As a Nigerian, if you scroll through social media on any given day, there is a high chance you will find the same genre of post: a photograph of a sick relative or acquaintance, an account number in bold, and a plea for strangers to fund a surgery or another medical intervention. Medical crowdfunding has become the country's unofficial health insurance scheme. That is not a testament to Nigerian generosity, although we have plenty of it. It is an indictment of a financing system that has outsourced the basic business of keeping people alive to the goodwill of the public.
There is a law that was ideally designed to end this arrangement. It is called the National Health Act, and its Basic Health Care Provision Fund (BHCPF) is the country's first statutory mechanism for financing primary healthcare. There is also a bill, already passed by one chamber of the National Assembly, to double that fund. The chamber that has not acted is the House of Representatives.
The Senate Did Its Part
Credit must be given where it is due. On April 23, 2026, the Senate passed the National Health Act (Amendment) Bill, 2026 (SB 886), sponsored by Senator Ipalibo Banigo, raising the BHCPF's share of the Consolidated Revenue Fund from one per cent to two. The journey was not frictionless: the bill cleared second reading in October 2025 and then sat in committee well beyond the timeline Senate leadership had reportedly set, until sustained civil society pressure helped move it. But it moved, it passed, and the Senate has been able to say, accurately, that it has done its part.
That sentence cannot be said of the House.
A Promise Made, a Promise Parked
In its Legislative Agenda, the 10th House of Representatives named health a priority and pledged to address the funding problem in the sector by amending the National Health Act to increase the BHCPF. That is not a promise made in passing; it is a written commitment, and it is one that AdvoKC has tracked since the beginning of this Assembly.
Nearly six months after the Senate's vote, the bill is still waiting for the House's concurrence. By September, reporting by Nigeria Health Watch indicated that the bill had received only its first reading in the House. This week (October 22nd, 2026) , AdvoKC called on the Speaker, Rt. Hon. Tajudeen Abbas, to place the bill on the Order Paper, direct the House Committee on Healthcare Services to conclude its work, and publicly commit to a timeline for concurrence and harmonisation with the Senate and also sent in Letters to the Speaker to that effect. We also noted that the House resumed plenary on September 29 after an extended annual recess, only to adjourn again until October 13.
There is a certain consistency here. A chamber that can find time to recess can surely find time to read a bill whose entire purpose is to keep primary health centres open.
What the Lifeline Looks Like in Numbers
The case for urgency does not rest on mere rhetoric. It rests on arithmetic.
Under the existing framework, 50% of the fund goes through the National Health Insurance Authority (NHIA) for the Basic Minimum Package of Health Services, 45% goes through the NPHCDA for essential drugs, vaccines, equipment and primary healthcare facilities, and 5% goes to emergency medical treatment. So half of every naira in the fund is, in effect, a premium subsidy. It pays for enrolling poor and vulnerable people in an insurance-style package at primary health centres, so they are not paying cash at the point of care.
Who pays? According to the National Health Accounts 2023–2024, out-of-pocket payments still accounted for 58.3% of total health expenditure in 2024. That is an improvement on previous years, but households remain the largest source of health financing at 66%. Government spending accounted for just 12.4%, and social health insurance for 5%. The WHO had earlier placed Nigeria's out-of-pocket share at 74.7% in 2020, the highest in West Africa.
Who is covered? The National Bureau of Statistics reported that only 2.8% of women and 2.7% of men were covered by health insurance in 2021. The gap between urban and rural Nigeria was stark: 5.2% of urban women were covered, against 0.8% of rural women. A peer-reviewed analysis of the 2023 People's Voice Survey put NHIS coverage at about 2% and found that insurance reached mainly better-educated and higher-income Nigerians. Nigeria Health Watch reported in April that around 21 million Nigerians are enrolled in health insurance in some form. Even on that more generous figure, the majority remain unprotected.
