Health
A Lifeline under Life Support: How National Health Insurance Scheme Robs Nigerians of Quality Healthcare
By Blessing Udeobasi
When the Nigeria Health Insurance Scheme was set up by Decree 35, of 1999, it promised to alleviate the healthcare challenges faced by millions of Nigerians. However, nearly two and half decades later, the scheme has been marked with numerous shortcomings leading to a near defeat of its purpose.
The NHIS was created to ensure universal health coverage for Nigerians, starting with federal employees and expanding to formal and informal sectors. In theory, the brilliant initiative covers a range of services, from consultations to surgeries and maternity care by pooling funds together, to provide healthcare without the financial shock associated with sudden illness or accidents.
While some Nigerians expressed sincere gratitude for a scheme of this nature, many believe that there is still much room for improvement so that the scheme can meet the needs of citizens better.
“My experience with NHIS has been fair despite its ups and downs. I’m already aware that nothing is perfect in Nigeria but I’d say they’re trying to an extent. It feels good to go to the hospital sometimes and not pay a dime,” says Ms Cynthia*, A federal government employee’s dependent residing in Nsukka.
For employees of federal institutions, both private and public, the NHIS automatically deducts a small portion of salaries to fund the scheme, while other segments of the population can voluntarily enroll. However, despite these efforts, the NHIS’s reach and efficiency are limited.In 2018, Nigeria had the third highest out-of-pocket health expenditures in the world, with 76.6% of all health spending in the country paid directly by individuals.
The World Health Organization also estimates that Nigeria has the highest out-of-pocket expenditure on health in West Africa.Our Dream NHIS Exists Only on Paper In a bid to salvage this situation and to achieve universal health coverage, former President Mohammadu Buhari, in May 2022 signed the National Health Insurance Authority Act into law.
According to the Act, each employer wishing to participate in the scheme registers with the NHIS and is assigned a registration number. They select an accredited HMO and the NHIS issues an ID card to the enrollee and their eligible dependents. The Primary Care Provider (PCP) takes care of all the primary health care issues of the enrollee based on the NHIS benefit while the HMO pays the PCP a global capitation per member every month, which has been pre-agreed.
The HMO also reimburses the specialist on the pre-agreed Fee-For-Service tariff as prescribed by the NHIS whenever the claim is presented.As revealed on the NHIS website, enrollees are entitled to benefits such as out-patient care, prescribed drugs, pharmaceutical care and diagnostic tests, maternity care for up to four live births for every insured couple in the Formal Sector Programme, preventive care, including immunization, family planning, antenatal and postnatal care, consultation with a specialist such as physicians, paediatricians, obstetricians, gynaecologists, etc., and hospital care in a standard ward for a stay limited to a cumulative 15 days per year among other benefits.
Current Reality of NHIS EnrolleesWorthy of note is the fact that it is one thing to enact a law, but another thing to ensure strict implementation across the board. This now begs the question: Is the NHIS meeting the healthcare needs of Nigerians as purported in their mission statement and guidelines? What challenges are preventing the effective implementation of the scheme? How are the failures of the NHIS impacting the health and welfare of Nigerians?
According to a 2017 study conducted by the Research Department of the Central Bank of Nigeria, limited coverage, in-extensive prescriptions, conflict of interests between the NHIS and HMOs, low participants’ coverage, issues of mistrust, total government financing limitation as well as low budget allocation compared to need, were the major issues confronting the achievement of quality healthcare delivery from the Scheme.
“One of the major challenges is that some drugs especially very expensive ones are not made available through the NHIS. Oftentimes, the hospital tells us to either pay out of pocket or buy those drugs from the market because the NHIS does not cover them. There may be other similar drugs that the program covers but in most cases, the most effective one is never covered by NHIS,” says Mr Romanus Ikeh*, a staff of the University of Nigeria Nsukka, who has been enrolled since 2016.
It is not just Ikeh who has faced similar experiences with the health insurance scheme. Ms Rita*, a stay-at-home mum resident in Anambra State told this reporter that she recently visited the hospital and the doctor prescribed a medicine worth N12,000 for her. However, when she got to the hospital’s pharmacy, she was told it was not available and that she should buy it from the market.
“Meanwhile, I saw them giving the same medicine to someone else. When I tried to find out the reason for that, I discovered that the patient they gave the medicine to was not enrolled under NHIS.” Ms Rita said. Similarly, Ms Chinenye* a nursing mother, also a resident in Anambra State said she was denied a delivery mat on one of her visits to the hospital. “When I registered for antenatal using my insurance card, one of the things the doctor prescribed for me was a delivery mat, but when I got to the pharmacy, they just gave me some of the prescribed medications and asked me to pay for the delivery mat because it’s part of surgical equipment which my HMO did not cover,” she said.
