Most enrollees in Nigeria’s Contributory Health Insurance Scheme are yet to receive real value for their money, as they complain of poor services, lack of access to designated facilities, and the exclusion of terminal ailments and surgeries from the programme.
A nationwide investigation conducted by LEADERSHIP Weekend revealed that, although many states have domesticated the scheme, a significant number of enrollees from both the formal and informal sectors, as well as vulnerable groups, are not entirely satisfied with the service providers’ operations.
It was also found that service providers are exploiting subscribers in rural areas due to the beneficiaries’ ignorance of what the programme entails and a communication gap.
Of the 20 states covered by the investigation, Enugu and a few others have yet to enrol their workers and private individuals in the scheme, while Akwa Ibom State only joined the scheme last week.
Efforts to expand health insurance coverage across various population groups in Nigeria gained momentum in 2022, when the National Health Insurance Authority Act (NHIA) 2022 was enacted on May 19, 2022. This Act replaced the National Health Insurance Scheme Act of 1999, under which only about 10 percent of the population was registered.
The NHIA 2022 mandates health insurance coverage for all Nigerians through a compulsory framework implemented in collaboration with state health insurance agencies. A key provision of the Act, outlined in Sections 25 and 26, is the creation of the Vulnerable Group Fund (VGF), which specifies multiple funding sources to support health insurance for underserved groups.
The legislation also enhances the NHIA’s regulatory and promotional capacity, with the ultimate goal of ensuring access to affordable and quality healthcare for all citizens.
However, two years after the Act’s passage, significant gaps remain in the health insurance system, especially in reaching rural and low-income populations. Currently, only 18.7 million people, out of an estimated 220 million Nigerians, are enrolled at both national and state levels.
National Health Insurance Enrollment Rises To 18.7m
NHIA’s director-general, Dr Kelechi Ohiri, stated that the enrolment figure marked an 11 per cent increase within the last year, from a base of approximately 16 million by the fourth quarter of 2023.
Efforts to obtain more information from the NHIA regarding how it handles complaints from subscribers were unsuccessful, as its acting director of media and public relations, Emmanuel Ononokpono, said he was not authorised to speak on the development. He stated that an official statement would be issued by the organisation soon.
In the three years since the establishment of the Bauchi State Contributory Health Scheme, workers are still facing enrolment hurdles.
Speaking to LEADERSHIP Weekend, a civil servant who requested anonymity for fear of reprisal said the scheme remains at the level of mere promises.
“My salary is being debited for the scheme, but I don’t see anything tangible coming from it yet. I am yet to be enrolled into the scheme, which is forcing us to pay exorbitant charges to cater for my health and that of my family,” he said. “It is worthless if we continue to pay for medical services despite being debited for the contributory health insurance scheme.”
Another potential subscriber, Mark Ibrahim, stated that the Bauchi State Health Contributory Management Agency (BASHCMA) failed to enrol him despite his consistent efforts.
“As I speak to you, I have not been enrolled in the scheme. The agency kept giving us hopes that never materialise,” he alleged.
The BASHCMA, established in 2021, has enrolled 52,000 workers and their dependants.
Katsina residents have expressed frustration over deteriorating services despite the surge in enrolment under the Katsina State Contributory Healthcare Management Agency.
According to Nasir Lawal, the agency’s director of planning, research, and statistics, the agency has enrolled over 293,008 residents in its health insurance scheme.
Lawal stated that beneficiaries who are registered with 170 accredited healthcare providers have access to healthcare services at both primary and secondary levels.
“We have carried out over 6,000 updates for enrollees, including changes of healthcare providers, adding dependants, and replacing identity cards,” he stated.
Despite these efforts, concerns have emerged regarding the quality of healthcare services. Many patients report that they are no longer able to access essential medicines and treatments under the scheme.
A corps member serving in the state, who preferred to remain anonymous, shared that they have stopped using their NHIS number at the Federal Teaching Hospital, Katsina, due to the unavailability of drugs.