What does the government commit? The 2026 health allocation of N2.48 trillion was roughly 4.2% of the proposed budget, against the 15% that African Union members, Nigeria included, pledged in the 2001 Abuja Declaration. Nigeria has never met that target, and the House of Reps. According to a World Bank review, most public health money goes to secondary and tertiary care, not the primary level where the BHCPF operates.
What are the facilities like? The NBS's 2023 National Health Facility Survey found that no region in Nigeria has 50% access to functional basic medical equipment in health facilities. Meanwhile, a Federal Ministry of Health response to a Freedom of Information request, reported by ICIR, identified 1,164 facilities on the BHCPF beneficiary list as only partly functional, roughly one in seven.
From Statistics to Survival
Statistics have a way of flattening people into decimals, so consider what they mean in practice.
Nigeria accounted for roughly 29% of global maternal deaths in the latest UN-agency estimates, with a maternal mortality ratio of about 993 deaths per 100,000 live births in 2023. Most of these deaths are preventable, and most are decided at the level the BHCPF is meant to fund: the antenatal visit, the skilled birth attendant, the commodities on the shelf, the functioning referral link.
The evidence that financial protection changes outcomes is not speculative. In an analysis of the 2018 Nigeria Demographic and Health Survey published in BMJ Public Health, women with health insurance had roughly twice the odds of delivering in a health facility (adjusted odds ratio 2.0) and nearly twice the odds of attending eight or more antenatal visits (adjusted odds ratio 1.9). The same study found that only 18.5% of women attended eight or more antenatal visits and just 40.6% delivered in a facility. These are associations rather than guarantees. But the direction is unambiguous: where care is financially protected, women reach it.
Here lies the connection the House seems to miss. The BHCPF funds the Basic Minimum Package of Health Services through the National Health Insurance Authority, supports essential drugs, vaccines and equipment through the National Primary Health Care Development Agency, and finances emergency treatment. It is already reaching primary care facilities and, by the Coordinating Minister's account, more than 10 million Nigerians. Doubling its statutory floor means a larger pool of guaranteed money for exactly the services whose absence we count in coffins, and for exactly the households currently counting naira in comment sections.
An Honest Caveat, and Why It Strengthens the Case
AdvoKC does not claim that doubling the BHCPF will, on its own, fix Nigerian healthcare. Money must be appropriated, released, and spent well. BudgIT's 2026 analysis found that, although federal health allocations rose nominally by 345% between 2021 and 2025, capital expenditure utilisation has not exceeded 40.7%. A bigger fund badly managed would simply be a bigger disappointment.
But that argument cuts against delay, not for it. If implementation is the challenge, then the House, which has oversight powers and a record of raising BHCPF implementation concerns on its own Order Paper, is better placed than anyone to insist that the doubled fund comes with the accountability it deserves. Oversight is a reason to pass the bill and scrutinise its execution. It is not a reason to let the bill idle.
The Calendar Is the Argument
Time is the one resource this bill cannot afford to lose. The bill still requires House concurrence, harmonisation with the Senate version where necessary, and presidential assent. The 2027 appropriation process is under way, and a narrowing legislative window ahead of the 2027 general elections means every adjournment risks pushing the increase out of next year's budget entirely. Each month of delay is a month in which the old, smaller figure remains the legal floor.
The cost of that delay is not abstract. It is the clinic without drugs, the mother without a skilled attendant, and the family drafting a social media appeal instead of a treatment plan.
What We Are Asking the House to Do
The Senate has shown that this bill can be passed. It has shown that the sponsor, the committee, and the chamber can be moved by evidence and by public pressure. The House now owes Nigerians three things: place the bill on the Order Paper, direct its committee to conclude without further delay, and announce a date by which concurrence will be voted on.
Nigerians have been generous to one another when the system failed them. They should not also have to be generous to a House that is still deciding whether primary healthcare is urgent business. A legislature that promised to double the fund, and then lets the calendar run out on the promise, is choosing the crowdfunding lifeline over a statutory one. It is time for the 10th House to choose differently.
