As the world searches for sustainable health financing solutions, Nigeria must look beyond outdated systems and embrace proven innovations from other resource-constrained regions. At the 2025 BusinessDay Health Conference, experts highlighted the Caribbean’s Stratified Pooled Risk Coverage (SPRC) model—an approach with striking similarities to the policies that transformed Colombia’s health sector into one of the best in the world. For Nigeria, this could be the blueprint for change.
Colombia’s Example: From Fragility to Global Benchmark
Twenty years ago, Colombia’s health system faced the same weaknesses now plaguing Nigeria—low insurance coverage, limited access, and broken financing. Today, it has achieved over 90% insurance penetration, universal benefit packages, and a reputation as a medical tourism hub. The key driver was a tiered pooled risk framework that spread costs fairly and improved efficiency.
By contrast, most Caribbean nations still struggle: only 10–15% of their populations are insured, while patients shoulder 35–40% of healthcare costs out-of-pocket. Nigeria’s case is worse—less than 10% of people are covered, and out-of-pocket payments exceed 70% of total health spending.
The Pricing Crisis: Lessons from the Caribbean
One of the biggest cracks in Caribbean health financing was outdated pricing. In Saint Lucia, for instance, a surgery—whether a caesarean or a complex neurosurgery—is reimbursed at a flat rate set in 1992. After doctors and consumables are paid, virtually nothing remains for hospital operations. This has left facilities underfunded and fueled medical brain drain.
Nigeria faces the same problem. Antiquated pricing models, inadequate capitation, and reimbursement delays are eroding trust and pushing providers into private practice or abroad. Without accurate costing, no insurance model can thrive.
The SPRC Framework: A Scalable Model for Nigeria
The Stratified Pooled Risk Coverage (SPRC) system is built on three tiers:
- Tier 1: Government-funded basic coverage for all.
- Tier 2: Private and employer-based policies for those who can pay.
- Tier 3: Catastrophic and overseas care, financed through specialised pooled insurance with large-volume discounts.
This structure pools risks, allocates resources more efficiently, and reduces inequities. In the Caribbean, SPRC is already replacing fragmented systems with digitally enabled, consolidated health finance authorities. Colombia’s experience confirms it works at scale.
For Nigeria, integrating SPRC into the National Health Insurance Authority (NHIA) could be transformational.
Pilots Already Show the Way
Nigeria does not need to start from scratch. Several state-level pilots already mirror SPRC principles:
- Kwara State (PharmAccess CBHIS): Launched in 2007, it offered subsidised premiums, pooled risks, and defined benefits for thousands of informal households.
- Lagos State (Ilera Eko): Technology-driven enrollment and claims management, with stratified benefits across income groups.
- Rivers State: Expanding pilots that combine public and private providers under unified schemes.
These initiatives prove SPRC can work in Nigeria if scaled strategically. Next steps should include:
- Expanding local pilots into multi-tiered schemes.
- Using states as regulatory “sandboxes” to refine digital tools and governance.
- Introducing new revenue streams, such as health savings schemes or “sin” taxes.
Nigeria’s Unique Advantage: Faith-Based Providers
Unlike many regions, Nigeria has a strong faith-based healthcare network that can be integrated into national coverage.
- The Christian Health Association of Nigeria (CHAN) runs over 2,000 facilities.
- The Islamic Medical Association of Nigeria (IMAN) operates clinics and missions in underserved areas.
These providers already deliver trusted care where government presence is limited. Contracting them into NHIA’s digital reimbursement system could expand coverage at relatively low cost.
The Digital Edge: Nigeria’s Secret Weapon
While the Caribbean is only beginning to adopt electronic claims and health records, Nigeria can leapfrog with its thriving fintech ecosystem. Platforms like Flutterwave, Paystack, Moniepoint, and health-tech innovators like Helium Health and Doctoora can build the infrastructure for seamless claims, payments, and data analysis—if coordinated at the national level.
Roadmap for Action
To make SPRC work in Nigeria, federal leadership must:
- Consolidate donor and public financing under NHIA tiers.
- Update reimbursement costs and abolish outdated pricing.
- Contract public, private, and faith-based providers under a single framework.
- Scale digital health infrastructure with local tech partners.
- Pilot SPRC-inspired schemes in states like Lagos, Kwara, and Plateau.
- Diversify funding via VAT surcharges, “sin” taxes, remittances, and health savings accounts.
Conclusion: A Nigerian Path to Universal Coverage
Colombia has shown it is possible. The Caribbean is evolving. Nigeria has the ingredients—scale, innovation, legal frameworks, provider networks, and fintech power. What’s missing is coordinated execution.
By adapting the SPRC model, leveraging faith-based networks, and using digital health financing as an economic strategy, Nigeria can build a system that delivers universal coverage—and become a global leader in health system innovation.
