“When society cannot fund every available treatment, how should it decide what to pay for, and what role can law play in scrutinising those decisions?”
Position of the law on funding medical treatment
Imagine a family sitting across from a hospital administrator. A doctor has recommended an expensive medicine for someone they love. The family cannot afford it and hopes a public health programme might help. But public funds are limited, and decision-makers must also consider the needs of other patients.
This illustrates a difficult policy question—not a report of a patient denied treatment under Nigeria’s new health-technology assessment process.
But the question remains urgent: when society cannot fund every available treatment, how should it decide what to pay for, and what role can law play in scrutinising those decisions?
Modern medicine can improve or extend lives through new cancer drugs, diagnostic tests, dialysis, transplantation and other treatments. But technologies differ in how well they work, what they cost, and what else a health system must give up to provide them.
Ignoring costs does not make scarcity disappear. Nor should a price tag alone settle a patient’s fate.
What Health Technology Assessment Can—And Cannot—Do
Health Technology Assessment, or HTA, is a structured, multidisciplinary way of examining a medicine, device, test, procedure or other health intervention.
It considers evidence about safety and clinical benefit, as well as cost, ethical questions, equity and effects on the health system. Its purpose is to inform policy decisions about whether, how, and at what price a technology should be used.
HTA is evidence for decision-makers; it is not, by itself, a verdict on whose life matters.
Nigeria is beginning to build such a process.
On 22 September, 2026, the National Health Insurance Authority (NHIA) announced that a National HTA Steering Committee had been inaugurated.
The Authority said the committee would support transparent topic selection, methodological standards, conflict-of-interest safeguards, public and stakeholder engagement, and ways for assessments to inform benefit-package design, purchasing and reimbursement.
The NHIA also reported that it had developed an HTA framework, a reference case, process guidelines, terms of reference, a conflict-of-interest policy and stakeholder mapping.
It said three pilot assessments had been completed: kidney replacement therapy, colorectal cancer screening, and sorafenib for advanced liver cancer.
These are significant steps.
But the announcement did not attach the assessment reports or explain whether their findings have changed a coverage or purchasing decision.
Until such material is available, we should not claim that an HTA has already caused a particular patient to be refused—or guaranteed—a treatment.
The Authority has also pointed to a Nigerian EQ-5D-5L valuation study, a tool used to measure health-related quality of life in economic analysis.
The 2026 study drew on interviews with 1,200 adults in 12 states, selected through a multi-stage stratified quota approach across Nigeria’s geopolitical zones, and produced the first Nigerian value set for this measure.
Using local preferences may make future analyses more relevant to Nigerian circumstances. It does not, by itself, answer the ethical question of how benefits and burdens should be shared.
The Person Behind The Calculation
One common measure used in economic evaluation is the quality-adjusted life year, or QALY. It combines how long people live with a measure of their health-related quality of life.
In simple terms, it helps compare the health gains associated with different interventions.
A QALY is a measure of health outcomes—not a measure of a person’s worth.
That distinction is fundamental.
A health system may legitimately ask how much health a particular intervention produces for the resources invested. It must never allow that economic question to become a judgment about whose life is more valuable.
The patient with a rare disease is not worth less because treatment is expensive. The person living with disability is not worth less because a particular measure captures fewer quality-adjusted life years.
Critics warn that generic quality-of-life scores and a focus on total health gains can disadvantage some people with disabilities or chronic conditions, or hide how benefits are distributed.
This is a concern about how evidence is interpreted, not proof that every QALY analysis is discriminatory.
It is a reason to examine distributional effects, and to consider clinical need, severity, equity and patient experience alongside cost-effectiveness.
Imagine two patients: one with kidney failure who needs continuing care, and another with advanced cancer who has been offered an expensive medicine that may extend life.
Their conditions and treatments cannot simply be reduced to a contest between two numbers. Evidence can help explain likely benefits and costs; public values and fair process must help determine what counts as an acceptable trade-off.
What Nigerian Law Provides
Nigeria’s legal framework includes both broad health-policy commitments and more specific statutory duties.
Section 17(3)(d) of the Constitution directs the state towards ensuring adequate medical and health facilities for all persons. Because this falls within Chapter II, it is generally not enforceable on its own as a freestanding claim, by virtue of Section 6(6)(c).
That does not rule out every health-related legal challenge: a claimant may rely on a separate statutory duty or an independently enforceable right.
