By Vivian Ihechu, NAN
For years, millions of Nigerians have remained outside the national health insurance network, with out-of-pocket payments placing heavy financial burdens on both patients and healthcare institutions.
Previously, health insurance mainly covered formal government employees and some organised private-sector workers, leaving many without protection.
This landscape began to change with the introduction of the National Health Insurance Authority (NHIA) Act 2022, which made health insurance mandatory for all residents and dismantled earlier barriers.
Signed into law on May 19, 2022, by the late President Muhammadu Buhari, the NHIA Act replaced the old National Health Insurance Scheme Act of 2004.
Its objectives are to ensure universal access to healthcare for all Nigerians, to regulate and integrate health insurance schemes, to reduce out-of-pocket spending, and to improve the quality and accessibility of healthcare services.
By centralising regulatory authority, the Act ensures that Health Maintenance Organisations (HMOs) prioritise standardised benefit packages, creating a more equitable and predictable healthcare landscape for all citizens.
In 2025, the Federal Government announced a 93 per cent increase in the National Health Insurance capitation fee, raising the monthly rate from N750 to N1,450 per enrollee.
This adjustment, a cornerstone of the NHIA Act 2022 reforms, aims to strengthen healthcare providers’ financial viability amid rising medical costs.
By nearly doubling the capitation fee, the government sought to improve service delivery, ensure the sustainability of the newly mandatory insurance framework, and incentivise hospitals to provide high-quality care to the growing pool of insured Nigerians.
The move also encourages more citizens to enrol in health insurance, thereby reducing out-of-pocket healthcare spending.
Despite these reforms, many enrollees have expressed dissatisfaction with services and urged the NHIA, HMOs, and healthcare providers to improve service delivery.
Mr Adebayo Emmanuel, an employee of a shipping company in Apapa, described his experience with his HMO as encouraging.
“My office uses NEM Health Limited, and this has shielded me from out-of-pocket payments over the years. I consistently receive timely care whenever needed.”
In contrast, Mrs Oyeola Gabriel, a civil servant enrolled with Sunu HMO, reported dissatisfaction with the quality of drugs and services provided.
“My son had malaria and a bacterial infection. The medications given at the hospital didn’t work for three days,” she said.
“A friend advised buying a better brand, and within a day, his condition improved.”
She, however, commended HMOs for prioritising maternal and child healthcare, noting her positive experience during childbirth for her three children.
Mrs Ihe Chine, also enrolled with Sunu HMO, recounted declining service quality at AB Specialist Hospital in Lagos, ultimately leaving the facility after her son was unable to receive emergency treatment.
“We waited from 1:00 p.m. to 6:00 p.m. for a referral code. Eventually, we had to seek treatment elsewhere,” she reported.
Other enrollees, such as Mrs Deborah Okah and Mrs Titi Peters, cited issues including extended waiting times, delayed authorisation codes, poor medication quality, and perceived preferential treatment for patients paying out of pocket.
These experiences reflect the challenges of health insurance uptake and service delivery despite government efforts to expand healthcare access.
Mr Akeem Iba stated a preference for out-of-pocket payments, citing concerns about the efficiency of health insurance.
Alhaja Munirat Asake, a trader, also expressed reluctance to enrol, favouring traditional medicine.
To bridge this gap, the Lagos State Government launched the Ilera Eko Health Insurance Plan, managed by the Lagos State Health Management Agency.
The scheme helps residents access affordable, quality healthcare, but awareness and affordability remain challenges.
Recognising such ongoing challenges, Dr Kelechi Ohiri, Director-General of NHIA, said that the agency had shifted to a proactive, enrollee-first approach.
To shape this enrollee-first approach, it is important to note that the NHIA’s reform agenda rests on four pillars: expansion, equity, quality of care, and sustainability.
Expanding coverage is essential in a nation of over 200 million people, where more than 70 per cent still pay out of pocket. Enrollment increased from 16 million to 21.7 million Nigerians in two years, a 35 per cent rise.
Ensuring equity means targeting vulnerable groups through the Basic Health Care Provision Fund, which now covers over 2.67 million Nigerians.
Next is improving the quality of care through provider standards, regulatory oversight, and digitalised operations across 7,000+ accredited facilities.
And promoting sustainability through domestic financing, private insurer partnerships, and collaboration with state governments.
Ohiri highlighted additional support measures, including free emergency cesarean sections, fistula surgeries, and cancer treatment.
According to him, over 40,000 women with pregnancy complications and nearly 4,000 fistula patients have benefited from these support measures to date.
“Health insurance is now mandatory, but enforcement, awareness, and trust are the real challenges,” he said.
On the way forward, Ohiri said that.
NHIA planned to leverage technology, including USSD platforms and digital systems, to reach informal sector workers and rural communities.
“Insurance is social solidarity. Those who are healthy support those who are sick. But for that system to work, more Nigerians must be enrolled,” Ohiri emphasised.
Dr Austin Aipoh, National President of the Healthcare Providers Association of Nigeria, stressed the need for grassroots engagement to include the informal sector, which constitutes 60 per cent of the workforce.
Lending her voice, the Acting General Manager of Roche Nigeria, Dr Bolarinwa Oyedeji, noted that investing in healthcare was not a cost but a catalyst for national development.
According to her, Roche’s partnership with NHIA includes cost-sharing initiatives that significantly reduce patients’ treatment costs, particularly in cancer care.
“When our health systems get smarter, our families stay strong, and our nation becomes wealthier.
“The average Nigerian is just one illness away from financial catastrophe. Expanding access to care is essential,” she said.
Oyedeji urged all Nigerians to embrace and enrol in a health insurance scheme. (NANFeature)