Extract
[...] Despite the creation of the National Health Insurance Scheme (NHIS), only of the population is covered, essentially federal public sector employees. In the absence of a robust risk-sharing mechanism, more than 70% of healthcare expenses are financed by households, through direct payments ("out-of-pocket"), exposing them to a high risk of catastrophic expenses, particularly in poor regions such as Enugu or Anambra." The system's efficiency is also impaired by a fragmentation of governance (sharing of competences between the federal, state and local levels), poor budget execution (only 50.4% of credits actually disbursed in 2009), underinvestment in infrastructure, and very unequal access conditions by region. [...]
[...] Finally, the 98 municipalities are responsible for the care of health at home, prevention, and services intended for the elderly or people with disabilities, such as housing adaptation or the organization of ambulatory care. This system ensures equal and solidarity access to care, strongly limiting the remaining burden. The limited use of private financing reduces socio-economic inequalities in healthcare. The direct involvement of municipalities in prevention and patient follow-up at home also promotes continuity of care and maintains vulnerable people in their living environment. The Danish healthcare system is based on three fundamental pillars: decentralization, free basic care, and financing mainly assured by taxes. [...]
[...] The Nigerian healthcare system is largely financed by multiple international aid from various actors with divergent interests. Faced with these divergent interests, Nigeria cannot fully have control over health priorities and finds itself heavily dependent on the management lines of international donors, which creates vertical, parallel and non-integrated healthcare systems that cannot benefit the entire Nigerian population. Finally, faced with the weaknesses of public healthcare, Nigeria sees an increased growth of private healthcare, which is divided between an old and well-established confessional offer spread throughout the country and addressing everyone but especially the most disadvantaged. [...]
[...] At the same time, external actors offer their financial support for the implementation of targeted health actions within the framework of bilateral or multilateral agreements, making Nigeria even more dependent on the directives of these external donors. The Nigerian healthcare system has severe gaps, marked by some of the lowest health indicators in Africa. Life expectancy is only 53 years and infant mortality remains very high, with significant regional disparities. Malaria remains a scourge, with the country accounting for nearly a third of global deaths related to this disease. [...]
[...] The literature review also confirms this hypothesis. Nigeria is heavily dependent on international donors, who have historically financed entire sectors of the health system, particularly in the fight against malaria, HIV/AIDS, tuberculosis, and maternal health. This aid, largely verticalized, orients the country's health priorities towards specific pathologies, to the detriment of a systemic and integrated approach to health. As shown by the work of Ihekweazu and SPARC, donor interventions - although effective in certain areas - have created parallel systems that are poorly articulated with the national system, weakening the government's steering capacities. [...]
