Comparative Health Governance: The Private Sector's Role in Universal Health Coverage in Nigeria and Kenya (2021-2026)

Abstract

This comparative study analyses the governance of the private health sector within Universal Health Coverage (UHC) frameworks in Nigeria and Kenya. It addresses the critical question of how these two major African economies are integrating private actors to strengthen health systems and advance UHC. Employing a rigorous qualitative case study design, the research analyses national policy documents, legislation, and strategic plans from 2018 to 2024. This is complemented by semi-structured interviews with purposively sampled policymakers, regulators, and health financing experts from both countries. All procedures received ethical approval. The findings reveal divergent governance models. Kenya exhibits a more structured, strategic-purchasing approach, primarily via the National Hospital Insurance Fund, to formally engage private providers. In contrast, Nigeria's approach remains less cohesive, characterised by a reliance on out-of-pocket spending in a large, poorly regulated private sector, despite the 2022 National Health Insurance Authority Act. The study concludes that the efficacy of the public-private mix for UHC is contingent upon deliberate governance. It contributes to African health policy discourse by demonstrating that strategic coordination, equitable financing, and robust public stewardship are paramount for leveraging the private sector to achieve equitable health outcomes.

Key Points