The National Bureau of Statistics (NBS) reports that about 63%, or six out of every ten Nigerians, are multidimensionally poor, with health shocks ranking among the top five causes of impoverishment.
A 2023 World Bank survey titled “Welfare Impacts of Health Shocks in Nigeria” found that households hit by sudden medical events were three times more likely to fall into poverty than those unaffected.
Back in Enugu, Chinyere, a 38-year-old woman, experienced a financial nightmare when her husband slumped while returning from work last November.
He was rushed to the nearest private hospital and diagnosed with a stroke. The bills for tests, emergency care, physiotherapy, and medications totaled over N2.5 million.
“The moment he was wheeled into the emergency unit, the nurse asked for a deposit of N500,000. I had to borrow it. Then came the CT scan, drugs, and physiotherapy sessions. By the time we were discharged, all our savings were gone. My children’s school fees were unpaid,” she recounts.
On February 18, Akinbobola Folajinmi, a Lagos State resident, lost his wife, Kemi, due to pregnancy complications. In video clips that have since gone viral, he explained how he took Kemi to a medical facility along the Lagos Lekki-Epe Expressway in Ibeju-Lekki. It was an emergency, but the hospital turned them away after he was unable to deposit N500,000.
“Unfortunately, they blindly rejected us and asked me to take her to the General Hospital at Epe, even though the doctor knew that Epe from Lakwe was way too far for her condition. Before we could rush her to Epe, she was gone,” Folajinmi says.
The Health Bill Trap
For many, a single unforeseen illness or health emergency can spiral into a life-altering financial disaster—a phenomenon aptly dubbed the “health bill trap.” This trap springs from a confluence of factors, including inadequate healthcare infrastructure, the prevalence of out-of-pocket healthcare payments, families often falling into poverty after a major illness or accident, and a significant gap in health insurance coverage.
Nigeria’s healthcare system is significantly underfunded and underinsured. According to the National Health Accounts, out-of-pocket expenditure accounted for over 72% of total health spending in 2022, meaning nearly three-quarters of healthcare costs are borne directly by individuals—many of whom live on less than $2 per day.
The Lack of Health Insurance and its consequences
These stories are not isolated incidents; they reflect the reality for millions of Nigerians who lack adequate health insurance. While the National Health Insurance Authority (NHIA) aims to provide universal health coverage, its reach remains limited.
Many Nigerians are unaware of the benefits of health insurance, lack trust in insurance providers, or have had bad experiences with the system, leading to a high level of distrust.
Without insurance, individuals are forced to pay out-of-pocket for healthcare, making them vulnerable to catastrophic expenses. This reliance on direct payments creates a vicious cycle of poverty, where a single medical crisis can erase years of hard-earned savings.
The Two-Tiered healthcare system
The “health bill trap” also impacts the healthcare system itself. Overburdened public hospitals, often lacking essential resources, struggle to provide adequate care. Private hospitals, while offering better facilities, are often prohibitively expensive. This disparity creates a two-tiered system, where access to quality healthcare is determined by socioeconomic status.
- The financial burden on patients also leads to delayed treatment and non-compliance with medical advice. Many individuals postpone seeking care until their condition worsens, requiring more complex and expensive interventions. Others abandon treatment due to financial constraints, resulting in poor health outcomes and increased mortality.
- The lack of universal health coverage means patients are frequently turned away from care due to their inability to pay upfront. In Lagos, 29-year-old Blessing John was refused admission at two hospitals after developing complications because she could not immediately provide a N150,000 deposit.
“It was only at the third hospital that a Good Samaritan, who had seen me in distress, offered to help. By then, I had lost a lot of blood,” she recounts.
The health sector’s struggle to meet demand
A 2022 study by the Health Sector Reform Coalition found that 41% of Nigerians delayed or avoided hospital care due to financial constraints. This delay often results in worsened outcomes and higher eventual costs. A common coping strategy for medical emergencies is selling assets, taking loans, or crowdfunding on social media, but these come with their own costs.
“The economic fallout from a single medical bill can be generational,” notes Dr. Eze Victor, a health economist at the University of Abuja. “The health bill trap is a complex issue that requires a concerted effort from the government, healthcare providers, and the community.”
According to Dr. Victor, by addressing the root causes of this problem, Nigeria can create a more equitable and resilient healthcare system, where access to quality care is not determined by one’s financial status. “Only then can the nation truly break free from the devastating cycle of poverty triggered by medical emergencies.”
What needs to Change?
Experts believe that to prevent health-related poverty and the health bill trap, Nigeria must rapidly scale up health insurance coverage, strengthen primary healthcare, and improve emergency medical services.
“Universal health coverage is not a luxury. It’s a necessity,” argues Dr. Larne Yusuf, a medical doctor based in Lagos. “We need mandatory community-based health insurance, subsidized premiums for the poor, and a financing model that pools risks.”
- International models offer hope. In Rwanda, over 90% of citizens are covered through a community-based insurance scheme, funded partly by taxes and donor support. Ghana’s National Health Insurance Scheme, though not without flaws, has also improved access for the poor.
- In Nigeria, civil society groups are urging both federal and state governments to prioritize health insurance in their budgets and enforce existing laws.
“There must be political will,” says Dr. Yusuf. “Until healthcare is seen as a public good rather than a private burden, we will keep pushing people into poverty.”
- Mrs. Njide Ndili, PharmAccess Country Director and President of the Healthcare Federation of Nigeria (HFN), emphasized the need to focus on quality in healthcare delivery, especially as Nigeria moves toward wider insurance coverage.
“The country has passed the National Health Act, making health insurance mandatory, but the uptake remains low. Why is that?” she asked.
“Insurance is about paying in advance for a service you might need in the future. That requires trust—trust that the system will work when you need it, and that the care you’ll receive will be of good quality. If people are asked to pay for insurance but get turned away at the hospital or face poor treatment, the system breaks down.”
According to Mrs. Ndili, the key lies in improving quality across the board. “So, it’s really about building trust in the entire care experience—trust in the infrastructure, in the personnel, and the processes. One without the others leads to inconsistent outcomes,” she said.