“After prescriptions, we are forced to purchase the drugs ourselves, outside the hospital, using personal money,” he lamented.
Aisha Mamma, a resident of the state, echoed similar frustrations. She said while hospitals perform proper diagnoses, the lack of vital drugs leaves patients stranded. “We get the diagnosis, but there’s no medication available for our conditions,” she said, highlighting the growing inefficiency in service delivery.
The Katsina State health insurance scheme, which deducts contributions from public servants and formal sector employees, was designed to ease access to healthcare. For public servants, 2.5 per cent of their consolidated salary is deducted, while private sector employers contribute 10 per cent and employees contribute 5 per cent. Yet, beneficiaries are left disillusioned by the gap between what the scheme promises and the reality on the ground.
In Jigawa State, the outcry against poor services provided by the service providers accredited by the State Contributory Health Insurance Management Agency (JiCHIMA) is loud.
The agency, which commenced operations in 2022, has registered over 220,000 beneficiaries, including more than 45,000 civil servants and their families.
The scheme has accredited 281 health facilities as service providers across the state.
Recently, the state government approved N1 billion for enrolling 14,315 vulnerable and underprivileged individuals into the scheme, with a total of 500 beneficiaries from each of the 287 political wards in the state.
Due to a series of complaints about poor services, JiCHIMA threatened to sanction service providers that fail to deliver quality and standard services to the people.
In an interview, the executive secretary of JiCHIMA, Hamza Kakuri, stated, “We are paying these accredited facilities their capitation on the 25th of every month, meaning the services are pre-paid, so there is no reason whatsoever not to provide the services for which they were paid.
“It is not a privilege; it is a right for the people to receive the services they have paid for. However, we have received numerous reports of how some facilities provide inadequate services to their clients,” Nura said.
Ibrahim Sulaiman, a civil servant in the Jigawa State Ministry of Higher Education, remarked, “I took my child to a hospital where I registered, but I ended up sourcing 70 per cent of the prescribed drugs myself, which is a common trend among the service providers in the state.”
The situation with the National Health Insurance Scheme (NHIS) in Borno State is mixed. Some enrollees commend it while others lament poor services.
For Hauwa Bata, a staff member at Peace FM in Maiduguri, one of the Federal Radio Corporation of Nigeria (FRCN) outlets, the scheme’s economic aspect is worthy of embracing, but she faulted the system for providing substandard drugs to patients.
Ladi Josh, who is enrolled in a premium type of NHIS, found the services he received in Ibadan better than those available in Borno.
Josh cited his neighbour as an example. In search of better service, he has enrolled in three different hospitals in Maiduguri.
Shuaibu Usman, another premium service enrollee, mentioned that sometimes it is challenging to find doctors on duty at the hospital where he and his family have enrolled.
At the state level, Dr Babagana Kadai, the permanent secretary of the Borno State Ministry of Health and Human Services, indicated that the health insurance scheme has been beneficial to civil servants.
In Gombe State, Governor Inuwa Yahaya established the State Contribution Health Insurance Scheme, known as “Gohealth,” in 2021. The government has so far enrolled over 300,000 persons into the scheme, who have been accessing services at a significantly reduced cost. Initially, the scheme enrolled public servants, but the Director-General of Press Affairs to the Governor, Isma’ila Uba Misilli, stated that with the inclusion of Almajirai and other vulnerable individuals, the number has increased to 300,000. However, residents have identified a challenge: most beneficiaries are state civil servants, leaving local government workers out of the scheme.
In Kaduna, the state government launched a health insurance scheme enacted by law in 2018, which created the Kaduna State Contributory Health Management Authority (KADCHMA) to manage the scheme. According to KADCHMA, the scheme aims to advance the human capital development component of the Sustainable Development Goals (SDGs) and provide access to affordable and quality healthcare services for the people of the state. However, speaking with LEADERSHIP Weekend, one enrollee at Television Garage Primary Healthcare (PHC), Raymond Sanga, expressed mixed feelings about the scheme, advising that more needs to be done by the providers.
