Ebere Nwoji
The National Health Insurance Authority (NHIA), said Nigeria has made significant progress in its efforts to achieve Universal Health Insurance Coverage (UHC), as health insurance enrolment has risen to over 22 million showing acceleration of the implementation of mandatory health insurance across the country.
Speaking at the Annual General Meeting of the Nigerian Association of Insurance and Pension Editors (NAIPE) in Lagos on Tuesday, the Director-General of NHIA, Dr. Kelechi Ohiri, said the Authority had moved beyond policy formulation to delivering measurable improvements in healthcare access, service quality and consumer protection, in line with the federal government’s health sector reform agenda.
Describing implementation as the defining challenge of the current phase of reforms, Ohiri said: “Nigeria has the policy. Nigeria has the legislation. The decisive variable is now implementation — consistent, rigorous and accountable execution that converts political commitment into healthcare access for real Nigerians.”
He added that the progress recorded so far demonstrated that sustained collaboration among the federal government, states, healthcare providers, Health Maintenance Organisations (HMOs), employers and development partners was beginning to translate reform into tangible results for citizens.
According to him, the number of Nigerians covered by health insurance has climbed to 22.03 million, representing a 35 per cent year-on-year increase, driven by stronger partnerships with State Social Health Insurance Agencies (SSHIAs), wider engagement with Ministries, Departments and Agencies (MDAs), organised labour, employers and the private sector, as well as the gradual implementation of the mandatory health insurance provisions of the NHIA Act.
He explained the transformation of the former National Health Insurance Scheme (NHIS) into the NHIA represented a fundamental institutional reform that has strengthened regulation, consumer protection, accountability and strategic purchasing, while providing the legal and operational framework required to achieve Universal Health Coverage.
Ohiri said improving the experience of enrollees remained central to the Authority’s reform agenda. He disclosed that NHIA had strengthened its complaints management system, introduced faster resolution timelines, intensified compliance monitoring of HMOs and healthcare providers, and enforced sanctions where standards were breached.
According to him, so far, 3,878 complaints have been resolved, representing an 87 per cent resolution rate, with 95 per cent concluded within prescribed timelines, over N14.2 million refunded to enrollees, and non-compliant facilities sanctioned.
He added that the Authority had also introduced service standards, including the one-hour treatment commencement expectation for enrollees requiring urgent care, to ensure that health insurance translates into timely, quality care.
The NHIA boss also highlighted major reforms designed to improve service delivery by healthcare providers. These include a 93 per cent increase in capitation payments and a 378 per cent increase in fee-for-service reimbursements, measures he said were enabling providers to invest in personnel, equipment and infrastructure while delivering better care to patients. He added that 7,592 healthcare facilities had so far been assessed under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement nationwide.
He further highlighted targeted interventions for vulnerable groups, including support for over 48,500 pregnant women, expanded maternal and newborn healthcare, the Vulnerable Group Fund and enhanced attention to pensioners and retirees, stressing that Universal Health Coverage can only succeed if it reaches every Nigerian, regardless of income or location.
Ohiri said the Authority’s reforms align closely with President Bola Ahmed Tinubu’s Renewed Hope Agenda, which places strong emphasis on social protection and expanded access to quality healthcare, as well as the health sector-wide reforms being coordinated by the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate.
While acknowledging that much work remains, he said the progress already recorded provides a strong foundation for achieving Universal Health Coverage through sustained implementation, accountability and public trust.
He highlighted ongoing reforms in the authority as development of healthcare provider compliance officers, signing of MoUs with community pharmacies to eliminate medicine stock-outs, introduction of one-hour referral authorisation policy, introduction of the NHIA enrollee charter, review of the claims management protocol and enhancement of regulatory oversight and real-time compliance monitoring.