Sustainable Health Insurance Expansion Reduces Maternal and Child Mortality in Nigeria

Nigeria faces significant challenges in maternal and child healthcare, with high mortality rates largely driven by financial barriers and limited access to quality care. Approximately 77% of healthcare costs are paid out-of-pocket by Nigerians, making hospital care unaffordable for many vulnerable families. These challenges contribute to a high incidence of preventable deaths among mothers and young children, particularly within the first two months of life. To address these issues, Nigeria established the Basic Health Care Provision Fund (BHCPF) in 2014, aiming to offer free maternal and child health services funded by national revenue. However, enrollment in this program has remained critically low, covering less than two percent of vulnerable populations over a decade later. Global Affairs Canada (GAC) partnered with the Clinton Health Access Initiative (CHAI) to enhance capacity within six Nigerian states—Bayelsa, Ekiti, Kaduna, Katsina, Niger, and Ondo—to manage and scale health insurance programs. This collaborative model focused on training local health facility managers, establishing enrollment systems, and requiring state government co-investment to ensure sustainability beyond donor funding. As a result, health insurance coverage in these states increased by 301%, reaching over one million vulnerable individuals with access to free healthcare services. The program emphasized the importance of developing local expertise and operational autonomy, allowing states to continue expanding coverage after external support ended. This shift reduced out-of-pocket expenses for families and improved timely access to quality maternal and child healthcare. State officials reported measurable improvements in healthcare delivery and are now better equipped to tackle maternal and child mortality head-on. This initiative highlights the critical role that sustainable funding models and capacity-building play in advancing universal health coverage in resource-limited settings. By moving beyond short-term financial aid and fostering systemic growth within state governments, the project exemplifies how strategic investments can multiply impact and create enduring health benefits. For Nigerian families, such advancements translate into a future where financial hardship no longer dictates survival during childbirth, reinforcing healthcare as a fundamental right rather than a luxury. The program's transition to full state management in late 2025 marks a new phase focused on long-term scalability and continued enrollment growth leveraging locally sourced resources and expertise. Individual beneficiaries have reported significant enhancements in treatment access and outcomes, illustrating the tangible benefits of health insurance expansion. This case study provides valuable insights for policymakers and insurance market stakeholders aiming to design effective, sustainable health financing strategies in similar contexts. It underscores the importance of combining government commitment with international collaboration to build resilient health insurance frameworks that address critical gaps in maternal and child health coverage in Nigeria.