Without Health We Have Nothing 1

Gabriel Oke

By Gabriel Oke

The current state of Nigeria's National Health Insurance Scheme: Redefining strategies to achieve Universal Health Coverage

HPHR Journal Fellow Gabriel Oke interviews Dara Ajala-Damisa on the ''Without Health we have Nothing'' series

You can follow and keep up with Dara Ajala-Damisa here: Dara Ajala-Damisa

Health insurance overview

Health insurance is a contract in which an organization is given a predetermined amount of money each month, and in exchange, the organization promises to pay doctors, hospitals, and pharmacies when the subscriber accesses health services – for preventive, chronic, emergency, diagnostic, etc. medical care – and purchases treatments. The idea is that the smaller, regular sums paid when in good health offsets the larger, full cost of care when a subscriber becomes ill or wounded. In Nigeria, there are two major forms of health insurance:

  • The government-run National Health Insurance System (NHIS)
  • Private health insurance companies (e.g., Axa Mansard, Hygeia HMO, Liberty Health, etc.)
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Nigerian Guide: Health Insurance

NHIS Overview

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Punch: Health Insurance

Public health insurance is administered by the Nigerian National Health Insurance Scheme (NHIS). The NHIS covers Nigerian nationals who meet the following conditions: government employees; those who work in the organized or informal private sector; children under the age of five; chronically disabled people; and jail inmates. Altogether, NHIS covers only about 5% of Nigerians.


NHIS aims to attract more resources to the healthcare sector, improve access to resources, and increase utilization of healthcare services. This is done in collaboration with private companies and private healthcare providers.

NHIS provides the following coverage:

  1. Prescriptions, medications, pharmaceutical treatment, and diagnostic testing
  2. Outpatient care or treatment
  3. Maternity care for up to four live births for every insured contributor/couple
  4. Preventive care, including immunization programs, health education, family planning, prenatal and post-natal care, as well as adult immunization against HPV and hepatitis
  5. Consultations with specialists, such as physicians, obstetricians, gynaecologists, general surgeons, orthopaedic surgeons, etc.

The economics of NHIS

Employers pay 10% and employees pay 5% for agencies in various tiers of government and the organized private sector, totaling 15% of each employee’s wage. In some situations, the employer may elect to cover the entire 15% of the employee’s salary; however, the employee may choose to make additional payments to strengthen their package as well. The enrollee’s contributions to the plan will cover the enrollee, one spouse, and four children under the age of 18. If the scheme is expanded to include more persons and children above the age of 18, the NHIS will assess further contributions.


The employee has to cover whatever is not covered under the NHIS Scheme and Health Management Organisation policies they are subscribed too. This means that if the HMO and NHIS policy and agreement is that malaria treatment is covered, then the subscriber will not pay for treatment for malaria. But, if there are some laboratory tests the subscriber needs, that are not covered in their scheme and policy, then they will have to pay for these tests completely out-of-pocket.


The problem with this arrangement is that most times, patients or their relatives don’t know ahead of time how much of their payment is covered under NHIS. They have to visit the NHIS office in hospitals to find out whether what they are about to pay for is covered by NHIS or not. Thus, despite this payment scheme, when it comes to paying for medical expenses, out-of-pocket payments are still very high. This has continued to drive many families into catastrophic health costs and poverty.

Nigeria Health Watch: Universal Health Coverage

Analysis and Recommendations

Contributors to the flaws of the NHIS include:

  • Inadequate legal framework to support the NHIS system and deployment of services at various health care centers
  • Underfunding of healthcare funds and health insurance plans by the government
  • Inappropriate regulatory systems and coordination of the health management organisations serving as insurers and supporting the deployment of insurance services at health care centers
  • Inconsistency on the part of subscribers


The uptake of health insurance can be facilitated using the following strategies:

  • Ensuring a solid, consistent, and permanent health insurance scheme is in place by making sure the current subscribers are well-taken-care-of during hospital visits. If this is done, community members would inform their friends and families and recommend that hospital for their care. Thus, government should improve on health financing and management for health insurance in the country.
  • Creating awareness about the benefit of health insurance is essential and community mobilization to markets, offices, and populated settings would increase uptake of health insurance.
  • Learning from and adapting other successful solutions, such as the delta state health insurance commission, which has made commensurate progress in registering a large number of people within a short period.



1. Ifeanyi Nsofor: Without Health, we have nothing (TedxOguiRoad, 2018). Available at: https://www.youtube.com/watch?v=u4r_0TLTBQw

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