VSI – Vision Spring Initiatives

The Universal Health Coverage: Why it must count for women and girls.

The Universal Health Coverage: Why It Must Count for Women and Girls 

Nigeria is the biggest country in West Africa with diverse people and cultures. Nigeria’s Universal Health Coverage is one of the many areas the country is working to keep pace with leading countries in the world. To close the existing gap in health care for women and girls is therefore critical towards achieving SDG goal 3:7.  Currently, only about 5% of Nigerians have prepaid health care through the National Health Insurance Scheme (NHIS). The large majority of Nigerians (95%) are without any form of coverage. Among the 95% are women and girls. 

Nigeria has the third highest infant mortality rate in the world and also is the largest contributor to global mortality rate. The rates are high not because the diseases leading to death cannot be cured or prevented, Women, girls and children are dying from preventable and treatable sexual health complications as a result of entrenched resistance to women’s autonomy and control over their bodies. This is often justified on the basis of culture and/or religion. Poor health care systems and weak policy implementation add to women’s risk of death. The target of the National Health Insurance Scheme was to provide universal coverage for all Nigerians by 2015. Unfortunately this target is nowhere near being met.

The recently released NDHS 2018 data in the country states that unmet need for family planning declined from 20% in 2008 to 16% in 2013 before increasing to 19% in 2018. 10% of maternal deaths in Nigeria are due to unsafe abortion. Access to safe abortion is restricted in Nigeria. A 2015 national study of abortion incidence in Nigeria reveals the challenges that remain to improve conditions for Nigerian women and girls. Only 16 percent of all women of reproductive age use any contraceptive and an even lower percentage of 11 percent use a modern method, which results in almost 10 million unintended pregnancies, of which more than half end in an induced abortion.

The slogan of leaving no one behind CAN only be achieved if government health plan target those most in need of it; women, girls and children. There is need for universal access to quality and affordable comprehensive sexual and reproductive health information, education, including comprehensive sexuality education, and health services. 

There is no doubt that Nigeria’s health care system is deficient and in urgent need for redemption. The National Strategic Health Development Plan 2018-2022 recognises this need, that is why one of its pillar is to promote universal access to comprehensive quality sexual and reproductive health services throughout the life cycle and reduce maternal, neonatal, child and adolescent morbidity and mortality in Nigeria. The Second National Strategic Health Development Plan is the country’s road map that will ensure overall improvement of health of Nigerians through five strategic pillars and 15 priority areas. In the 2018 budget, the government allocated 1% of the consolidated revenue fund tagged Basic health care provisions Funds. In the 2019 budget proposal, President Muhammad Buhari allocated =N=340.45 billion to the health sector, which is 3.9 percent of the =N=8.73 trillion expenditure plan. Political will is required to achieve the implementation of these health commitments which must target women and girls whose health needs remain unmet.

Central to women and adolescents health and well-being is the realization of their human rights, including their sexual and reproductive rights. If we are to achieve the SDGs and UHC, we have to pay special attention to women, children and adolescent health needs. We must remove obstacles such as negative abortion laws and provide access and ownership to women and girls in health care delivery.

Majority of Nigerians who cannot afford quality health care rely on quacks, some resort to self-medication. In order to ensure implementation of the Health Scheme, the federal government needs to invest substantially into the Scheme and seek partnership with private sector and civil society groups as part of their responsibility to the society. Every Nigerian has right to access quality health care. We must move from words to action. The remaining 95% of Nigerians should be covered; with women and girls in the fore front as they are particularly affected by abuse and violence, including sexual and gender-based violence. The Universal Health Coverage Must Count for Women and Girls.


Ngozi Nwosu-Juba

Project Director

Vision Spring Initiatives, Lagos Nigeria.









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