Nigeria's financing of health care during the COVID-19 pandemic: challenges and recommendations

An analysis of the financing of Nigeria’s health care system in response to the COVID- 19 pandemic, using three key health care financing indicators: revenue collection, pooling, and purchasing was conducted. Nigeria projected that it would need US$330 million to control its COVID-19 pandemic. However, it raised more than US$560.52 million, of which more than 90% came from the private sector and the donor/philanthropist community. The pooled COVID-19 fund is mainly being expended on temporary public health and clinical care measures, with little invested to strengthen the health system beyond the pandemic. The poor turn-around time for COVID-19 test results and the huge stigma associated with the disease results in most persons with mild to moderate symptoms seeking care from alternatives to the healthcare institutions designated for COVID-19 health care. The huge out-of-pocket expenses, and the inability of most Nigerians to earn money because of measures instituted to contain the pandemic, will likely cause many Nigerians to become economically impoverished by the COVID-19 pandemic. COVID-19-related commodity procurement was least responsive to the needs of those most in need of care and support. The government needs to institute several fiscal policies to improve funding of the health sector. These include taxing of diaspora remittances; swopping debt reduction for domestic investment in health systems; auctioning or sale of emissions permits; trading of Special Drawing Rights; effective collection of corporate and business taxes; and addressing cross-border tax fraud, evasion, and avoidance. Immediate response to ease the financial impact of COVID-19 is inclusion of COVID-19 management in health insurance packages and increase in domestic government health spending to at least 5% of gross domestic product. The long years of neglect of the health system in Nigeria makes it unprepared to meet the demands that COVID-19 has placed on it. Multiple mechanisms for resourcing healthcare are still open to the government of Nigeria. Universal health coverage should be a priority response as a measure to mitigate the impact of COVID-19, especially on the most vulnerable citizens.