Discrimination, Nonchalant Attitude Towards EnrolleesEnrollees of the NHIS have expressed concerns over the discrimination and lackadaisical attitude displayed by NHIS staff towards them in offering healthcare services. “Their services are very poor. You go wait tire. I don’t know if they intentionally scatter patients’ folders. At the hospital where I’m currently enrolled, you’ll spend more than one hour before they even locate your file. They are not organized at all. They will just be looking for your folder everywhere, at the doctor’s office, pharmacy, or registration office. Just everywhere,” Ms Chinenye continued.“As an NHIS patient, if the doctor prescribes a high-priced medication for you, you’ll have to go through a whole lot of processes to get it.
First, they will write to your HMO to ascertain your eligibility for that medication and you will wait for hours for your HMO to reply before you’ll be attended to. And probably, by the time your HMO is sending the referral code, the hospital may have closed for the day. There’s this medicine called MMR vaccine, I needed two doses for my son and it was around N16,000 each. They delayed me for several hours in the name of getting a referral code,” Chinenye added.
For Cynthia, It all depends on the hospital one is enrolled in. She told this reporter that most public hospitals are guilty of neglecting or discriminating against NHIS patients while they give better attention and service to non-NHIS patients. However, she added that private hospitals tend to treat patients better. Even when they discriminate, they don’t do it with impunity as in public hospitals. “I noticed that sometimes when you bring your child to the hospital for a presumed ‘minor illness’ like cough or headache, they don’t take you seriously because they think you’re abusing the insurance and that the sickness is not serious enough to warrant a hospital visit. That’s the kind of attitude we usually face as NHIS enrollees”, Cynthia continued.
The experiences of Chinenye, Cynthia, and Romanus corroborate the findings of a recent study which revealed that academic staff find it difficult to utilize the NHIS due to inadequate staffing, poor management, and negative attitude of health workers.
Way Forward The National Health Insurance Scheme was envisioned as a solution to Nigeria’s healthcare challenges, but it is clear that the system is struggling to live up to its promise. The current economic reality of Nigeria, characterized by inflation, depreciating naira, and rising living costs, has significantly impacted the efficiency of the scheme in several ways. This puts pressure on healthcare providers participating in the NHIS. Many hospitals are forced to either increase out-of-pocket charges for patients or reduce the quality and availability of services covered under NHIS to cope with rising operational expenses.
Essential services like medications, diagnostics, and treatments that should be fully covered are often inadequately provided, leading to a gap between the scheme’s promises and its actual service delivery.In May 2024, the Association of Nigeria Private Medical Practitioners (ANPMP) issued an ultimatum threatening to pull out of the national health insurance scheme indefinitely starting from August should the NHIA fail to adjust the Fee-For-Service tariff, which has remained at N750 for the past 12 years.“We have resolved that within the next three months if we don’t get a proper and equitable review of the national health insurance scheme tariff, we are going to boycott that scheme until further notice,” Kay Adesola, the Association’s president told BusinessDay.
For the NHIS to truly fulfill its promise, more funding is necessary to improve health infrastructure. Much of this funding should not only come in the form of budgetary allocations but also an upward review of the tariff paid to hospitals for the services they render to NHIS enrollees.
There is also a need for better monitoring of the scheme’s implementation to ensure that funds meant for healthcare are not diverted elsewhere. Strengthening partnerships with private healthcare providers and leveraging technology to streamline service delivery could also play a key role in improving the scheme.
N.B: Sources’ names have been changed to protect their identities
ENUGU — The Presidential Candidate of the National Democratic Congress (NDC), Mr Peter Obi, and the party’s Enugu State Governorship Candidate, Sir Chinyeaka Ohaa, on Thursday, August 13, 2026, visited Parklane Specialist Hospital, Enugu, to show solidarity with patients battling kidney disease and other related illnesses.
They arrived at about 5:00 p.m. in the company of other party leaders, including the NDC Senatorial Candidate for Enugu East, Ada Ogbu; Hon. Kentus Eze; Hon. Ike Ezugwu; Architect Everastus Odo; Comrade Obi Mamah, H(JP); Hon. Odo Joel; and other party faithful who turned out to receive Peter Obi.
