Crowdfunding is Nigeria’s Newest ‘Health Insurance’ Scheme
- Tijani Abdulkabeer
- Jun 20
- 4 min read
After being bedridden with a serious illness for a month, law student Afọlábí Saheed realized that he and his family had exhausted all their resources to pay for his treatment, and yet there were still more bills to pay. While his health insurance allowed him to pay discounted prices for some tests and drugs, it only covered a meagre part of the major medical bills. Saheed and his family felt helpless until crowdfunding from neighbors and friends saved the day.
Fueled by social media, crowdfunding is now the unofficial health insurance scheme for Nigerians. Saheed said that the National Health Insurance Authority provided subsidies for his illness but “the crowdfunding was even more helpful than insurance.” Crowdfunding for healthcare bills is a growing trend, particularly given the challenges in accessing quality and affordable healthcare.
In 1999, the Nigerian government established the National Health Insurance Scheme through Decree No. 35 to promote, regulate, and integrate health insurance schemes and provide mandatory health insurance for Nigerians and legal residents.
In 2022, the government replaced the 1999 insurance scheme with the National Health Insurance Authority to regulate health services and insurance in Nigeria. The Insurance Authority established a fund to pay for the insurance premiums of vulnerable people like Saheed. According to Dr. Kelechi Ohiri, director-general of Nigeria’s National Health Insurance Authority, two million Nigerians have been enrolled in the national health insurance program, representing 8.9% of the population. But challenges such as limited funding and an inadequate structure to implement existing funds cripple the ability of the insurance authority to effectively discharge their duties, according to Atitebi Simiat Abiola, State Coordinator for the Insurance Authority in Ekiti State, Southwest Nigeria.
As a result, many Nigerians end up having to pay for medical emergencies out of pocket, creating a new financial emergency for the affected families. As of 2022, Nigeria had the highest out-of-pocket healthcare spending in West Africa, making this essential service a significant burden for the people. Recent research also shows that out-of-pocket payments account for over 76% of the total health expenditure of the people.
Why crowdfunding?
“Crowdfunding is certainly not a sustainable means of access to health care, nor is it ideal. It is sad that many Nigerians have to resort to this to get access to healthcare,” says Olohikhuae Egbokhare, Assistant Director at Georgetown University's O’Neill Institute for National and Global Health Law.
Last year, while university student Zainab Ajiyobiojo was representing her college in a sports competition, her right humerus broke. She was immediately rushed to the school clinic and then was referred to the University College Hospital, but eventually was advised to go to a private hospital to get surgery. “I was to be operated on for the removal of the nerve and putting an implant to join the broken bone together,” she said.
However, after the doctor mentioned the costs for the surgery, Ajiyobiojo’s family was thrown into distress. They only had two days to raise one million naira (equivalent to USD 670), and her parents started running around for financial support. Ajiyobiojo suggested crowdfunding, even though there was a great risk for the family to rely solely on the support of friends as well as complete strangers — if this attempt was unsuccessful, she might never be able to use her arm again. “It was my last and only hope. My parents were not cool with it, but they had no option other than to allow it,” she said. Luckily, it worked, and Ajiyobiojo was able to get her surgery.
Worldwide, only 10% of medical crowdfunding campaigns have been reported to reach their fundraising target. In a struggling economy like Nigeria, this means that many campaigns will end up unsuccessful if citizens don’t have enough money to help friends and strangers with their medical bills. Although Saheed and Ajiyobiojo were lucky, a recent investigation shows how inadequate health insurance coverage and the unreliable cycles of crowdfunding for health purposes have led to the death of some Nigerians. Yet, the government has not identified the barriers to adequate health coverage in Nigeria or addressed these issues.
Optimizing Health Insurance in Nigeria
Health insurance in Nigeria not only suffers from a lack of funding but also from a poor public perception of its effectiveness. Knowledge of the benefits of health insurance schemes remains low among Nigerians, says Tanimola Makanjuola Akande, a professor, Epidemiology & Community Health at the University of Ilorin.
“The government at all levels has not done enough to cover the vulnerable populations,” he said.
To address this crisis, Egbokhare noted that the government needs to increase the health budget allocation. The 2024 fiscal budget allocated 5.46% of it to the health sector, of which less than 2% goes to the Insurance Authority. Nationally, healthcare allocations are low in comparison to the 2001 Abuja declaration of allocating 15% of the national budget to health.
“The Nigerian government needs to increase investment in the health sector. Tertiary and state hospitals, as well as primary healthcare centers, must be improved and properly funded, and doctors empowered with all the tools they need to care for their patients adequately,” Egbokhare said. “The medical profession is seeing a huge rate of brain drain as medical professionals are underpaid and unfairly treated, and have to perform procedures and surgeries in less than ideal conditions. This is unacceptable.”
A recent report highlighted the benefits of an effective funding mechanism, optimization of the operational process, and effective governance in tackling Nigeria’s healthcare financing crisis. If adopted, these strategies will assist the government in channeling healthcare spending to the citizens with clearly measurable outcomes. To boost health insurance coverage, the government will also need to create policies for healthcare cost reduction, according to another study focused on Nigerian healthcare providers.
The most sustainable way of financing health, Akande said, is through health insurance. Crowdfunding is just a makeshift solution that arose due to systemic failures and shouldn’t be seen as a reliable long-term alternative for health insurance. “The government should step up interventions to scale up coverage of citizens. This is the major pathway to achieving Universal Health Coverage.”
“This is a long-term goal that requires coordination across levels of government, but also requires actionable strategies and plans to ensure that things are moving along,” Egbokhare stressed.
