Beyond Donor Aid and Scarce Public Sector Financing: Mobilising Impact Investment to Address Out-of-Pocket Expenditures in Nigerian Chronic Kidney Disease Care

Abstract

In Nigeria, the primary method of financing the management of Chronic Kidney Disease (CKD) is through Out-of-Pocket (OOP) expenditure. This crisis has reached a critical level, requiring urgent attention for both policymakers and scholars to identify a lasting solution to the catastrophic financial burden that patients and family members undergo. Against this backdrop, this study employs desk-based research and targeted interviews to explore the best possible alternative CKD financing in Nigeria. The desk-research findings identified impact investment as a credible alternative to addressing this financial burden. However, considering that impact investors credibility is high in investing in projects with social impact, the new norm in impact investing is for projects to yield the dual benefits of social impact and moderate financial returns. Based on this, interviews were conducted to determine the best possible investment in the areas of kidney replacement therapy that impact investors will invest in to garner both financial returns and social impact. Interview insights confirm that such dual benefits are possible when impact investment is directed towards five critical areas: community-based preventive projects; supply chains and pharmaceutical projects; low-cost dialysis projects; training and workforce development projects; and health technology innovation projects. In conclusion, the study emphasised the need to embrace impact investment in these areas to alleviate substantially the economic strain on CKD patients as well as broaden and strengthen Nigeria’s healthcare financing landscape.