The visit followed a humanitarian gathering convened by Okwuluora to draw attention to the plight of more than 500 kidney patients and their families struggling to afford treatment.
Over 500 Kidney Patients Cry for Help as Families Battle for Survival
It was an emotional scene as men, women and children living with kidney-related illnesses converged at Parklane, hoping to receive urgent assistance.
Many of the patients showed visible signs of prolonged illness and hardship. Some were due for dialysis but could not afford the treatment, leaving them and their families trapped in a painful struggle for survival.
The severity of their condition was evident, with some displaying swollen hands, arms and legs, while others had bloated abdomens and anxiety-filled faces as they awaited assistance.
Among those present was a 13-year-old boy from Akure, Ondo State. His mother said she had sold virtually everything she owned to sustain his dialysis treatment for the past five years. Despite the sacrifices, the boy was at Parklane hoping to benefit from the intervention.
The large turnout has renewed concerns over the growing burden of kidney disease and the rising cost of dialysis and transplant care in the South-East and other parts of the country.
Speaking at the event, Okwuluora commended the stakeholders who supported the initiative and called for sustained assistance for kidney patients and their families.
The national and state leadership of the NDC also commended Okwuluora for his consistent commitment to Nigerians in need, particularly those battling critical health challenges.
In his remarks, Peter Obi expressed concern after listening to the testimonies of the patients. He called on well-meaning Nigerians, corporate organisations and governments at all levels to support kidney patients in dire need of assistance.
The organisers and families of the patients expressed gratitude to Obi for honouring the invitation and using his platform to draw attention to the plight of sick and vulnerable Nigerians.
They also thanked Sir Chinyeaka Ohaa for standing with the people of Enugu during the difficult moment and for demonstrating what they described as leadership that places human lives first.
Appreciation was equally extended to NDC supporters who attended the gathering, with attendees saying their presence offered hope and reassurance to the patients and their families.
The NDC leadership reaffirmed its commitment to advocating for improved healthcare funding, greater access to dialysis and policies aimed at reducing the burden of catastrophic healthcare expenses on families in Enugu State and across Nigeria.
Gov. Peter Mbah says Enugu State remains fully ready to support Nigeria Centre for Disease Control and Prevention (NCDC) on health security facilities and projects within the state.
Mbah said this on Wednesday in Enugu when the Director-General of Nigeria Centre for Disease Control and Prevention (NCDC), Dr Jide Idris, paid him a courtesy call during a working visit to the state.
Represented by the Deputy Governor, Chief Ifeanyi Ossai, the governor said that the government had prioritised all issues concerning security especially those dealing on health security and invested heavily on health and related concerns.
According to him, we are fully ready and committed to work with you by providing land, logistics and other necessary requirements to make all health security projects/initiatives a reality.
He said, “We are fully aware of the need to focus and give priority to health security projects and issues.
“As a state, the high volume of travellers coming in their thousands to the state each day have increased our socioeconomic activities, made more investment possible and increased all forms of tourism.
“However, we recognise that only two weeks of a confirmed outbreak of any dreaded disease will scare away these large inflow of people coming into the state.
“This alone will affect and wipe away the striving tourism industry, our people’s vibrant trade and commerce, striving transport ecosystem, investors influx and the huge investment we have put to make Enugu the most attractive city in Africa.”
Mbah said that every effort or investment in health security “is in the right direction to secure our selves, investments, hopes and future.”
The governor commended the NCDC on their recent fight against COVID-19 and all initiatives to ensure prevention of Ebola virus as well as containing other outbreaks in the country.
“I must commend NCDC team for inspecting the ongoing South-East High Definition Molecular Laboratory and other health projects meant to serve our people, South-East and every Nigerian,” he said.
He assured that the government would undertake any responsibility to ensure that NCDC facilities continue running as well as protecting such facilities notwithstanding the premises they are domiciled in within the state.
On the issue of Ebola Virus, the govenor said that the state was taking the designation of Enugu State as a state with high importation risk “very serious”.
“From assessment, the scare of the disease coming to Enugu is real through the Akanu Ibiam International Airport. We are tightening all preventative measures and protocols, while ensuring robust synergy with relevant stakeholders on it.
“The state ministry of health and its partners are on alert over the issue and we are providing necessary support and access to our office on it,” he said.
Mbah called on the NCDC to give the state needed support in terms capacity building and training, close coordination and guidance as well as awareness materials and support in its preventive efforts.
Earlier, Idris said that visit was meant to access uncompleted South-East High Definition Molecular Laboratory, the level of Ebola Prevention and Preparedness at the Akanu Ibiam International Airport and other related projects.
