**4. Conclusion and recommendations**

This study has shown that about 70% of Nigerians pay for healthcare through OOP, hindering their access to quality healthcare. While the trend continues, many households in the country have been impoverished through catastrophic health expenditure. This has culminated in the poor health-seeking and consequent poor health indices. Therefore,

However, the country has the potential to reverse the trend by learning from other countries all over the globe which have achieved UHC by adopting either a tax-based insurance scheme or an SHI scheme. Consequent to this, it is recommended the scheme is overhauled and repositioned to promote equity and access to healthcare. This can be done using an excise tax or "sin tax". The revenue generated could be used to finance the health of the entire country in combination with the existing NHIS. Moreover, this study recommends that the law that established the NHIS should be amended to make insurance mandatory to increase participation. However, adequate awareness should be created for the same reason. The currently fragmented NHIS should be amalgamated for efficiency, risk sharing and fund pooling. The benefits package should also be reviewed to be more comprehensive to attract and encourage enrollees. Enrolment could also be boosted by providing free healthcare to the poor and the vulnerable group, thereby removing inequality and inaccessibility. Finally, in line with the 15% Abuja declaration, there is a need for the government to demonstrate political commitment toward UHC by increasing budgetary allocation to health.
