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In alignment with the global effort towards Universal Health Coverage (UHC), Nigeria is striving to guarantee fair access to high-quality and affordable healthcare for all its citizens.
However, advancements have been slow, highlighted by substantial out-of-pocket healthcare costs, inadequate health insurance coverage, and low national and regional health budgets.
Nigeria experiences one of the world’s highest rates of out-of-pocket healthcare spending, with approximately 77 percent of healthcare costs being paid directly by individuals, as reported by the World Health Organization (WHO).
It’s not just a Nigerian issue; the WHO indicates that global progress towards universal health coverage is lagging behind, a vital aim of the Sustainable Development Goals focused on health and well-being.
“This global trend is evident across all regions and most countries. Protecting individuals from the financial impact of paying for health services out-of-pocket can reduce the risk of poverty, which may be exacerbated when the costs of necessary care lead individuals to deplete savings, liquidate assets, or incur debt, damaging their future and often that of their children.”
In a nation as diverse and populous as Nigeria, where individuals are struggling with high living costs, financial barriers, and rising healthcare and medicine expenses, out-of-pocket payments for healthcare have become prohibitively expensive, prompting people to self-medicate, overlook symptoms, or seek divine intervention.
Millions of Nigerians, especially those in rural and underserved areas, encounter obstacles in accessing healthcare due to systemic inequalities and financial limitations. Delays in seeking timely medical care exacerbate morbidity and mortality rates among the population. For many Nigerians, UHC is not merely an objective, it represents a lifeline.
The Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, reported during the second anniversary of President Bola Tinubu’s administration that only 16 million Nigerians were enrolled in health insurance when the administration began in 2023.
“We’ve made strides in expanding health insurance enrollment nationwide. Over nearly 25 years of health insurance in Nigeria, there were just 16 million enrollees when we took office, averaging less than a million each year. However, in just two years, we have added four million Nigerians to the National Health Insurance Scheme. If this trend had continued in previous years, Nigeria would now have over 100 million enrollees.”
Pate shared that the government is collaborating with state health insurance authorities to reform the health insurance scheme to reach more Nigerians, particularly vulnerable populations. In Lagos State, the Lagos State Health Management Agency (LASHMA), established in 2015, oversees the state's social health insurance program named “Ilera Eko Scheme.”
This program aims to improve access to effective, quality, and equitable healthcare services while providing financial protection from healthcare costs for all state residents.
With an estimated population of 30 million and an annual growth rate of six to eight percent, Lagos faces significant healthcare demands, necessitating innovative, scalable, and resilient solutions.
The Lagos State Commissioner for Health, Prof. Akin Abayomi, revealed during Gov. Babajide Sanwo-Olu’s second term anniversary that currently, only five percent of Lagos residents are enrolled in the state's social health insurance.
Abayomi outlined a bold 30-year plan to increase enrollment from five percent to 90 percent.
He acknowledged the need for an increased budget allocation from the current eight percent to a target of 15 percent, supported by dynamic reallocations throughout the fiscal year to achieve universal health coverage.
The Ilera Eko health insurance scheme offers various plans at different price points for individuals and families, enabling access to both private and public hospitals across the state.
The scheme covers 80 percent of hospital expenses, including consultations, treatment for common illnesses, maternal care, management of chronic diseases, and surgeries, among other services.
To enhance health insurance coverage, Gov. Sanwo-Olu signed an Executive Order in July 2024, mandating that all residents, employers, and workers in the state subscribe to the social health insurance.
The government plans to fully enforce mandatory health insurance for all residents by the third quarter of 2025. Currently, around 1.3 million residents are enrolled in LASHMA’s Ilera Eko health insurance.
The Permanent Secretary of LASHMA, Dr. Emmanuella Zamba, stressed the importance of raising public awareness and affirmed LASHMA’s commitment to communicating that health insurance is a necessity rather than a privilege.
“We are dedicated to ensuring that every Lagosian recognises the significance of social health insurance and that it is now a mandatory requirement,” she stated.
Zamba also highlighted the agency's strategic initiatives to involve the informal sector in the health insurance system through the “ILERA ‘N TIWA Cooperative,” offering flexible payment plans for artisans, traders, and low-income earners to ensure they are included in healthcare services.
Additionally, the Ilera Eko Academy initiative aims to train a larger sales force to enhance public awareness and increase enrollment.
The Permanent Secretary noted that LASHMA has broadened its registration options to improve accessibility, including establishing physical enrollment centers throughout Lagos, designated community pharmacies, USSD registration, and an online portal.
“The agency has also launched an equity fund that guarantees healthcare access for over 300,000 vulnerable residents,” she said. “This equity fund, financed by one percent of Lagos State’s consolidated revenue, sets a standard as a first-line charge, ensuring funds are consistently available for vulnerable groups.”
Regarding the affordability of social health insurance, Zamba mentioned that the enrollment fees are N15,000 for individuals, N55,000 for a family of four, and N80,000 for a family of six. Enrollee Mrs. Funke James shared that she received free treatment for a severe cough infection and medications valued at over N80,000 through the scheme.
“My daughter also underwent a Caesarean Section without any costs. I am genuinely thankful to the government,” she expressed.
Similarly, Hassan Balikis praised the program, recounting her experience of receiving three free medical tests after falling ill, stating, “I didn’t grasp the extent of the benefits until I needed them. This program is truly a lifesaver.”
Despite the government's commendable efforts to enhance health metrics and care quality in Lagos State, the Ilera Eko scheme continues to face challenges such as long wait times, low enrollment, and accessibility issues, as reported by some beneficiaries and Civil Society Organizations.
While Lagos State displays strong political will and has made significant progress, there remains much to be done in delivering equitable, affordable, and accessible healthcare services to ensure that no one is left behind.
