Nigeria’s health financing reform, anchored on the Sector-Wide Approach (SWAp), is gaining global traction as government and development partners rally behind efforts to improve accountability, reduce fragmentation, and deliver quality healthcare for citizens.
At a national policy dialogue on health financing yesterday in Abuja, senior representatives from the World Bank, UNICEF, the Foreign, Commonwealth & Development Office (FCDO), the Bill & Melinda Gates Foundation, Gavi, the Vaccine Alliance, and the SWAp Coordination Office outlined how reforms could reshape Nigeria’s health system over the next five years.
Dr Owen Smith, Lead Health Specialist at the World Bank, said stronger public financial management (PFM) would be central to results.
“If the National Health Insurance Authority tells states to pile up receipts for safe deliveries and we will reimburse you, we will stop seeing tragic cases where women die because they cannot afford care.
“PFM is about how you build, implement, and execute budgets. If Nigeria gets this right, other countries will come here in five years to learn what was done well,” Smith said.
He urged Nigeria to move away from fragmented financing approaches and adopt a sequenced strategy, prioritising reforms over defined periods.
He warned that duplication and gaps in current spending patterns reduced efficiency, adding that limited political and financial capital must be carefully channelled to maximise health outcomes.
FCDO’s Senior Health Adviser, Mr Dave McConalogue, said the future must be about ownership, not aid dependency.
“Official development assistance is not a lifestyle; it is about supporting a country under its own leadership. Success is when donors step back and the government takes full ownership.
“In five years, I would like to see Nigeria in a position where partnerships are less about aid and more about knowledge transfer,” McConalogue said.
He called for a cultural shift in the way development partners supported Nigeria’s health sector, urging greater alignment with government priorities through SWAp.
He added that moving away from siloed interventions toward pooled funding and coordinated technical support would make aid more effective and sustainable.
Deputy Director for Health and Nutrition, Ethiopia Office, Bill & Melinda Gates Foundation, Mrs Susna De, described SWAp as an opportunity to accelerate impact.
“We hope that Nigeria’s SWAp becomes so successful that beyond strengthening institutions, it accelerates life-saving innovations for women and girls.
“Nigeria’s federated model makes this one of the boldest SWAp reforms globally, and its success could inspire other large countries,” she said.
She called for institutionalisation of reforms, urging expansion of Nigeria’s donor base beyond traditional partners.
She noted progress in reducing fragmentation and strengthening annual operational planning but cautioned that sustaining momentum would require co-financing with states, improved PFM, and attracting new actors such as philanthropies, diaspora groups, and the private sector.
Policy and Advocacy Manager at Gavi, Ms Keightley Reynolds, the Vaccine Alliance, said Nigeria has the potential to become a regional exemplar.
“Today, we have one delegation coming to learn from Nigeria; in five years, let’s have 20. Small reforms at the state level, particularly in PFM, could dramatically improve service delivery and quality of care,” Reynolds said.
She urged Nigeria to strengthen budget credibility and adopt sustainable vaccine financing mechanisms to secure long-term immunisation programmes.
She added that the gap between budget allocations and actual revenues undermined planning, stressing the need for credible revenue models, realistic budgeting, and joint planning between health, finance, and budget ministries.
Reynolds also backed proposals for a first-line charge for essential public health commodities to guarantee timely funding.
Senior Health Specialist at UNICEF Nigeria, Dr Alex Adjagba, likened PFM to the heart of the health system.
“The way blood flows through the body is the way PFM works for the health sector. Without it, no matter how much money you raise, results will not come. UNICEF has been working with states to map bottlenecks so that resources flow efficiently from federal to local levels,” he said.
Adjagba warned that without a reliable PFM system, donor and government funds would fail to achieve results.
He stressed thath sustainable financing would require stronger accountability and integration of resources through mechanisms like the National Health Insurance Authority (NHIA).
On the government side, Dr Muntaqa Umar-Sadiq, National Coordinator of the SWAp Coordination Office, said the reforms were aimed at improving visibility of spending and building accountability.
“We are introducing a more disaggregated chart of accounts to track spending on human resources, commodities, and key delivery indicators.
“This will enable states to access resources, hold themselves accountable, and strengthen co-financing mechanisms.
“With one budget and one plan, both federal and state governments can align to drive results,” he explained.
He said reforms, such as a more detailed chart of accounts would improve visibility of health spending, strengthen accountability for results, and enable states to access resources under the Health Optimisation for People Everywhere (HOPE) operation.
The partners agreed that Nigeria’s SWAp represents a turning point — shifting from fragmented donor projects to a unified platform where government leads, partners align, and citizens benefit.