As equitable access to quality health care continues to occupy the policy agendas of state and national government in Nigeria, the single greatest barrier is the absence of effective institutional arrangements for universal health coverage. The policy makers are saddled with the pressure of how to reconfigure and strengthen the health system to align it with the objectives of UHC, so as to bridge the presently identified gaps and meet the projected health needs of the people of Nigeria over the next decade. Of course, this will require political and financial commitment from the federal as well as state governments through increasing the proportion of government general revenue allocated to health care. Therefore, instituting a system of UHC for Nigeria will require a flexible architecture to deal with inequities in health outcomes, regional and sociocultural diversity, the differential health insurance coverage and health care needs of populations in different locations.
The efficiency of social health insurance schemes in Nigeria will depend on the effectiveness of the structure of health care delivery systems as well as the nature of supply and distribution of health care resources. There is confusion in the present delivery arrangements among the three tiers of government. The overlapping of roles and responsibilities has resulted in inefficiencies to the extent that significant proportion of Nigerian population is denied access to health care on daily basis. Apart from the problems of institutional arrangements, human resources management is poor leading to inefficiency and poor service delivery. The public service delivery system is weak and unable to provide a minimum package of quality health care. For the private sector, there is no effective mechanism for monitoring the qualities of services delivered in private health facilities across the country. If the current delivery of care is highly deficient, how can NHIS ensure efficient delivery of care?