Nigeria’s healthcare system stands at a critical crossroads. Despite decades of policy reforms, donor interventions, and repeated commitments to Universal Health Coverage, millions of Nigerians still face the grim reality of paying for healthcare from their own pockets. For many families, a single illness can wipe out savings, disrupt livelihoods, or push households permanently into poverty. Public hospitals struggle with inadequate funding, health insurance coverage remains limited, and donor-driven programmes, though valuable, are often short-term and unpredictable. The result is a fragile system where access to quality healthcare is too often determined by income, geography, or sheer luck.
Against this backdrop, new thinking around healthcare financing has become not just desirable but urgent. Increasingly, policymakers, development partners, and scholars are recognising that government funding and conventional insurance mechanisms alone cannot close Nigeria’s enormous health financing gap. There is a growing need for locally grounded, culturally legitimate, and sustainable financing models that empower communities and restore dignity to healthcare access.
It is within this context that Ethical Health Finance and the Lafiya Programme have emerged as a compelling and distinctly Nigerian response to a long-standing national challenge. Anchored in community ownership and rooted in long-established ethical and faith-based endowment traditions, the model seeks to mobilise resources that already exist within society but have remained largely untapped for health.
By transforming Zakat, Waqf, Christian endowments, and other ethical philanthropic instruments into structured, transparent mechanisms for healthcare funding, the Lafiya Programme is redefining how communities participate in financing their own wellbeing.
In this interview, the Managing Editor, Time Nigeria Magazine, Abdulrahman Aliagan among other Journalists speaks with key drivers of the initiative, including Dr. Usman Gwarzo, Team Leader of Lafiya Programme who is at the forefront of Ethical Health Finance implementation. He offers rare insights into the structural weaknesses of Nigeria’s health financing system, the philosophy behind Ethical Health Finance, the practical lessons from community-level implementation, and the growing national interest in scaling the model. His perspective reveal how trust, ethics, and local ownership may hold the key to rewriting Nigeria’s healthcare funding story—from the grassroots upward. Enjoy!
Nigeria’s healthcare system is often described as being in a financing crisis. From your perspective, what exactly is the problem with how healthcare is funded in the country?
The problem is both structural and systemic. Nigeria’s healthcare system is chronically underfunded relative to its population size and disease burden. Government budgetary allocations to health remain far below the Abuja Declaration target of 15 percent, and what is allocated is often fragmented, inefficiently spent, or delayed. As a result, most Nigerians pay for healthcare directly from their pockets.
This heavy reliance on out-of-pocket spending exposes families to catastrophic health expenditure.
People sell assets, borrow money, or resort to public fundraising to pay hospital bills. For many, illness becomes a pathway to poverty. Donor funding, while helpful, is unpredictable, project-based, and not designed to be permanent. Health insurance coverage is also still very low. When you combine all these factors, you have a fragile financing system that cannot sustainably support Universal Health Coverage.
Is this what led to the creation of the Lafiya Programme?
Yes, very much so. The Lafiya Programme was launched in February 2022 with support from the UK Foreign, Commonwealth and Development Office (FCDO), building on lessons from Nigeria’s COVID-19 response. We deliberately designed it as an upstream, adaptive, and flexible programme. Rather than focusing on short-term service delivery, Lafiya addresses systemic bottlenecks that undermine Universal Health Coverage.
These include weak governance, poor institutionalisation, inadequate healthcare financing, limited use of data for decision-making, and emerging health security threats linked to climate change and population growth. From the beginning, it became clear to us that without solving the financing challenge, progress in other areas would be limited.
At what point did Ethical Health Finance enter the picture?
As we worked with federal, state, and local governments to strengthen public financing through planning, budget tracking, expenditure analysis, and optimisation of the Basic Healthcare Provision Fund, we realised something important: public financing alone will not close Nigeria’s health funding gap.
We therefore began to explore alternative financing pathways that are locally rooted, culturally legitimate, and sustainable. Rather than inventing something entirely new, we adopted what I describe as an “opportunistic” approach. We looked for low-hanging fruits that already existed within Nigerian communities. That was how Ethical Health Finance emerged.
What exactly is Ethical Health Finance, and how does it work?
Ethical Health Finance is a community-driven health financing model that leverages faith-based and ethical philanthropic instruments such as Zakat, Waqf, and Christian endowments to support healthcare. These instruments have existed for centuries and are deeply trusted by communities, especially in Northern Nigeria.
Historically, endowments funded education, housing, and social welfare, even in institutions like Harvard, Yale, and universities in Malaysia and Indonesia. Health, however, was largely neglected.
What we did was to adapt these ethical resources—without distorting their religious foundations—into a structured, transparent financing mechanism for healthcare. We worked through Emirate councils, Islamic and Christian religious leaders, and community structures to institutionalise this approach.
How do communities participate in this model?
Communities are not passive recipients. They are the owners of the process. Each participating community conducts a needs assessment to identify its priority health challenges. This could be shortages of health workers, lack of infrastructure, poor drug availability, weak supervision, or poor service quality.
Based on these priorities, a financing and implementation plan is developed locally. Funds are mobilised through donations, crowdfunding, and community launches. Importantly, not all funds are spent immediately. Communities adopt investment models—often using a 40:60 formula—where part of the money addresses urgent needs while the larger share is invested to generate long-term returns.
In some communities, this has led to the establishment of health-linked social enterprises such as community pharmacies that provide subsidised medicines and generate income to sustain health interventions.
How far has this initiative gone so far?
Within just three years, Ethical Health Finance expanded from 12 Local Government Areas to 138 LGAs across five states. Communities mobilised over ₦2 billion in Zakat and Waqf contributions in 2025 alone, both in cash and in kind.
What is particularly encouraging is that when communities raise their own resources, they become more invested in governance and accountability. They ask questions, monitor performance, and demand better services. That grassroots accountability is a major strength of this model.
How does this initiative align with national health policy?
It complements national efforts. It does not replace government funding or health insurance. Instead, it fills critical gaps and reduces catastrophic health expenditure. It strengthens community ownership and supports Universal Health Coverage from the bottom up.
That is why the Federal Ministry of Health and Social Welfare, the National Health Insurance Authority, and development partners like the World Bank have all shown strong interest.
What was achieved at the recent Lafiya Programme Ethical Health Finance Workshop in Abuja?
The three-day workshop brought together policymakers, academics, civil society, faith-based actors, and development partners. We finalised key Ethical Health Finance knowledge materials, adopted a national logo, co-created a scale-up plan, and established a National Ethical Health Financing Technical Working Group.
There was a strong consensus that this model should be scaled nationally.
Finally, what does Ethical Health Finance mean for Nigeria’s future?
It means that Nigerians no longer have to wait for donors or government alone to solve their health financing problems. It shows that communities are not resource-poor; they are structure-poor.
Ethical Health Finance offers a Nigerian solution to a Nigerian challenge—one rooted in trust, ethics, community ownership, and sustainability. If scaled properly, it can fundamentally change how healthcare is financed in this country.
