Kudos to President Tinubu for widening health insurance

President Bola Tinubu’s recent directive mandating all Ministries, Departments, and Agencies (MDAs) to enrol their employees in the National Health Insurance Authority (NHIA) scheme represents not just a policy order, but a renewed signal of intent to prioritise the welfare of public servants in Nigeria.

Coming at a time when the country is battling economic headwinds and systemic healthcare challenges, the move offers a glimmer of hope for a workforce that often bears the brunt of Nigeria’s fragile health system.

The directive, issued on September 3, stipulates compulsory compliance by all MDAs and introduces a new benchmark for accountability. Any entity seeking to participate in public procurement is now required to present a valid NHIA-issued Health Insurance Certificate. This is not a mere bureaucratic hurdle, it is a fundamental shift towards mainstreaming health insurance into the daily workings of governance. For years, Nigeria has struggled with policies that look good on paper but fail to find traction in implementation. This new enforcement mechanism suggests that the administration wants to move beyond rhetoric into measurable results.

Health insurance schemes worldwide are recognised as vital social interventions designed to provide affordable access to healthcare and shield citizens from catastrophic out-of-pocket spending. For civil servants, whose wages often lag behind inflation and living costs, the guarantee of health coverage means no longer facing the dilemma of choosing between paying school fees and paying hospital bills. The scheme protects their financial stability, enhances their quality of life, and by extension, boosts morale and productivity in the public sector.

But the NHIA, as it stands, covers only a fraction of Nigeria’s population. Millions of Nigerians, especially those in the informal sector such as market women, artisans, transport workers, and smallholder farmers remain completely excluded. They continue to rely on personal savings, family contributions, or in some cases, traditional and unproven remedies when illness strikes. This reality starkly underlines the need for the scheme to evolve from being primarily for federal workers into a universal health insurance framework that guarantees equitable access for all citizens, regardless of their socioeconomic background.

The principle behind health insurance is simple but powerful: pooling resources from taxes, worker contributions, and premiums to spread the financial risk of healthcare across the entire population. This collective mechanism ensures that no single individual is left financially crippled by illness. Countries that have embraced this model offer clear lessons for Nigeria.

The United Kingdom’s National Health Service (NHS), for instance, remains one of the most admired public health systems in the world. It is heavily funded by public resources, with expenditure reaching £188.5 billion in 2023/24 and projected to hit £204.9 billion in 2024/25. Despite challenges of its own, the NHS embodies the idea that access to healthcare is a right, not a privilege. It also demonstrates the economic logic of health investment: by employing 1.37 million people, the NHS is not just a service provider but a major employer, contributing to economic growth while safeguarding public health.

Closer to home, Ghana’s National Health Insurance Scheme (NHIS) has made commendable strides. Its coverage includes maternity services, surgical procedures, and other critical interventions. Importantly, it is funded through a combination of taxes and individual premiums, with exemptions for the poorest citizens. South Africa, on its part, is advancing towards a National Health Insurance system that centralises funding to lower costs and improve access, while Egypt is implementing a Universal Health Insurance plan designed to extend coverage to every family in the nation. These examples demonstrate that universal health coverage is not a utopian ideal, it is an achievable reality with the right mix of policy commitment, financing, and transparency.

Nigeria’s own health insurance story, however, has been marked by delay and half-measures. Although the National Health Insurance Scheme was first established in 1999, more than two decades later, less than 10 per cent of the population has been covered. The NHIA Act of 2022 was intended to reset the system and accelerate progress, yet it has taken three years before significant steps like Tinubu’s directive are being rolled out. The gap between policy and implementation remains Nigeria’s biggest stumbling block.

Tinubu’s directive does attempt to address this gap by empowering the Secretary to the Government of the Federation to enforce enrolment and monitor compliance across MDAs. If rigorously pursued, this could drastically expand coverage within the federal workforce, creating a strong base from which to extend health insurance nationwide. But for the scheme to truly transform healthcare in Nigeria, it cannot stop at civil servants. It must integrate state governments and the private sector into its framework, creating a robust, inclusive system that caters to the poor, the underserved, and those in informal employment.

The stakes are high. Nigeria spends only 5.3 per cent of its national budget on healthcare, far below the 15 per cent target agreed under the Abuja Declaration of 2001. With such low investment, ordinary Nigerians are forced to cover 70 per cent of health expenses out of pocket, a situation the World Bank warns pushes as many as 100 million Nigerians into poverty annually. Universal health insurance could reverse this trend by spreading risk, reducing financial shocks, and ensuring that even the poorest families can access quality care when they need it.

The benefits go beyond financial protection. A robust insurance system incentivises preventive care, ensuring early detection and treatment of diseases before they spiral into costly hospital admissions. Studies suggest that preventive interventions reduce hospitalisation rates by 20–30 per cent, easing the strain on Nigeria’s overstretched hospitals and clinics. At a time when malaria, tuberculosis, and maternal mortality still claim over 300,000 lives annually, the importance of early interventions cannot be overstated. If properly managed, the NHIA could become a powerful tool in reducing infant and maternal deaths, which remain among the highest in the world.

Note that unlike Nigeria’s flawed cash transfer programs, health insurance systems are inherently data-driven. They require strong monitoring and resource allocation systems, which in turn promote transparency and accountability. Fraudulent practices that have plagued other welfare interventions can be curtailed through digital enrolment, biometric verification, and independent audits. Globally, nations with strong universal health insurance programs report not only better health outcomes but also longer life expectancies and more resilient populations.

Collaboration with states will also be crucial in making the NHIA work. Health needs differ across Nigeria’s diverse regions: what rural farmers in Zamfara need may differ significantly from the priorities of urban traders in Lagos. By tailoring service delivery through state partnerships, the scheme can ensure relevance, responsiveness, and efficiency.

In the final analysis, Tinubu’s directive is a welcome catalyst, but it must not be allowed to remain a one-off gesture. To succeed, Nigeria’s health insurance system must be expanded into a universal framework backed by equitable funding, strong oversight, and inclusive participation. It must be anchored not only in federal mandates but in a genuine collaboration between government, the private sector, and communities.

Nigeria stands at a critical juncture. Without bold reforms, millions more will continue to fall through the cracks of a broken health system. But with vision, political will, and sustained investment, health insurance could become the foundation of a more equitable society, one where no Nigerian is left behind simply because they cannot afford to fall sick.