He highlighted three main challenges including limited risk pooling, over-reliance on out-of-pocket payments, and inadequate protection for vulnerable groups.
The Director-General of the National Health Insurance Authority (NHIA), Kelechi Ohiri, has disclosed that more than 90 per cent of Nigerians remain outside the health insurance system, despite a 2022 law mandating coverage for all citizens.
Mr Ohiri made this known on Wednesday during his presentation on the “Status of demand-side financing in Nigeria: challenges and opportunities in health insurance”, at the ongoing National Health Financing Dialogue in Abuja.
He said the NHIA Act of 2022 was designed to make insurance compulsory, but fewer than 20 million Nigerians, less than 10 per cent of the population are currently covered.
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“We cannot continue to have a system where health shocks push families into poverty. Insurance is meant to be the cushion, but the pool remains too shallow,” he said.
He highlighted three main challenges including limited risk pooling, over-reliance on out-of-pocket payments, and inadequate protection for vulnerable groups.
He stressed the need to strengthen demand-side financing by subsidising premiums for the poor and vulnerable, enforcing mandatory enrolment for the formal sector, and expanding innovative financing mechanisms such as earmarked levies.
The dialogue, which runs ord to pay are identified and prioritised. This will help us ring-fence resources for them,” he said.
He explained that the NHIA is working to ensure ‘no one slips through the cracks,’ while also reviewing benefit packages to include prosthetics, physiotherapy, and rehabilitation services.
He also added that the NHIA is collaborating with the Ministry of Women’s Affairs and development partners like UNFPA to provide rehabilitation and empowerment programmes.
Pensioners were also highlighted as a forgotten group with panelists including the Executive Secretary of Ondo State Health Insurance Authority, Abiodun Oyeneyin, and Executive Secretary of Imo State Health Insurance Agency, Uchenna Ewelike, saying many retirees lose coverage when states stop paying their premiums, leaving them exposed at the point of greatest vulnerability.
Accreditation and quality of care
A recurring concern raised at the event is the quality of services offered under health insurance schemes and whether accredited facilities meet the standards required to inspire confidence among enrolees.
Mr Ohiri noted that the cross-sectoral approach between ministries is essential for building trust in the system, stressing that accreditation is not merely about registering facilities but ensuring they deliver safe, reliable, and patient-centred care.
However, Executive Secretary of Bayelsa State Health Insurance Agency, Agadah Zuoboemi, the Executive Secretary of Ogun State Health Insurance Agency, Afolabi Dosunmu and the Executive Secretary of Benue State Health Insurance Agency, Kenneth Korve said their agencies rely on regular quality assurance checks, mystery client visits, and 24-hour feedback systems to maintain standards between accreditation cycles.
Yet, they admitted that weak oversight and limited resources continue to undermine trust in the system.
Mr Oyeneyin, the Executive Secretary of Ondo State Health Insurance Authority, explained that the state now insists on periodic monitoring of facilities and direct engagement with professional associations to weed out unqualified providers.
Mr Ewelike, Executive Secretary of Imo State Health Insurance Agency said political buy-in was key to enforcing quality.
He recalled how the government only approved full insurance for pensioners after the agency demonstrated that substandard services were undermining public confidence.
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“We had to convince the government that quality care is not just a health issue but also a political one. Families will only support and defend a programme that gives their parents dignity at the point of care,” he said.
Political will and enforcement as game changers
When asked what could significantly raise health insurance coverage in their states, Mr Oyeneyin and Mr Ewelike both pointed to two missing ingredients: political will and enforcement.
However, the Executive Secretary of Kogi State Health Insurance Agency, Adekunle Aladare, argued that in many states, over 80 per cent of the population are in the informal sector.
Mr Aladare said a good number cannot pay 100 per cent of the premium.
“Government must provide partial subsidy and that can only come when there is political will,” he said.
Others called for a national enforcement strategy to make health insurance truly mandatory, beyond legislation.