The director-general of KADCHMA, Malam Abubakar Hassan, affirmed the authority’s commitment to promoting the health and wellbeing of women, children, and all residents of Kaduna, emphasising that maternal and child mortality should not be associated with Kaduna State. He praised the government’s dedication to the health of its people.
The Niger State government domesticated the scheme in 2021 under NICARE, which was launched in September 2022. The arrangement was for the state government to expend one per cent of its consolidated revenue as an equity fund for the State’s Contributory Health Scheme (NICARE) for poor and vulnerable groups.
The Kwara State health insurance scheme has been activated and is in full operation. To make the scheme accessible to all segments of society, the Kwara State Health Insurance Agency inaugurated regional offices in Lafiagi (Kwara North) and Offa (Kwara South).
The executive secretary of the agency, Dr Olubunmi Jetawo-Winter, stated that the move to open regional offices was aimed at widening awareness of the concept and enhancing access to affordable healthcare services. “These regional hubs will provide the same services to the people in these catchment areas, just as we would have provided from our office in Ilorin,” he said.
A retiree, Hajia Jumoke Adeyemi, stated she has been enjoying the services provided by the health insurance scheme in her locality, noting that the yearly premium is only N9,000. Another beneficiary, Ali Rabiu, applauded the scheme but wished it should include the treatment of other ailments and surgeries that require high costs for treatment in hospitals.
Findings in Kebbi State revealed that beneficiaries easily access services with their registration cards, particularly in Birnin Kebbi, Jega, Argungu, Augie, Bunza, Maiyama, Yauri, Zuru, and Gwandu local government areas. Some beneficiaries told our correspondent that they were pleased with the services.
Mr Paul Ajeye, an enrollee of the National Health Insurance Scheme (NHIS) at Abdullahi Wase Teaching Hospital in Kano, mentioned that his challenge whenever he visits the hospital is the long wait to see a doctor due to high patient traffic. He also added that sometimes certain drugs are unavailable after a doctor’s prescription, forcing him to purchase them externally.
Similarly, a civil servant with the state government, Abubakar Garba, reiterated the delay in seeing a doctor due to a poor doctor-patient ratio in the public hospital he uses. Regarding the treatment offered, Garba noted instances where he was informed that some drugs or treatments were not covered by his scheme, necessitating out-of-pocket payments.
The Benue State Health Insurance Agency (BNSHIA) has enrolled 57,356 individuals across the 276 council wards in the 23 local government areas, including internally displaced persons (IDPs). The head of Information and Communication Technology, Nicodemus Tarza, explained that 51,938 are individual enrollees, while 5,418 are IDPs in Makurdi, Guma, Gwer West, Logo, and Agatu areas.
A beneficiary, Abah Sylvester, who did not wish to mention his service provider and HMO, claimed he has not been treated fairly. Every time he visits the hospital, they select expensive drugs for him to buy externally, claiming they are unavailable.
Hanemfe Samu, another civil servant, expressed disappointment at the Federal Medical Centre (FMC) in Makurdi, noting that all the drugs prescribed by the doctor are consistently unavailable, forcing her to purchase them externally year after year.
Ogun State government has joined the ranks of states in Nigeria that have domesticated the NHIS for both public and private sector participation. The state Commissioner for Health, Dr Tomi Coker, who spoke with LEADERSHIP Weekend in Abeokuta, the state capital, mentioned that enrollees are expected to pay N48,000 for a health scheme covering a family of six, comprising a husband, wife, and four children under the Ogun State Health Insurance Agency (OGSIA).
Meanwhile, one beneficiary, Abiodun Elegbede, described the scheme as a scam, stating that beneficiaries are subjected to extra charges before accessing quality healthcare services.
Elegbede, who has been enrolled since October 2023, emphasised that the only drug administered to him and his family members has been Paracetamol, while the state hospital in Ijaye claims its pharmaceutical stores have exhausted their stock.
