Healthcare financing refers to how money is raised, pooled, and allocated to pay for health services. In Nigeria, the health sector relies on three main funding mechanisms: government budgetary allocations, external donor funds, and private payments. Unfortunately, public funding has historically fallen far below the Abuja Declaration target of fifteen percent of the national budget. This underfunding leaves a massive financial gap in the public health system. Consequently, health facilities often lack basic drugs, functional equipment, and adequate staffing. Midwives working in primary and secondary facilities feel the brunt of this deficit daily, as they try to manage obstetric emergencies with severely limited resources.
Out-of-pocket expenditure means patients pay directly for medical services and medications at the point of care, without any insurance cover. In Nigeria, this accounts for a staggering percentage of total health spending. For pregnant women, this system is dangerous. When a family must find cash immediately to pay for a caesarean section or blood transfusion, severe delays happen. Women often stay home during complications because they cannot afford consultation fees, laboratory tests, or prescribed drugs. This financial barrier directly drives up maternal and neonatal morbidity and mortality rates across the country, pushing vulnerable households into deeper poverty when a medical crisis strikes.
The National Health Insurance Scheme was established to provide social health security and ensure access to affordable healthcare for all Nigerians. The scheme operates by pooling financial risks so that the healthy subsidize the sick, and the rich subsidize the poor. Under the formal sector program, contributions are shared between employers and employees. However, expanding coverage to the informal sector, which makes up the vast majority of Nigeria's workforce, remains a major hurdle. Recent reforms under the National Health Insurance Authority aim to make basic health insurance mandatory, striving to protect citizens from catastrophic health spending.
Maternal and child health services are supposed to be prioritized under social health insurance packages. Standard benefits often cover antenatal care visits, normal deliveries, caesarean sections, immunizations, and basic neonatal care. In recent years, vulnerable group funds have been introduced to cover pregnant women and children under five without requiring them to pay monthly premium contributions. Despite these supportive policies on paper, pregnant women often face unexpected out-of-pocket costs at accredited facilities. Hospitals may ask them to buy consumables like syringes, cotton wool, or sutures because those items are supposedly out of stock.
Primary health care centers serve as the first point of contact for rural and semi-urban communities, making them crucial for universal health coverage. Yet, implementing health insurance at this level faces severe operational bottlenecks. Many primary health clinics lack accredited status because they fail to meet minimum staffing, infrastructure, and drug supply standards. Capitation payments received by these facilities are often too small and delayed, making it difficult to maintain operations. Additionally, poor community awareness regarding how to register and use insurance cards keeps utilization rates discouragingly low.
Midwives are more than clinical care providers; they act as financial navigators for women and families during childbirth. In clinical settings, a midwife must understand which services are covered by the patient's insurance plan to prevent unnecessary delays in treatment. Midwives also educate pregnant women on the importance of registering with health insurance schemes during early antenatal visits. Furthermore, midwives advocate for indigent mothers by connecting them with social welfare officers or equity funds. By keeping accurate records of services rendered, midwives ensure that facilities can claim reimbursements correctly.