Agency links insurance compliance to government contracts, increases provider tariffs by 378%

The National Health Insurance Authority (NHIA) has disclosed that health insurance coverage in Nigeria has expanded to more than 24 million people, representing a 35 per cent increase in the last three years, following the implementation of mandatory health insurance and sweeping regulatory reforms.

The Director-General of NHIA, Dr. Kelechi Ohiri, who disclosed this at the inaugural Nigeria Health Financing Research and Learning Forum in Abuja, said the authority was strengthening enforcement mechanisms to make health insurance a core requirement for government procurement, licensing and permits.

Ohiri said the reforms were designed to accelerate Nigeria’s progress towards Universal Health Coverage (UHC), protect households from catastrophic out-of-pocket healthcare expenditure and ensure that access to healthcare was no longer determined by the ability to pay.

He, however, stressed the need for Nigeria to take ownership of its health financing research agenda, warning that dependence on externally designed and commissioned studies could undermine the country’s capacity to sustain long-term reforms.

The forum, themed, “Evidence and Learning for Nigeria’s Health Financing Future: Building a Locally Led Research and Learning Ecosystem,” brought together policymakers, researchers, development partners, state health insurance agencies and civil society organisations to examine evidence-based approaches to health financing.

According to the Director General, Nigeria’s health financing policy has, for too long, been shaped by studies designed, commissioned and analysed outside the country, with findings presented to government only after research had been completed.

While acknowledging the contributions of international partners, he said episodic research was insufficient to build the institutional capacity required to sustain health sector reforms.

He said: “For far too long, Nigeria’s health financing policy landscape has been shaped by studies designed, commissioned and analysed outside our borders, with findings presented to government at the finish line.

“While these studies have provided valuable insights, episodic research cannot build the durable institutional capabilities required to sustain long-term reforms.”

Ohiri said the country was now taking steps to assert its research sovereignty by determining its own priorities, commissioning studies locally and embedding evidence generation into the implementation of health financing policies.

He clarified that research sovereignty did not mean isolating Nigeria from international support, but ensuring that the country remained in the driver’s seat in defining its research questions and translating findings into policies.

“International partnerships remain vital, but foreign funding must complement, not substitute for, domestic investment in our health financing architecture,” he said.

The NHIA boss said the initiative was in line with the Federal Government’s broader health sector reforms under the Nigerian Health Sector Renewal Investment Initiative, adding that the forum would review five landmark studies commissioned by the authority on embedded learning.

Participants would also examine lessons from Ethiopia, Ghana and India to identify strategies that could strengthen Nigeria’s health financing system.

Ohiri said the research initiative was directly linked to the operational reforms being implemented by the NHIA, stressing that evidence was critical to determining what was working, what required adjustment and where implementation gaps remained.

On efforts to strengthen healthcare delivery, he said the authority had increased capitation rates by 93 per cent and fee-for-service tariffs by 378 per cent after 12 years of static payment rates.

The adjustments, he said, were aimed at ensuring that accredited healthcare facilities received adequate compensation to provide quality services to enrollees.

He noted that expanding insurance coverage without addressing the financial sustainability of healthcare providers could undermine the effectiveness of the reforms.

Ohiri also disclosed that the authority had introduced a “One-Hour Rule” to prevent administrative delays from obstructing access to medical care.

Under the policy, healthcare facilities are required to attend to emergency cases immediately without waiting for authorisation from Health Maintenance Organisations (HMOs).

For routine consultations, HMOs are expected to issue authorisation codes within one hour, failing which healthcare providers are required to proceed with treatment, while the NHIA monitors compliance.

He said the policy was designed to ensure that administrative procedures did not take precedence over patients’ health and well-being.

On the protection of vulnerable Nigerians, the NHIA director-general said the authority was leveraging the Basic Health Care Provision Fund (BHCPF) and the operationalisation of the Vulnerable Group Fund (VGF) to subsidise insurance coverage for poor households, pregnant women and other vulnerable populations.

He said the interventions were critical to ensuring that families were not pushed into poverty by medical bills.

Ohiri added that the authority had also strengthened its digital transformation agenda through the launch of a self-service electronic portal and automated compliance verification systems.

The platforms, he said, would enable Nigerians to enrol in health insurance, manage their dependants and verify certification online, while improving transparency and reducing administrative bottlenecks.

Ohiri urged participants at the two-day forum to move beyond academic discussions and develop concrete commitments that would strengthen the country’s health financing research and implementation capacity.

“Every reform we undertake, from tariff adjustments to digital verification, requires rigorous, locally generated evidence to tell us what is working, what needs refinement and where gaps remain,” he said.

He called on policymakers, researchers, development partners and state-level implementers to scrutinise the commissioned studies, refine national research priorities and develop time-bound commitments capable of advancing Nigeria’s UHC agenda.

The NHIA boss said the ultimate objective was to ensure that health financing reforms translated into better health outcomes, improved access to services and stronger financial protection for Nigerians.