Health insurance is a reliable way to achieve universal health coverage (UHC) and an alternative health finance mechanism that can mitigate the consequences of health users’ fees1. However, it does not come without challenges. Effective healthcare services are difficult to be provided in Nigeria because of the high level of corruption, characterized by poor governance, a lack of transparency, poor accountability, and inefficiency2. The Nigerian healthcare system has been plagued by issues of fraud and corruption, including fraudulent health insurance claims. In addition to causing financial losses, this undermines public confidence in the system3.
The following are additional challenges of health insurance that prevent its effectiveness and wide adoption in public health:
- Low Health Insurance Coverage: A major challenge is the low coverage of health insurance in some regions of Nigeria. Many people, especially in rural areas, do not have health insurance coverage, which restricts their access to essential healthcare services. Although, the Nigerian government created an initiative, called Basic Healthcare Provisions Funds (BHCPF) which is focused on donating funds to improve access to primary health care, particularly to the poor but there are still huge gaps in the implementation at each state4.
- Inadequate Infrastructure: Nigeria’s healthcare infrastructure is often inadequate, especially in rural areas. The perceived value of health insurance might be lowered due to a lack of well-equipped healthcare facilities and medical personnel, which can discourage enrollment.
- Lack of Awareness and Education: The informal sector in particular lacks knowledge about the advantages of health insurance and how it operates. Even if there are affordable possibilities, enrolling is hampered by this lack of knowledge5.
- Data and Information Management: The effective handling of health insurance data can be hampered by inadequate digital infrastructure and health information systems, which can make it challenging to enroll, track claims, and analyze trends.
- Political and Socioeconomic Factors: The distribution of funding for public health efforts, such as health insurance programs, can be impacted by instability in Nigeria’s political and socioeconomic environment. This is reflected in the political will and commitment to operationalizing health programs and initiatives.
A thorough and coordinated strategy involving the government, healthcare providers, insurance firms, civil society organizations, and other stakeholders is needed to address the health insurance challenges in Nigeria. Here are a few recommendations.
- Public Awareness Campaigns: Launch targeted campaigns to educate the population about the importance and benefits of health insurance. These campaigns should be attentive to cultural differences and utilize a variety of media channels to engage the people. The Nigerian government has been involved in promoting health insurance awareness through agencies such as National Health Insurance Scheme (NHIS), now, National Health Insurance Authority (NHIA). The agency has been working to expand its reach and increase awareness of its programs. However, these campaigns should be attentive to cultural differences and utilize a variety of media channels to engage the people. According to research published in BioMed Central Public Health, social media has been revealed as a positive influence on public health protection6 with the potential to change individuals’ behavior towards establishing a healthy lifestyle7,8,9
- Subsidies and Premium Support: Implement subsidies or premium support systems to lower and middle-income individuals and families to make health insurance more accessible. In 2014, a catalytic funding mechanism, Basic Healthcare Provision Funds (BHCPF) was signed into law in 2014, under section 11 of the National Health Act. It provides funds for the Basic Minimum Package of Health Services (BMPHS), strengthens the national health system, most importantly at the primary health care (PHC) level by making provision for routine daily operation post of PHCs and ensuring access to healthcare for all, especially the poor, thus contributing to the overall national productivity10.
- Strengthen Regulatory Framework: To promote transparency, accountability, and fair practices, strengthen and implement the regulations and Acts that control health insurance. In 2022, the President signed into law the new National Health Insurance Authority Act (NHIA) which supersedes the National Health Insurance Scheme Act, Cap. N42, LFN, 2004 (the Old Act). The Act promotes and regulates health insurance schemes and establishes universal health coverage for all Nigerians11.
- Public-Private Partnerships: Collaborate with private sector entities to leverage their expertise in insurance administration and healthcare delivery. Health insurance systems can be made more accessible and effective through public-private partnerships.
- Research and Data Analysis: Conduct research and gather data to better understand the specific challenges and needs of different populations. Data-driven insights can inform the design of targeted health insurance solutions.
- Continuous Monitoring and Evaluation: Review the effectiveness and efficiency of health insurance programs and systems regularly, get beneficiary feedback, and make the necessary improvements.
To ensure that health insurance effectively contributes to improving public health outcomes for all members of the population, issues such as disparities in access due to coverage, rising healthcare costs, and any ambiguiety in the insurance policies need to be addressed. Furthermore, putting these suggestions into practice calls for collaboration, resource allocation, and a sustained commitment to improving the health insurance landscape in Nigeria. By addressing these challenges comprehensively, Nigeria can work toward achieving better healthcare access, improved health outcomes, and greater financial protection for its population.
- Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the sustainable development goals: development and baseline data for an index of essential health services. Lancet Glob Health. 2018;6(2):152–68.
- Ciccone DK, Vian T, Maurer L, Bradley EH. Linking governance mechanisms to health outcomes: a review of the literature in low-and middle-income countries. Soc Sci Med. 2014;1(117):86–95
- Akinnaso, N. (2014). The politics of health care in Nigeria. Retrieved from http://www.punchng.com/opinion/viewpoint/the-politics-of-healthcare-in-nigeria.
- NIGERIA HEALTH WATCH. The State of States on Primary Healthcare Delivery in Nigeria. August 2022. https://articles.nigeriahealthwatch.com/the-state-of-states-on-primary-healthcare-delivery-in-nigeria/
- Chukwudozie A. Inequalities in Health: The Role of Health Insurance in Nigeria. J Public Health Afr. 2015 Aug 16;6(1):512. doi 10.4081/jphia.2015.512. PMID: 28299138; PMCID: PMC5349265.
- Al-Dmour H, Masa’deh R, Salman A, Abuhashesh M, Al-Dmour R. Influence of social media platforms on public health protection against the COVID-19 pandemic via the mediating efects of public health awareness and behavioral changes: Integrated model. J Med Internet Res. 2020;22(8):1–15
- .Appel G, Grewal L, Hadi R, Stephen AT. The future of social media in marketing. J Acad Mark Sci. 2020;48(1):79–95.
- Naslund JA, Bondre A, Torous J, Aschbrenner KA. Social media and mental health: benefits, risks, and opportunities for research and practice. J Technol Behav Sci. 2020;5(3):245–57
- Webb T, Joseph J, Yardley L, Michie S. Using the Internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e1376.
- NATIONAL PRIMARY HEALTH CARE DEVELOPMENT. https://nphcda.gov.ng/bhcpf/.
- The Nigeria National Health Insurance Authority Act and its implications towards achieving health coverage. Ipinnimo TM, Durowade KA, Afolayan CA, Ajayi PO, Akande TM. The Nigeria national health insurance authority act and its implications for achieving universal health coverage. Niger Postgrad Med J. 2022 Oct-Dec;29(4):281-287. doi: 10.4103/npmj.npmj_216_22. PMID: 36308256.