Outside a public clinic in Abuja’s Galadimawa district, Dorcas Joseph clutched an unaffordable hospital bill, a stark reminder of one of Nigeria’s healthcare challenges.
Joseph approached this reporter in desperation, seeking financial assistance to cover a medical bill exceeding N30,000 for her two-year-old child’s treatment, which included essential medications and intravenous fluids.
Overcome with distress, she pleaded, “I need to pay for these treatments so the hospital can start treating my baby.”
Vulnerable Group Fund can’t help
Millions of Nigerians, including Joseph, were promised financial relief from healthcare costs through the Vulnerable Group Fund, designed to support those struggling to afford medical care.
Established under the National Health Insurance Authority Act 2022, this fund aims to provide safety nets for vulnerable citizens who face poverty while seeking healthcare. It targets 83 million Nigerians, offering them critical financial support to access essential medical services without incurring crippling expenses.
The Vulnerable Group Fund was hailed as a ground-breaking initiative to enhance healthcare access for Nigeria’s most vulnerable populations.
The Fund is designed to subsidise health insurance coverage for vulnerable individuals and cover premiums for the indigent.
This includes people with disabilities, refugees, survivors of human trafficking, pregnant women, the elderly, and other children under five.
Nigeria is home to approximately 31 million children under the age of five, with a staggering 75 percent living below the poverty line, according to United Nations Children’s Fund (UNICEF).
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The country shoulders a significant burden of under-five mortality, where poverty is a major contributing factor.
Two years on, the Vulnerable Group Fund remains dormant due to funding hurdles and incomplete implementation frameworks.
An National Health Insurance Authority (NHIA) official acknowledged that although the Vulnerable Group Fund has been formally established, it remains inactive due to a lack of financial appropriation from the federal government.
Despite the lack of clear communication from the Ministry of Health and the NHIA on the activation timeline for the Vulnerable Group Fund, eligible Nigerians are directed to register via a link on NHIA’s website.
However, this link currently redirects to an error page.
Furthermore, the government has yet to establish the governing council, a crucial body required by sections 27 and 28 of the Act to oversee the Vulnerable Group Fund and ensure accountability.
Amongst other responsibilities, the council is tasked with formulating and submitting criteria to the health minister for approval, outlining how subsidies will be disbursed to state health insurance schemes for the healthcare needs of vulnerable and indigent Nigerians.
The council is also responsible for defining the criteria to identify indigents in Nigeria, establishing a formula for disbursing funds, and issuing directives to the NHIA on managing the Vulnerable Group Fund.
In managing the Fund, the council will develop and implement policies to meet its objectives, as well as approve procedures for collecting lawful contributions to the fund.
Vulnerable Nigerians, lacking insurance, face immense hardship as they struggle to afford spiraling healthcare costs. With inflation exacerbating the price of essential goods and services, healthcare has become an unaffordable luxury for many.
BusinessDay’s investigation reveals that clinic and hospital visits have become substantially more expensive, with basic consultations, tests, and medications imposing an unsustainable financial strain on low-income families.
Furthermore, the cost of common medications for conditions such as malaria and diabetes has more than tripled.
Experts warn that the lack of safety nets in the health sector is worsening healthcare inequities, with vulnerable groups disproportionately affected.
The World Health Organization emphasizes that shielding individuals from the financial burden of out-of-pocket healthcare expenses helps prevent them from being pushed into poverty.
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The WHO has cautioned that a significant portion of the population—potentially up to 80 percent—risks falling into poverty due to illness or healthcare costs.
Nigeria’s health insurance penetration is still low despite reforms. A report published October, 2024 entitled, ‘Leveraging Economic Development through Human Capital in Nigeria: The Roles of Foreign Direct Investment and Health,’ by the African Economic Research Consortium revealed that only five percent of Nigeria’s 208 million had health insurance in 2022. However, the NHIA says up to 18 million Nigerians are now covered by insurance.
Need for urgency
Adaobi Onyechi, a public health expert, has urged the government to accelerate implementation of the National Health Insurance Act, emphasising that health insurance is crucial for achieving universal health coverage and reducing healthcare disparities.
Despite the Act’s passage, efforts by the 9th National Assembly to incorporate the Vulnerable Group Fund into the 2023 budget were unsuccessful.
The Ministry of Finance explained at the time that the VGF could not be accommodated because there were still unutised funds in the health sector.
Also, allocation to the fund is notably absent from the proposed N54.6 trillion 2025 budget currently before the National Assembly.
In the 2024 budget, a N5 billion allocation was made for “contributions to vulnerable groups for catastrophic expenditure,” though it remains unclear whether this is specifically earmarked for the Vulnerable Group Fund.
The sources for the Fund include: Basic Health Care Provision Fund to the Authority; health insurance levy; Special Intervention Fund allocated by the government and appropriated to the Vulnerable Group Fund; money that accrues to the Vulnerable Group Fund from investments made by the council that would oversee the Fund; and grants, donations, gifts and any other voluntary contribution made to the Vulnerable Group Fund.
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