Kelechi Ohiri, Director General, National Health Insurance Authority (NHIA), has disclosed that despite decades of reforms and new funding initiatives, only about 10 percent of Nigerians are currently covered by health insurance, leaving the vast majority exposed to high out-of-pocket healthcare costs.
He revealed the figure on Wednesday at the ongoing National Health Financing Dialogue in Abuja, warning that limited coverage continues to push millions into poverty and undermines the country’s drive toward universal health coverage.
In his presentation on ‘Status of Demand-Side Financing in Nigeria: Challenges and Opportunities in Health Insurance’, Ohiri highlighted both the progress and the daunting challenges Nigeria faces in expanding health insurance coverage, stressing that out-of-pocket payments remain the biggest threat to achieving universal health coverage (UHC).
He outlined the historical gaps in financing, ongoing reforms, and future strategies to ensure financial protection for Nigerians.
Ohiri noted that out-of-pocket expenditure still dominates health spending in Nigeria, creating a class of “health-poor” citizens people who, despite earning some income, are pushed into poverty when faced with chronic illnesses or catastrophic health costs.
“Prepayments, like insurance, will always be a better way of protecting yourself financially. But without wider coverage, too many Nigerians remain vulnerable,” he said.
According to him, only about 20 million Nigerians are currently covered by health insurance, representing just 10 percent of the population.
“This means that 90 percent of Nigerians, particularly those in the informal sector and poor households, still lack protection.
“While social health insurance schemes run by states have expanded coverage for vulnerable groups, the private sector remains underutilised, accounting for just 1.8 million enrollees nationwide”, he noted.
Ohiri explained that Nigeria’s first health insurance law of 1999 was voluntary and targeted mainly at the public sector, leading to adverse selection where only the sick sought coverage.
The 2014 National Health Act expanded access through the Basic Health Care Provision Fund, while the 2022 NHIA Act made health insurance mandatory and empowered the Authority to regulate all schemes nationwide.
Despite this progress, Ohiri acknowledged persistent challenges, including fragmented risk pools, outdated tariffs, inadequate reimbursement rates, and rising medical costs that have eroded trust in health insurance.
“The system cannot work if the tariffs and reimbursements are not revised in line with inflation and the rising cost of care. Otherwise, quality will continue to suffer,” he warned.
The NHIA, he said, is prioritising four pillars: expanding coverage, promoting equity, improving quality of care, and ensuring sustainability.
On coverage, he stressed that enforcing the mandatory health insurance law requires collaboration across government ministries, civil society, and the media to build public awareness and trust.
Ohiri announced that the NHIA is targeting the poor and vulnerable with dedicated interventions.
According to him, over 2.7 million people are already being supported under the Basic Health Care Provision Fund, while new initiatives have been launched to finance access to comprehensive emergency obstetric care, fistula treatment, and mental health services.
“Nigeria has one of the highest maternal mortality rates in the world. By removing financial delays, we can save women’s lives during emergencies,” he said.
He disclosed that NHIA has embarked on an actuarial review of benefit packages, which led to a 93 percent increase in capitation rates and a 370 percent rise in service tariffs to reflect current realities.
The Authority has also digitised hospital accreditation processes, introduced a one-hour waiting period rule to reduce delays in patient care, and partnered with research institutions to strengthen evidence-based reforms.
Ohiri emphasised the need to strengthen both public and private insurance players. While many private health maintenance organisations (HMOs) face headwinds, he said reforms are underway to improve their profitability, accountability, and contribution to national coverage.
The NHIA boss said implementation of the mandate for compulsory insurance will be critical.
“It is not enough to pass laws; enforcement requires a whole-of-government approach. But beyond enforcement, Nigerians must see the inherent value of insurance as a social safety net that protects them from falling into poverty,” he added.
Ohiri reaffirmed President Bola Tinubu’s commitment to UHC, describing it as the central guiding principle of health reforms.
He mentioned that while progress has been made, the journey requires adaptation, innovation, and collective action to ensure that every Nigerian, regardless of income status, has access to quality and affordable healthcare.