He commended the state government on huge investment in Primary Healthcare Centres, general hospitals, tertiary hospitals and recently the Enugu International Hospital meant to attract medical tourism.
The director-general said that the NCDC wanted the state government to get involved in protecting And maintaining the South-East High Definition Molecular Laboratory and other facilities of the agency coming up in Enugu.
“We are here to strengthen the existing cordial relationship with the state and see how both NCDC and Enugu State Government can collaborate to strengthen issues of health security,” he said.
The Enugu State Government and key health sector partners have pledged a commitment to sustain the gains of the IntegratE Project.
The IntegratE Project is a five-year family planning initiative that expanded access to reproductive health services through Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) within the state.
The Commissioner for Health, Prof. George Ugwu, gave the commitment on Wednesday during the dissemination of the Enugu State Private Sector Family Planning performance under the IntegratE Project, which ran from Oct. 2021 to July 2026.
Ugwu said that the project had significantly improved reproductive health services and positive outcomes for women in the state over the past five years.
He described family planning as a sensitive but essential service, assuring that the government would continue expanding access while ensuring responsible use.
Ugwu said that Gov. Peter Mbah’s administration remained committed to strengthening primary healthcare outcomes in all ramifications
He revealed that more than 100 new primary healthcare centres would become operational before the end of the year.
The commissioner said that the state government’s commitment to innovation would continue to position the state as a leader in modern healthcare delivery.
Speaking, the representative of the Pharmacy Council of Nigeria (PCN), Mrs Ifeyinwa Ohiaeri, described the project as a major intervention that strengthened family planning services through pharmacy practice.
Ohiaeri stressed that “family planning remains critical” to reproductive, maternal and adolescent health.
She said that the dissemination provided an opportunity to review achievements, challenges and strategies for sustaining the project’s impact, while reaffirming its commitment to professional ethics and quality service delivery.
The representative of the Enugu State Primary Health Care Development Agency, Mrs Maureen Nwankwo, said the agency would sustain the gains achieved.
Nwankwo noted that the programme had helped reduce unintended pregnancies, maternal and child deaths through improved access to family planning services.
Group Director of Donor-Funded Programmes at the Society for Family Health, Mr Emeka Okafor, said the national project tested the pharmacy-led delivery model for family planning in Enugu State.
Okafor noted that while about 70 per cent of residents patronise private health providers, much of the state’s routine health data comes only from the public sector, leaving a significant gap.
He said that according to the project’s implementation report, 29,262 women accessed family planning services through trained PPMVs in Enugu State, while 14,541 referrals were made to public health facilities.
He said that the project also exceeded training targets, introduced digital supportive supervision and contributed to the institutionalisation of the Tiered Accreditation System for PPMVs.
The Pharmaceutical Society of Nigeria (PSN) and the National Association of Patent and Proprietary Medicine Dealers (NAPPMED) also pledged continued support for the initiative/project at the grassroots.
No fewer than 20,966 Nigerian health workers relocated abroad within one year, according to official figures contained in the State of Health of the Nation Report 2025, obtained by Saturday PUNCH.
The mass exodus comprised 3,919 doctors, 7,487 nurses and midwives, 6,861 medical laboratory professionals, 702 pharmacists, 658 physiotherapists and hundreds of other healthcare specialists.
The growing migration came under the spotlight following the relocation of a Senior Consultant Neurosurgeon at the University of Ilorin Teaching Hospital, Dr Salamat Aliu-Ibrahim, to the United States.
Aliu-Ibrahim, a renowned neurosurgeon, now serves as Medical Director, Paediatrics, at Freeman Children’s Clinic, a facility under Freeman Health System in Joplin, Missouri.
Data obtained from the United Kingdom’s General Medical Council showed that 4,691 Nigerian-trained doctors joined the UK medical register between May 2023 and April 2026.
According to the GMC register, 15,896 Nigerian-trained doctors are currently licensed to practise in the UK, comprising 9,664 males and 6,232 females.
However, President Bola Tinubu, on Friday, appealed to Nigerian medical professionals in the diaspora to encourage more Nigerians abroad to return home and contribute to the country’s development, stressing that there is no place like home.
20,966 Nigerian Health Workers Migrated
An analysis of the State of Health of the Nation Report 2025 showed that only 60,551 of Nigeria’s 95,456 registered doctors currently hold active practising licences, representing 63 per cent. Only 51 per cent of licensed doctors are actively employed within Nigeria’s health system.
