For many of the participants, it was their first-ever formal training in health financing.
“These opportunities are rare for many of our staff,” said Igwe. “The knowledge we gain here will help us strengthen health insurance implementation in our states and improve access to care for our people.”
His words point to a challenge many health systems face. Health insurance does not work only because a policy exists. It works when the people managing it have the skills, tools and support to make fair and informed decisions on behalf of the beneficiaries.
In Nigeria, this is especially important. Out-of-pocket payments remain a major barrier to care. In 2023, household out-of-pocket spending accounted for about 72% of current health expenditure in Nigeria, according to the World Health Organization Global Health Expenditure Database. High out-of-pocket payments are linked to catastrophic and impoverishing health spending.
For a trader in Gombe, a pregnant woman in Ebonyi or a family caring for a child with malaria in Anambra, the way health care is financed can determine whether health care is received early, delayed or even missed altogether.
To support Nigeria’s efforts to reduce this burden, World Health Organization (WHO) in Nigeria, in partnership with the National Health Insurance Authority (NHIA) and with funding from the Global Fund, organized a four-day health financing training for 49 technical and management staff from NHIA and State Social Health Insurance Agencies in Anambra, Ebonyi, Gombe, Kwara and Lagos states.
The training supports implementation of Nigeria’s Health Sector Renewal Investment Initiative, national efforts to expand health insurance coverage and the use of the Basic Health Care Provision Fund as a key financing mechanism under the National Health Act. It also aligns with the government’s broader priority to improve health financing, strengthen primary health care and expand financial protection for poor and vulnerable people.
Before the training, a WHO-supported baseline assessment in participating states found gaps in health financing knowledge, health insurance operations and health systems management. Only 20% of SSHIA staff have received training in health financing, and at the same time, 100% of respondents expressed a strong need for the training. These gaps affected the ability of institutions to design, manage and expand insurance schemes for people most at risk of being left behind.
WHO provided technical leadership in designing the training curriculum, drawing on global guidance and adapting it to Nigeria’s reform priorities. Sessions were led by more than 20 experts from WHO Nigeria, WHO Regional Office for Africa, the Gates
Foundation, the Centre for Health Economics and Development, NHIA, the Federal Ministry of Health and Social Welfare and the Private Sector Health Alliance of Nigeria.
The training focused on practical issues faced by states. Participants discussed how to raise and manage funds, improve financial protection, purchase health services in ways that improve quality and value for money, and use evidence to guide decisions. They also looked at how health financing connects with integrated service delivery, health security, climate resilience and digital systems.
“Knowledge must lead to action and impact on the population we serve,” said Dr Francis Ukwuije, WHO Nigeria health financing technical officer. “Our aim is to support the government and institutions to use evidence-based practical tools to improve financing decisions that have the best value for money and help more people access quality essential services.”
At the end of the programme, participants completed post-training assessments with the mean score increasing from 58% before the training to 61% after the training. With 64% of participants who improved in their scores, and a statistically significant paired t-test (t(32) = 3.64, p < 0.001), there is evidence that the increase in scores demonstrated that the training had a positive impact on participants' knowledge of key concepts of health financing and health insurance.
The immediate outcome is clear: 49 (21 females, 28 males) staff from federal and state health insurance institutions completed the WHO innovative health financing training and are better prepared to support insurance implementation in their states. The expected outcome is stronger state capacity to manage insurance schemes, improve decision-making and support coverage for poor and vulnerable groups, including women, children, persons with disabilities and people in rural communities.
NHIA Director-General Dr Kelechi Ohiri, represented by Aliyu Mohammed, said the work reflects the shared responsibility of government, WHO, the Global Fund, state agencies and partners to expand health insurance coverage. “The progress we have made shows what is possible when people and institutions work together for the common good,” said Ohiri.
Representing the WHO Representative in Nigeria, Dr Mary Nana Ama Brantuo acknowledged progress made by the Government of Nigeria in expanding health insurance coverage and reaffirmed WHO’s technical support in line with national priorities. “This training is part of a broader effort to strengthen the systems that make universal health coverage possible in Nigeria,” she said. “By investing in people and institutions, WHO supports lasting improvements in financing access to quality health services for all, especially those most in need.”
The initiative is part of the learning agenda of the Global Fund-supported Resilient and Sustainable Systems for Health pilot project on vulnerable populations coverage and the full integration of HIV and tuberculosis services into state health insurance schemes in Nigeria. It also demonstrates WHO’s commitment to translating global norms and best practices into country-led action, fostering peer learning and supporting governments to build resilient, equitable and people-centred health systems.
For participants, the next step is to apply the learning in their states. This includes strengthening insurance operations, improving planning, supporting long-term approaches to financing health services and ensuring that vulnerable people are considered in decisions.
Continued investment in health financing capacity and collaboration across federal and state institutions will be important for Nigeria’s progress towards universal health coverage.
For Igwe and his colleagues, the training was not only about policy. It was about helping build a system where more people in communities can get quality health care when they need it, without fear of financial hardship.
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