Article 16 of the African Charter on Human and Peoples’ Rights recognises the right to the best attainable state of physical and mental health and calls on states to take necessary measures to protect health and ensure medical attention when people are sick.
The Charter has force of law in Nigeria through the African Charter (Ratification and Enforcement) Act. That protection matters, but it should not be overstated as an automatic entitlement to every medicine or intervention a patient or clinician may request.
Section 3(3) of the National Health Act 2014 provides that all citizens are entitled to a basic minimum package of health services. Section 3(1) leaves the package’s contents to be prescribed by the Minister after consultation with the National Council on Health.
The National Health Insurance Authority Act 2022 requires the NHIA to enforce the basic minimum package across health-insurance schemes and to provide or require mechanisms for receiving and resolving complaints.
Neither Act expressly names HTA nor guarantees public funding for every available treatment. HTA is an administrative and policy initiative that the NHIA says will help inform its statutory work.
If a coverage decision is challenged, the legal question will depend on who made it, the applicable package and rules, the process followed, and the rights or duties engaged.
Law can scrutinise whether the decision-maker had authority, observed applicable procedures, and acted within statutory limits. Judicial review examines legality; it does not automatically invite a court to replace a lawful clinical or economic assessment with its own.
Fair Process Is Part Of The Answer
For patients, “it is too expensive” is not a meaningful explanation by itself.
The NHIA says the new system is intended to make coverage and benefit-package decisions “systematic, transparent and defensible” —and it identifies stakeholder and citizen engagement and conflict-of-interest safeguards as part of the national HTA architecture.
That commitment raises an important question: if HTA is going to influence what Nigerians receive through publicly financed healthcare, how transparent should the evidence and reasoning behind those decisions be?
A fair process should make clear what evidence was considered, what alternatives were compared, and how uncertainty was handled.
Relevant conflicts of interest should be managed, competing considerations explained, and routes for questions or complaints made accessible.
Patients and caregivers should have a meaningful opportunity to contribute. They know about treatment burdens, travel costs, lost income, and the daily realities that may be missed by a clinical trial or economic model.
Decision-makers should also ask who benefits and who may lose access if a policy is adopted.
These are standards against which the design and operation of the system can be assessed. Whether a particular standard is legally enforceable will depend on the applicable statute, rules and decision-making process.
The Test Of A Health System
The test is not whether a system promises everything to everyone. No health system can do that.
The test is whether its decisions are based on credible evidence, made by the proper authority, explained openly, and reviewed when circumstances or evidence materially change.
Where practical, decision-makers can also consider price negotiation, phased introduction, alternative treatment pathways, and targeted support for people at risk of exclusion.
Nigeria’s HTA initiative deserves serious attention—not as a machine for rationing lives, but as an opportunity to make difficult spending decisions more reasoned and accountable.
The role of law is not to promise every treatment, or to decide clinical merits in place of experts. It is to help ensure that public bodies act within their powers, respect the applicable package and rules, and remain answerable for how they reach consequential decisions.
The NHIA should publish the framework, methods and pilot findings, and explain how patients and the public can take part.
Citizens should know where to raise a concern, and how a decision may be questioned under the applicable rules.
A humane health system cannot afford everything. But scarcity should not shield public decisions from legal scrutiny or excuse arbitrary, unexplained choices.
A budget must count the cost of treatment. The law must keep the decision-maker accountable—and preserve the equal worth of the people affected.
What Nigerians Should Know
•Basic Minimum Package: Section 3(3) of the National Health Act 2014 provides that all citizens are entitled to a basic minimum package of health services. The contents are prescribed by the Minister of Health after consultation with the National Council on Health.
•NHIA Act 2022: The NHIA is required to enforce the basic minimum package across health-insurance schemes and to provide or require mechanisms for receiving and resolving complaints.
•Constitutional limits: Section 17 (adequate medical facilities) is generally not directly enforceable on its own. But other rights and statutory duties may provide a legal basis for challenge.
•African Charter: Article 16 recognises the right to the best attainable state of health, and has force of law in Nigeria through the Ratification and Enforcement Act.
•Fair process: The NHIA says decisions should be systematic, transparent and defensible. Whether a particular procedural standard is legally enforceable will depend on the applicable statute and rules.
•Judicial review: Courts can examine whether a decision was made lawfully—within the decision-maker’s powers and following proper procedure. They do not ordinarily substitute their own view of the clinical or economic merits.
•Sanu is a Nigerian legal practitioner and health-law advocate. This column explains health law and policy for everyday Nigerians.
