As Nigeria rolls out mandatory health insurance, lessons from states, civil society, and private partnerships show what it will take to turn policy into real access for citizens.
President Bola Tinubu has directed all federal Ministries, Departments, and Agencies (MDAs) to compulsorily enroll their employees in the National Health Insurance Authority (NHIA) scheme.
The directive, issued on September 3, is being positioned as a major step towards advancing universal health coverage (UHC) in Nigeria.
It signals the country’s intent to shift from a system where most citizens pay out of pocket for healthcare to one where insurance becomes a national right.
But how can this new directive translate into actual access to affordable and subsidised healthcare for the populace?
State-Level Lessons
A handful of states and civil society groups offer some clue. In Lagos, for instance, the Ilera Eko scheme was launched to provide affordable coverage for residents and vulnerable groups.
While the programme faced initial resistance due to mistrust of public health systems, partnerships with private hospitals have helped build its credibility.
In the same vein, Kano State introduced its State Contributory Health Scheme, which pools resources from formal sector workers, community groups, and government grants.
By involving religious and community leaders in sensitisation and outreach, the scheme has expanded to the grassroots and is now considered a huge success in the state.
Meanwhile, Kwara pioneered one of the earliest state health insurance schemes with support from Health Policy Plus and other international donors. This demonstrates how donor-government collaboration can help scale up coverage.
The Role of Civil Society and Private Partnerships
While state governments are working behind the scenes, Groups such as Nigeria Health Watch and other smaller NGOs have invested in health literacy campaigns, teaching communities about the benefits of health insurance. Without such education, enrolment figures risk remaining strong on paper but weak in practice.
Private Health Maintenance Organisations (HMOs) are also making insurance more flexible and attractive, especially for Nigeria’s vast informal workforce.
By working with cooperatives and market associations and other grassroots groups, HMOs are embedding insurance packages into everyday financial activities such as loan repayments or savings contributions.
These partnerships highlight that health coverage cannot be achieved by the government alone. Civil society provides legitimacy and trust. On the other hand, the private sector offers new innovations and insights. Together, they can complement the state’s capacity, ensuring that mandatory enrollment is enforced on a national scale.
Making Mandatory Insurance Work
For Tinubu’s directive to thrive, three priorities stand out. First, the government must invest in transparent digital systems that make verification seamless and reduce opportunities for fraud.
The NHIA’s planned real-time certificate authentication is a promising step, but it must be implemented judiciously. Transparency and accountability are non-negotiable.
Second, enrollment for health insurance must be complemented with improved service delivery. If citizens are forced to pay but still face shortages of drugs and health workers, including dilapidated facilities, confidence in the system will falter.
Insights from Lagos and Kano show that partnerships with the private sector can help improve quality where public capacity is limited.
Conclusion
Universal health coverage will remain an empty slogan if it only benefits those at the top of the ladder. Nigeria’s new directive offers an unprecedented chance to make health insurance a national reality.
But success will depend on how well the federal rollout builds on state innovations, civil society advocacy, and private sector ingenuity—ensuring that health insurance works not just for some, but for all Nigerians.