The nursing and midwifery workforce, Nigeria’s largest health profession, has also suffered substantial losses, recording the highest level of migration among health professionals.
Although Nigeria has 267,951 registered nurses and midwives, comprising 73,130 nurses, 21,031 midwives and 173,790 nurses with post-basic qualifications, only 113,123 currently hold active practising licences, representing an effective licensing ratio of 42 per cent.
Of those with active licences, 78 per cent remain employed in the country.
The report further showed that 658 physiotherapists have migrated, leaving only 852 of the country’s 8,642 registered physiotherapists with active practising licences.
Similarly, 21 occupational therapists have migrated, while only 11 of the 176 registered professionals currently hold active licences.
There are 257 registered occupational therapist assistants, but only 51 currently possess practising licences.
The report also showed that 431 optometrists have migrated abroad. Of the 6,975 registered optometrists, only 2,156 hold active practising licences, while 66 per cent remain employed locally.
Among opticians, only 307 of the 2,976 registered professionals currently hold practising licences, while 18 have migrated abroad.
UK, US, Canada, Saudi Arabia Top Destinations
The United Kingdom remains a leading destination for Nigerian health workers, particularly doctors and nurses, due to easier professional registration, better remuneration, structured specialist training and persistent workforce shortages within the National Health Service.
Although international recruitment has slowed since 2025, Nigeria remains one of the major source countries for overseas-trained nurses practising in the UK.
A breakdown of data obtained from the UK GMC register showed that 7,875 Nigerian-trained doctors were licensed to practise in the UK in 2020, rising to 9,976 in 2022.
In 2023, the number rose further to 12,198, making Nigeria the third-largest source of foreign-trained doctors in the UK, behind India, with 38,228 doctors, and Pakistan, with 27,739.
Figures from the UK Nursing and Midwifery Council also showed a sharp rise in the number of internationally educated nurses and midwives on its register, driven largely by recruitment from countries including Nigeria, India, Ghana and the Philippines.
According to the council, the number of Nigerian nurses and midwives in the UK has risen above 16,000.
Beyond the UK, the United States and Canada have also become increasingly attractive destinations for Nigerian healthcare professionals.
As of 2020, a total of 3,895 Nigerian-trained doctors were licensed to practise medicine in the US.
Australia has also intensified recruitment of overseas-trained doctors and nurses to address shortages in regional and rural health services, while Saudi Arabia and the United Arab Emirates continue to attract Nigerian healthcare professionals with tax-free salaries, subsidised accommodation and other employment benefits.
The Enugu State Government, through the Ministry of Health, has sealed four private health facilities in Enugu North Local Government Area for operating without valid licences and failing to meet regulatory requirements.
The ministry’s Public Relations Officer, Mrs. Chidiogo Ugodu, disclosed this in a statement issued on Thursday in Enugu, noting that the enforcement action was carried out on July 8.
According to the statement, the ministry has intensified the monitoring and supervision of private health facilities across the state to ensure quality healthcare delivery and strict compliance with regulatory standards.
The renewed enforcement exercise was initiated by the Commissioner for Health, Prof. George Ugwu.
As part of the exercise, the Director of Medical Services, Dr. Chinyere Ezeudu, led a team of senior ministry officials on an unscheduled inspection of private health facilities in Enugu North LGA.
The ministry explained that the exercise was aimed at ensuring that all private hospitals and healthcare providers operating in the state comply with statutory requirements, including the renewal of operating licences and the registration of facilities yet to be captured by regulatory authorities.
During the inspection, the team visited seven private health facilities, assessing their operational status, licensing documentation, and compliance with established healthcare standards. Four of the facilities were subsequently sealed for regulatory violations.
Speaking on the exercise, Commissioner for Health, Prof. George Ugwu, reaffirmed the commitment of the state government, under the leadership of Governor Peter Mbah, to protecting residents by ensuring the delivery of safe, effective, and quality healthcare services.
He stressed that the monitoring and enforcement exercise would continue across the state to ensure that only duly registered and licensed healthcare facilities operate.
Ugwu also urged operators of private health facilities to regularise their operations by renewing expired licences and registering facilities that are yet to be approved.
“The ongoing monitoring exercise is not only a regulatory measure but also a critical step towards strengthening the health system and safeguarding the lives of citizens,” he said.
The latest enforcement follows a similar operation carried out a few weeks ago, during which the Ministry of Health sealed three illegal health facilities in Enugu South Local Government Area for operating without valid licences.
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