Commenting on the extra charges imposed on enrollees, Commissioner Coker stated that her ministry had instructed members of the public to contact a dedicated telephone number for assistance.
Mr Uche Onwuchekwa, a public servant in Imo State, noted the scheme’s significant benefits, as the state government subsidises the payment structure. According to the Commissioner for Information, Declan Emelumba, the Imo State Health Insurance Scheme is on course to achieving universal health coverage.
Over 450,000 individuals have been enrolled in the health insurance scheme in Ekiti State.
Speaking with LEADERSHIP Weekend in Ado Ekiti, the General Manager of the Ekiti State Health Insurance Scheme (EKSHIS), Dr Charles Doherty, stated that the state operates two equity programmes covering many people.
Doherty said, “We operate two equity programmes: the first is the Basic Health Provision Fund Programme, which has about 52,000 enrollees. The second, ‘ULERAWA,’ covers all residents of the state in specified bundled benefit packages, and close to 400,000 people have utilised its services.”
The scheme was domesticated in Ekiti State in July 2020, with over 5,000 citizens already enrolled at the time the programme commenced.
Meanwhile, many enrollees in both the public and private sectors seem dissatisfied with the services they receive from their providers, namely Health Maintenance Organisations (HMOs) and hospitals. However, enrollees who make monthly contributions as a percentage to the scheme have continued to express frustration over poor hospital services.
Civil servant Mr Adeola Ojo stated that the hospital where he and his family are registered refused to attend to him the first time he went there after paying four months’ premiums. Mrs Ajoke Olowolagba, a businesswoman, reported that the hospital she and her family use always asks them to purchase prescribed drugs if the price exceeds N600.
Since the state health insurance scheme in Cross River State was flagged off on March 9, 2021, during the administration of immediate past Governor Ben Ayade, 700,000 beneficiaries have enrolled. The Director-General of the Cross River State Health Insurance Agency, Dr Godwin Iyiala, disclosed this to LEADERSHIP Weekend on Thursday in Calabar during a telephone conversation. He noted that workers were enrolled after the state agency domesticated the scheme.
A worker with the Cross River State government and a beneficiary of the facility, Mr Charles Okoi, lamented that despite their names being captured and N1,000 deducted from their salaries monthly, medical services rendered to them have been inadequate.
The Osun Health Insurance Scheme (OHIS) was established in 2018. Currently, 257,462 people are enrolled in the contributory scheme in the state, and about three million people are planned to be enrolled in the scheme in the next three years.
Speaking with LEADERSHIP Weekend in Osogbo, the Executive Secretary of the agency, Dr Rasaq Akindele, stated that the 257,462 enrollees consist of 224,000 in the formal sector, while only 13,462 are from the informal sector. However, an enrollee of the scheme, Bola Adegoke, expressed disappointment at the attitude of some designated hospitals (service providers), claiming they treat patients under the scheme as second-class in terms of attention. She also complained about the lack of drugs in hospitals, stating that it is rare to find expensive drugs available.
In response to complaints about providers’ lackadaisical service delivery, the Executive Secretary assured that all enrollees have been provided with lifelines to call in case they are not attended to promptly.
Enugu State has yet to domesticate the health insurance scheme. Our findings revealed that a committee has been established to address the issue, but it has not submitted its report.
The Akwa Ibom civil service, with a workforce of about 53,000, including local government workers, has struggled for decades as successive administrations have failed to domesticate the Health Insurance Scheme (IHS), LEADERSHIP Weekend checks revealed. Some workers who spoke to our correspondent anonymously expressed ignorance about the scheme’s existence.
“We have been using our earnings to take care of our health and that of our children and other dependants. The state government has no other health subsidy for the workers that I know of,” a senior civil servant stated.
Addressing concerns about the alleged non-implementation of the scheme, the Commissioner for Health, Prof. Augustine Vincent Umoh, clarified that the law was only domesticated about one week ago, questioning why such complaints should arise given Governor Umo Eno’s prompt signing of the law.
