Despite a 2022 law making health insurance compulsory, more than 90 per cent of Nigerians remain uninsured, the Director-General of the National Health Insurance Authority (NHIA), Dr. Kelechi Ohiri, has revealed.
Speaking in Abuja at the National Health Financing Dialogue, Dr. Ohiri said fewer than 20 million Nigerians—less than one in 10—are currently covered. He warned that the lack of financial protection leaves millions vulnerable to health shocks that push families into poverty.
“We cannot continue to have a system where health crises impoverish families. Insurance should provide a cushion, but the pool is still too shallow,” he said.
Key Challenges Holding Back Coverage
The NHIA boss identified three major obstacles:
- Limited risk pooling due to low enrolment,
- Over-reliance on out-of-pocket spending, and
- Inadequate protection for vulnerable groups.
He called for urgent measures including subsidised premiums for the poor, stricter enforcement of mandatory enrolment in the formal sector, and innovative financing such as earmarked levies.
Forgotten Groups and Service Quality Concerns
The dialogue also spotlighted pensioners as a neglected group, with many losing coverage when states stop paying their premiums. Panelists warned that retirees—at their most vulnerable stage—are being left without access to essential care.
Participants also raised concerns about service quality at accredited facilities, noting that poor oversight erodes public trust. While some state insurance agencies said they conduct quality checks, “mystery client” visits, and 24-hour feedback systems, they admitted that weak monitoring and limited resources remain serious gaps.
Imo State’s Health Insurance Agency head, Dr. Uchenna Ewelike, stressed that political will is vital: “We had to show the government that poor services undermine public confidence. People will only defend a programme that treats their parents with dignity.”
Political Will and Enforcement Seen as Game Changers
Agency heads agreed that without strong political backing and a national enforcement strategy, mandatory insurance will remain more of an aspiration than reality.
Kogi State’s health insurance chief, Adekunle Aladare, pointed out that with more than 80 per cent of Nigerians in the informal sector, subsidies are unavoidable. “Government must provide partial support. That requires political will,” he said.
NHIA’s Next Steps
Dr. Ohiri disclosed that the NHIA is expanding its benefit packages to cover prosthetics, physiotherapy, and rehabilitation services. The agency is also collaborating with the Ministry of Women’s Affairs and development partners to support vulnerable groups, including victims of obstetric fistula.
“Our goal is simple: no one should slip through the cracks,” he said.
