Experts raise alarm over weak accountability, push for statutory role of civil society in health financing
Health professionals have expressed concern over the poor accountability systems in Nigeria’s health sector, urging that civil society groups and other non-state actors be legally included in major financing structures to improve transparency and results.
The call was made on Monday during a panel session at the ongoing National Health Financing Dialogue in Abuja, which focused on “Advancing Accountability in Health Financing: Improving Budget Transparency, Participatory Budgeting and Expenditure Tracking.”
The four-day forum, themed “Reimagining the Future of Health Financing in Nigeria,” brings together government health officials, development partners, CSOs, and the private sector to design strategies for sustainable funding. It is expected to produce commitments on cutting down out-of-pocket expenses, strengthening domestic funding, and enhancing accountability.
Demand for civil society inclusion
Gafar Alawode, Co-Convener of the Nigeria Universal Health Coverage (UHC) Forum, warned that Nigeria’s health financing reforms could collapse without stronger accountability frameworks.
He explained that CSOs are usually invited late into policy discussions, which weakens their influence on vital financing decisions.
“We must institutionalize accountability beyond political promises. Citizens shouldn’t rely on goodwill; there should be permanent systems that ensure transparency in financing and delivery,” he stressed.
According to him, reforms will remain fragile unless CSOs are empowered as watchdogs, with authority to scrutinise allocations and insist on transparency. He also emphasised the need for a whole-of-society approach where government, private sector, and CSOs work in synergy.
Moving beyond token representation
Aminu Magashi, Coordinator of the Africa Health Budget Network, added that CSOs themselves must be more strategic if they want to influence reforms. He pointed out that the civil society space in Nigeria is fragmented, with groups often working in silos on malaria, HIV, or family planning, while major reforms pass with little oversight.
He lamented that CSOs are frequently included only as observers instead of statutory members in key oversight bodies.
“If accountability is to be taken seriously, CSO participation must move beyond token gestures. There should be legal provisions mandating their presence in financing boards, with defined opportunities to speak on transparency and accountability,” he said.
He further called for CSOs to adopt a whole-of-policy-cycle approach—actively engaging at every stage: design, implementation, monitoring, and evaluation.
