globally. The MATS tool enabled over two million people in 22 states in Nigeria to be screened for TB in under two years. This type of novel digital solution is one effective way to bridge the gap in the early detection of TB cases and can be expanded to cover other diseases and health system matters.

Improving quality- SafeCare, a stepwise quality improvement approach developed by PharmAccess, has been introduced in select private and private facilities across Nigeria. Visiting the Federal Medical Center Ebute Metta — which has reached the next-highest SafeCare level — shows the transformation that can be achieved in government-owned tertiary institutions. To improve health service delivery, such quality improvement programmes need to be institutionalised throughout the entire healthcare system.

Universal Health Coverage — PharmAccess Foundation in partnership with the Global Fund has contributed to the implementation of health financing models by leveraging mobile technology and pooled funds in the fight against HIV, TB and malaria in a bid to promote UHC. The former Commissioner for Health of Lagos State, Dr Jide Idris in a press statement recognised Global Fund and PharmAccess as trusted partners in the grant implementation, for optimising health insurance in the state amd using digital technology.

Maternal and Neonatal Health — PharmAccess collaborated with MSD for Mothers and the Lagos State Health Management Agency (LASHMA) to launch the MomCare (Smart Contracts for Maternity Care) project. The MomCare project combines SafeCare certification and benchmarking providers, with LASHMA IT Platform and Mother Journey (a mobile application to track pregnant women along the care process) to improve maternal and child health outcomes.

Support for Regulation Strengthening — PharmAccess has provided support for regulation strengthening including to the Pharmacists Council of Nigeria for improving peer supervision and reduction in the incidence of fake drugs.

Creating a body of critical knowledge
Identifying, unpacking, and deconstructing the impact of such interventions and, importantly, the lessons learned can help to positively steer healthcare reforms. In the coming months, we will continue to review PharmAccess’ initiatives via a dedicated blog series. The goal is clear; to identify good practices, extract lessons learned, and highlight actual and potential bottlenecks. We hope to create a body of critical knowledge that can be applied to improve Nigeria’s dire health outcomes.

Njide Ndili is the Country Director for PharmAccess Foundation Nigeria Office



Nigeria Health Watch

We use informed advocacy and communication to influence health policy and seek better health and access to healthcare in Nigeria.