Aging, Poverty, and Healthcare Access and Affordability in Nigeria: Implications for Policy.

Abstract

Background: Nigeria's aging population is expanding rapidly. Older adults face intersecting challenges of poverty, chronic disease burden, and inadequate access to healthcare. With limited formal income support and minimal health insurance coverage, most elderly Nigerians rely on family or continue informal labor to survive. This compounds their vulnerability in later life.

Objectives: This article examines the economic and health-related barriers to healthcare utilization among older Nigerians. It incorporates recent demographic and epidemiological trends, wealth-based inequalities, rural-urban disparities, and evolving policy responses. The analysis integrates insights from the Nigeria Demographic and Health Survey (NDHS) 2018 and applies Andersen's healthcare access model.

Methods: A perspective approach was adopted to synthesize empirical literature, national data (including NDHS), and recent policy developments such as the National Health Insurance Authority Act and the National Senior Citizens Centre (NSCC) Act. Comparisons are drawn with other lower-middle-income countries, notably India, to highlight global relevance.

Findings: Older Nigerians, particularly women and rural dwellers, experience high poverty rates, with up to 85% of women aged 70 and above living in poverty. They face chronic multimorbidity and have some of the lowest health service utilization rates due to cost, distance, and systemic neglect. Although policy frameworks, such as the NSCC and Basic Health Care Provision Fund (BHCPF), exist, implementation remains weak.

Conclusions: Comprehensive reforms are essential to improve elderly health outcomes in Nigeria. Priorities include expanding subsidized health insurance, implementing universal social pensions, strengthening rural health services, and combating ageism. A coordinated and inclusive policy strategy can transform aging from a crisis into an opportunity for national development.