Report Exposes Nigeria’s Dismal Health Insurance Coverage: Only 5% Enrolled Amid UHC Push
A newly released report has spotlighted Nigeria’s woefully inadequate health insurance landscape, revealing that as of 2022, a mere 5% of the country’s 208 million people—or roughly 10.4 million individuals—were enrolled in any form of health coverage. Titled “Human Capital Development and Health Insurance in Nigeria,” the study, presented by the Nigerian Institute of Social and Economic Research (NISER) on October 10, 2024, underscores how this low penetration hampers the nation’s human capital potential and exacerbates financial vulnerabilities in healthcare access. Lead researcher Dr. Terrence Kairiza emphasized Nigeria’s demographic dividend, with over one-third of its population being youth, yet warned that without robust health investments, this “vast pool” risks being squandered.
The findings, covered prominently by Vanguard News, align with longstanding critiques of the National Health Insurance Scheme (NHIS), launched in 2005 to curb out-of-pocket expenses that currently devour 75% of total health spending. Despite ambitions for Universal Health Coverage (UHC) by 2030, the report highlights systemic bottlenecks, including complaints over substandard drugs and tiered treatment quality based on enrollee affiliations—issues that have eroded public trust.
Key Findings from the NISER Report
Drawing on data up to 2022, the report paints a stark picture of underutilization and inequities:
| Metric | Statistic | Context/Implication |
|---|---|---|
| National Enrollment Rate | <5% (10.4 million people) | Vast majority (95%) rely on out-of-pocket payments, pushing 100 million into poverty annually per WHO estimates. |
| Target Population | 208 million (Africa’s largest) | Youth bulge (35% under 15) offers growth potential, but low coverage stifles FDI and internal development. |
| Scheme Launch Impact | NHIS since 2005 | Intended to shield from catastrophic costs; yet enrollment stagnant due to informal sector exclusion (80% of workforce). |
| Regional Disparities | South West: 2.67%; North East: 0.86% | Southern urban areas lead due to better awareness; northern rural gaps tied to education and income barriers. |
| Overall Health System Performance | 45% capacity | Private providers handle 70% of services despite only 35% of facilities, per complementary 2025 reports. |
The analysis attributes low uptake to supply-side flaws like corruption allegations, fund mismanagement, and poor service delivery, alongside demand-side hurdles: limited awareness (only 19% of Nigerians know about schemes per 2024 polls), low income prioritizing immediate needs, and a cultural aversion to “long-term” planning like insurance. Claims payouts, while rising (₦3.1 billion in 2022 to ₦3.7 billion in 2023), remain a drop in the bucket against the ₦1.5 trillion health market.
Historical Context and Government Response
Nigeria’s health insurance journey has been fraught: Pre-2022 NHIA Act efforts yielded sub-optimal results, covering mostly formal sector workers (e.g., federal employees). The 2022 Act mandates coverage for all citizens and residents, introducing subsidies for vulnerables via a Vulnerable Group Fund. Coordinating Minister Prof. Ali Pate hailed it as a “turning point,” aiming for 50% enrollment by 2027 through state-level rollout and digital enrollment drives. Yet, implementation lags—only 3% of 2016 health spend was insurance-funded, and a 2023 ministerial admission pegged uncovered Nigerians at 90%.
NISER Director-General Dr. Adeyemi Adeniran positioned the institute as a policy think-tank under the Ministry of Budget and Economic Planning, urging evidence-based reforms for “inclusive development and shared prosperity.” The report calls for FDI in health infrastructure and education to unlock human capital, echoing WHO’s UHC framework where financial risk protection is key.
Implications for Nigeria’s Health Equity and Economy
This low coverage perpetuates a vicious cycle: High out-of-pocket costs (third-highest globally) deter preventive care, fueling a 45% system efficiency rate—1.7% below Africa’s average. Vulnerable groups (indigents, informal workers) bear the brunt, with maternal mortality at 512/100,000 live births (WHO 2023). Economically, it drains productivity; a 2025 BMC study links education and urban residence to higher uptake, suggesting targeted campaigns could boost rates.
Broader trends show glimmers of hope: The NHIA’s 2023 guidelines emphasize regulatory oversight, and private schemes are expanding (e.g., Lagos’ CBHI enrolled 40,000 by 2010). However, without addressing perceptions of “inferior” care—such as cheaper drugs for enrollees—skepticism persists.
Recommendations and Pathways Forward
- Awareness Drives: Partner with community leaders and digital platforms to educate on benefits; polls show knowledge gaps explain 40% of non-enrollment.
- Incentives for Informal Sector: Subsidized premiums and micro-insurance models tailored to low-income earners.
- Quality Assurance: Enforce standards to eliminate tiered treatments; integrate AI for claims transparency.
- Monitoring Progress: Leverage DHS data for annual audits; aim for 20% coverage by 2026 via state NHIA offices.
- For Individuals: Enroll via NHIA portals or apps; federal workers get free family coverage up to four dependents.
As Nigeria marks 65 years of independence, this report serves as a wake-up call: Bridging the 95% gap is essential for a “renewed health system” under President Tinubu. For the full NISER report or enrollment guides, visit nhia.gov.ng. If you’d like regional breakdowns, UHC comparisons with peers like Ghana, or updates on the 2025 health budget, let me know!