The road to UHC passes through gender responsive health systems: the case of WGH Nigeria

23 September 2024

Being the most populous country in Africa, with an estimated total population of 216 million, Nigeria faces multiple challenges to achieve Universal Health Coverage by 2030, in line with global SDG commitments. 

Nigeria currently ranks 157 of 167 countries in health system performance. The Nigerian public healthcare system is delivered through a three-tier arrangement system, ranging from primary level, mainly delivered through the community-based primary healthcare centres (PHCs), secondary in the state-owned or run health facilities, all the way to tertiary level care, where advanced services like cancer care and complicated surgeries are provided through tertiary and teaching hospitals. 

A glance at the Nigeria health system

UHC is a core theme in the national plan to deliver health, however the path to UHC for Nigeria is not without its challenges. These include financial, infrastructure and structural barriers, leading to poor health outcomes for the population, but also significant disparities in the more marginalized populations. For example, women in the rural areas often bear a double burden of facing barriers brought about by a confluence of patriarchal cultural norms, little access to education, lack of financial autonomy and lack of strong political participation.

The country’s health budget is often insufficient to provide adequate, affordable and wide-covering health services to its significant population. Instead of access to health insurance and financial protection, most Nigerians still purchase health care with personal, out-of-pocket funds leading to further impoverishment. Health infrastructure deficiencies are widespread, with many public-intended facilities lacking essential equipment and supplies, particularly in rural areas, where they are most needed. Service delivery suffers a significant shortage of healthcare professionals with doctors and nurses/midwives being shown to be 38.9 (1:2572) and 148 (1:677) per 100,000 population. 

The brain drain of health workers into other health systems means that even when available, the remaining overworked health workers have to contend with inadequate infrastructure, and with the continued loss of medical experience and talent. There is a lack of sufficient training to ensure that quality health care services are delivered. 

Nigeria’s strategy and progress on UHC

Nigeria’s National Health Act, enacted in 2014, laid the foundation for UHC by establishing the Basic Health Care Provision Fund (BHCPF). The BHCPF is funded by a multi-source contribution from the Federal government 1% of the national budget allocation, a matching proposed 25% by state and local governments, donors, partners and other private sector stakeholders. The World Health Organization (WHO) along with many other global, bilateral and multilateral actors, are examples of many technical partners supporting the vision of UHC attainment in Nigeria 

This fund, then managed by the NPHCDA (National Primary Healthcare Development Agency) aims to ensure that UHC Service delivery is implemented through a quality and functional PHC system. The primary health care facilities will be revitalized and sustained to ensure access and availability of preventive and basic curative services to the population, while also ensuring financial protection.

The inclusion of maternal and child health services as key components of the BHCPF underscores the government’s commitment to gender-responsive health care, including prioritizing gender-responsive health care as a cornerstone of their UHC strategy. 

As an example, one of the core health targets under this strategic funding is the health of women and children, through responsive sexual and reproductive health delivery, provision of nationwide skilled birth attendants, improved antenatal and immunization coverage. 

Human resources to deliver quality health services has also been gender aligned as health workers in the PHC system are made up of more than 75% of women delivering primary health care services as primary health care workers.

In implementation design, women are also key health service recipients, so special attention has been given to training health care workers on gender-sensitive care, making these centers more welcoming and effective for women. 

To overcome financial barriers to healthcare access, instead of exposure to impoverishment by out of pocket payments, Nigeria has implemented community-based health insurance schemes (CBHIS) to cushion the impact of health care costs. 

These schemes have been particularly beneficial for women and the rural-living, who often have less financial autonomy. By pooling resources at the community level, CBHIS ensures that women can access health care without the burden of out-of-pocket expenses. The schemes also educate communities on the importance of health insurance, fostering a culture of shared responsibility for health.

WGH Nigeria’s ethos and focus

Since its inception in 2020, Women in Global Health Nigeria has been a steadfast advocate for a more equitable and gender-responsive health system. Our efforts aim to highlight the contributions of Nigerian women in shaping global health programming, policy, and advocacy both domestically and internationally, ensuring they receive the recognition they deserve.

The Chapter is inclusive, welcoming individuals of all genders, career stages, and levels within the healthcare space, regardless of their background. This commitment to inclusivity is central to our understanding of gender transformative leadership. We believe that gender-responsive health systems are essential for achieving Universal Health Coverage (UHC) and have made this a priority focus.

Advocacy for UHC and gender equality

In the lead-up to the High-Level Meeting on Universal Health Coverage (UHC) at the UN General Assembly in 2023, WGH Nigeria actively advocated for gender equality in health through various high-profile engagements. Here are some key examples:

1. Social Norms Conference: As a technical partner at the Social Norms Conference in September 2023, we emphasized the importance of gender mainstreaming in development programming to ensure that health interventions are inclusive and effective for all. We facilitated an interactive discussion on a panel discussing the challenges and potential solutions in ensuring that gender is mainstreamed into development programs. 
2. Women in Leadership: We supported the Women in Leadership Action Network (WILAN) meeting in June 2023 to empower mid-career women in global health leadership. This initiative aimed to provide women with the necessary skills and opportunities to advance their careers and contribute to shaping health policies and programs.
3. Global Leadership: We participated in a Bill and Melinda Gates Foundation convening in June 2023 to discuss strategies for promoting female leadership in global health. This engagement allowed us to share our experiences and insights and contribute to developing innovative approaches for advancing women’s leadership in Nigeria, and globally. 
4. World Health Assembly: Bukola Shaba represented Nigeria at the World Health Assembly in Geneva, advocating for gender equality and UHC. Her participation was instrumental in raising awareness of the critical importance of gender-responsive health systems and in urging member states to commit to delivering on their promises made at UNGA 2019.
5. Community Health Workers: WGH Nigeria sponsored the National Association of Community Health Workers Conference in November 2023 to support frontline health practitioners, primarily women. This initiative aimed to recognize the invaluable contributions of community health workers and to advocate for improved working conditions and greater investment in their training and development.
6. National Health Leadership: We engaged health leaders at the National Council on Health meeting in November 2023, disseminating insights from the “State of Women in Health Leadership” report. This engagement provided an opportunity to raise awareness of the challenges and opportunities facing women in health leadership and to advocate for policy changes to promote gender equality in the health sector.
7. UN General Assembly: Dr. Amina Dorayi discussed UHC and aligning health investments post-COVID at the 2023 UN General Assembly. Her participation helped to keep UHC on the global agenda and to advocate for the necessary investments and policy reforms to achieve this critical goal.

As WGH Nigeria continues to follow up on the member state commitments made during the 2023 High Level Meeting, we remain committed to our advocacy work to ensure that gender-responsive health systems remain a priority for our country. 

In the words of Dr. Amina Aminu Dorayi, “Through gender transformative policy change, more women will be in decision-making positions to challenge harmful gender norms and make the world more equitable for everyone, everywhere.”