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With the looming 2030 deadline to achieve Universal Health Coverage (UHC), there are fears that many African countries will not meet the target as specifically stated in Sustainable Development Goal (SDG) 3.8. According to the World Health Organisation (WHO), the new global UHC report revealed that over 423 million people in Africa faced financial hardship in 2022 due to out-of-pocket health spending, with over 384 million pushed into poverty. Obviously, the rising healthcare expenditure in Africa has made medical treatment inaccessible to many people. Currently, Africa accounts for more than 20 per cent of the world’s population who face hardship due to health costs and almost one quarter of global health-driven poverty.
These issues came to the fore during the marking of this year’s Universal Health Coverage Day. The WHO Regional Director for Africa, Dr. Mohamed Janabi, lamented that the cost of medical services has remained unbearable while out-of-pocket payments still dominate health financing within the African region. The 2025 UHC Day campaign theme, “Unaffordable health costs? We’re sick of it,” focuses on the lived experience behind these statistics, reminding government decision-makers that unaffordable health costs are making our communities poorer and sicker and holding us back on all the Sustainable Development Goals. The UHC Day is celebrated annually on December 12 and is promoted by the World Health Organisation (WHO).
UHC is based on the principles of equity, non-discrimination and the right to health, ensuring that the most marginalized populations are reached and covered, and no-one is left behind. While countries design their own systems, the goal is to provide essential services through strong, community-based primary healthcare. It also requires government to invest in efficient systems and address social factors affecting health. The overall goal is to ensure that health is right, not a privilege, leading to better health security and reduced poverty worldwide.
The aim of the SDG Target 3.8 is to achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. According to WHO factsheet, UHC means that everyone can access needed, quality health services—like promotion, prevention, treatment, rehab, and palliative care, without facing financial hardship or poverty due to medical bills, ensuring far access for all, especially the vulnerable, as a global goal for health equity and security. It is a core part of the Sustainable Development Goal (SDG 3.8) and involves strong health systems providing protection and essential care.
The three pillars of UHC: access to health services, financial risk protection and quality of services ensure that everyone who needs services should get them, not only those who can pay for them. They also ensure that people should not fall into debt paying for treatment and care and services should be adequate and effective.
In Nigeria, out-of-pocket health spending is a major driver of poverty, pushing millions into hardship. Studies show that significant percentages of households face ‘catastrophic’ health spending. Some estimates suggest that over 70 per cent of health expenditure is out-of-pocket, pushing millions of people deeper into poverty annually. Since Primary Health Care (PHC) is the easiest route to achieve the UHC, we urge the federal, state and local governments to provide primary healthcare facilities in all parts of the country, especially in areas where none exists presently.
Apart from providing these centres, they must be equipped and made to work efficiently. The government should intentionally address the out-of-pocket medical expenditure which drives millions of Nigerians into poverty. Unfortunately, the National Health Insurance Scheme (NHIS) launched with fanfare some years ago is not effective. Sadly, it covers an insignificant proportion of over 200 million Nigerians. Due to the inefficiency of the NHIS, the government should fashion out a new health funding model that will ensure the right to health of all Nigerians.
Our dream of achieving the UHC by 2030 will be vitiated if there are no pragmatic plans to ensure that everyone who needs health services should get them promptly. In fact, the right to health should be treated as a fundamental human right. It is not a privilege. No Nigerian should be left out of the UHC. The reality on ground now is that many Nigerians patronize faith healers and unregulated herbal healers because of the rising out-of-pocket health expenditure.
Many pregnant women give birth in faith healing homes and some illegal maternity homes instead of registered health facilities on account of rising out-of-pocket health spending. The government can offer free health treatment to vulnerable Nigerians, including the aged, pregnant women, nursing mothers and children as a way of achieving the UHC target in five years time. The unaffordable health costs should worry the government and the health authorities and they should be sick of it. Above all, no Nigerian should die because he could not afford the cost of health care services.
