Nigeria’s health insurance coverage is behind peers such as Indonesia, South Africa, Algeria and India. Analysts attribute the situation to the nation’s low expenditure on health.
In Nigeria, only about 19.7 million Nigerians, representing 8.9 percent of the estimated 220 million population, are enrolled in any form of health insurance, according to the National Health Insurance Authority (NHIA) figures.
However, the nation’s peers are performing better. Indonesia, a populous, multi-ethnic federation and emerging economy enjoys nearly 100 percent health insurance coverage. Its health Insurance programme, Jaminan Kesehatan Nasional (JKN), covers approximately 98.19 percent of the population, according to Asian Pacific Solidarity Network (APSN), making it one of the largest single-payer health systems in the world.
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Algeria is an oil producer and an emerging economy like Nigeria. Its health insurance coverage is 90 percent, and emigrants can use it for free through the social security system when employers register them, according to the World Supporter, which provides immigration information.
South Africa’s public health insurance serves 84 percent of the population, though 16 percent have access to the better-funded private health insurance. South African President Cyril Ramaphosa signed the National Health Insurance (NHI) Act into law in May 2024 to provide universal health coverage for the citizens.
Similarly, half of India’s population could access public health insurance by 2023, according to Statista. India is an emerging market like Nigeria, though its population is seven times Nigeria’s.
Kelechi Ohiri, NHIA director-general, speaking exclusively with BusinessDay, said the conversations on how to make health insurance mandatory and bring in the informal sector is still ongoing.
“It is not something NHIA alone can do; we have to depend on other MDAs. Nigeria has a large informal sector, so it makes it tricky to enforce anything,” he said.
In Indonesia, low-income individuals and families receive premium assistance through the nation’s non-contributory scheme known as Penerima Bantuan Iuran [PBI).
In Nigeria, while the NHIA Act provides for a Vulnerable Group Fund which targets over 80 million Nigerians, the fund has remained dormant.
Issues around Nigeria’s health insurance
The NHIA DG acknowledged that there are lessons to be learned from countries that have achieved universal coverage.
He said, “We have a very fragmented system. Our political economy structures make this the case. I would have designed it differently, but this is what we have. So we must make it work. However, there are certain countries where certain similarities exist. Indonesia is one. It’s also big and relatively decentralised and deconcentrated. And they’ve managed to get to universal healthcare coverage, but it’s not without a very significant outlay of resources to do that. So, there are things to learn,” he said.
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Nigeria allocated N1.3 trillion ($867 million) to health in 2024, 4.6 percent of the total budget. Indonesia allocated $11.4 billion for its 285 million people, while India set aside $10.4 billion for the sector.
Tunde Laleye, former head of the Health and Managed Care Association of Nigeria (HMCAN), noted that fewer than 100 HMOs serving a country of over 200 million people is grossly inadequate by any measure.
Laleye also stressed that significant funding must come from the government coffers if the goal is universal coverage. “If the government wants everyone insured, they can afford it,” he said. He also alleged that vested interests in the pharmaceutical sector may have hampered insurance expansion.
Adaobi Onyechi, a public health expert, believes that political commitment is key to achieving health insurance success.
“Political will, institutional coherence, and policy clarity, not just resources, are the true determinants of success,” she said.
