As part of its renewed commitment to improving healthcare service delivery for enrollees across Nigeria, the National Health Insurance Authority (NHIA) sanctioned a total of 96 healthcare providers and health maintenance organisations (HMOs) in 2024 for various service failures.
According to a statement signed by the NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, the sanctions affected 49 healthcare facilities (HCFs) and 47 HMOs, following investigations into numerous complaints submitted by patients enrolled in both state and national health insurance schemes.
The complaints covered a wide range of issues, including:
- Non-availability of essential medicines
- Denial of services
- Out-of-pocket payments for services covered under the scheme
- Lack of payment documentation
- Delays or denials in referral authorization codes by HMOs
- Failure of HMOs to promptly settle reconciled payments
- HMOs’ negligence in quality assurance monitoring at partner facilities
“These findings are detailed in the NHIA’s 2024 Annual Complaints Report, compiled by the Enforcement Department under the leadership of Acting Director Dr. Abdulhamid Habib Abdullahi,” the statement noted.
Over 3,500 Complaints Handled in 2024
Ononokpono disclosed that a total of 3,507 complaints were received by the NHIA in 2024, with 2,929 cases—representing 84%—successfully resolved. A majority of the complaints (2,273) were directed against healthcare facilities, while 1,232 were filed against HMOs. Only two complaints were lodged against enrollees by service providers.
In line with the NHIA Act No. 17 of 2022, which mandates the Authority to establish effective complaint resolution mechanisms, various sanctions were applied based on the outcomes of the investigations. These included:
- 84 formal warnings issued to healthcare facilities
- ₦4,375,500 in refunds paid to 54 enrollees by 39 healthcare facilities
- Suspension of four HCFs and delisting of six others
- 35 warning letters sent to HMOs, with directives to implement corrective actions
- ₦748,200 in refunds issued by 12 HMOs to 15 affected enrollees
Efficient Complaint Resolution Timelines
The NHIA reported that all complaints were addressed within the standard response time of 10 to 25 days, with an average resolution time of 15 days for cases requiring investigations. The agency maintained a resolution rate of 84% within the stipulated timelines. Where issues could not be resolved within this timeframe, complainants were given status updates as investigations continued.
Complaints in 2024 were received through various channels, including in-person submissions, written letters, emails, telephone calls, the NHIA call center, and other communication platforms.
The NHIA’s Complaint and Grievance Management Protocol ensures timely responses, and includes escalation procedures for complex or unresolved issues, providing a structured approach to service accountability.
Driving Accountability and Quality of Care
Commenting on the development, NHIA Director General Dr. Kelechi Ohiri emphasized that the agency’s complaints management system plays a central role in its mission to enhance accountability, rebuild public trust, and improve healthcare quality for all enrollees.
“Our enforcement actions send a clear message: the NHIA will not tolerate substandard service delivery,” Dr. Ohiri said. “Enrollees deserve quality care, and we are committed to ensuring that providers uphold their obligations. These actions also aim to encourage increased enrolment by assuring Nigerians of improved service standards.”
