In 2001, the government of Nigeria, along with all African Union countries, pledged to spend 15 percent of its annual budget on health care. But the country has never come close to reaching that goal.

The result is that up to 70 percent of medical spending in Nigeria is out of pocket, forcing many with sudden health problems into debt or poverty.

Ajayi Taiwo is one of those people. Taiwo was involved in a car accident a year ago that injured his right leg and pelvis three weeks before his wedding.

Today, he’s still recovering.

“I actually spent like two … close to two months in the hospital and all the resources we had gathered together for the wedding to make it good actually went into hospital bills,” he said.

Discounts promised, not granted

The government hospital where Taiwo was taken would not grant him discounts promised under Nigeria’s national health care plan.

So he had to sell his car and other valuables to pay for care.

“Imagine — I went to a government hospital and I was paying heavily as if I was in a private hospital,” he said.

​Health care pledge

The 2001 health care pledge made by Nigeria and its fellow African Union countries is called the Abuja Declaration.

But 18 years later, Nigeria’s highest-ever budget share for health care was just 7 percent. Last year, it dropped to less than 4 percent.

The impact is that 70 percent of hospital spending in Nigeria is out-of-pocket, which pushes Nigerians like Taiwo into debt or poverty.

“Having to pay out of pocket is a huge, devastating effect on any family,” said Elijah Miner, a consultant surgeon. “I mean you’ve got to look out for food first for the family, school fees, and other things, just basic things to live and that’s why you find out that a lot of people that end up in the hospital come only when it is late simply because they don’t have the funds.”

Out-of-pocket costs

Nneka Orji is a financial officer in Nigeria’s Ministry of Health. She said the government is partnering with international and private affiliates to make health care more affordable.

“Our out-of-pocket expenditure was estimated at over 70 percent and even the estimate we have for 2017 is even higher,” she said. “So our goal is to use this strategy from the basket funding and making sure with basic minimum package of care to reduce the out-of-pocket expenditure.”

But until Nigeria dramatically increases its health care budget, patients like Taiwo likely face a struggle to stay physically and financially healthy.
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