The Director General of the National Health Insurance Authority (NHIA), Dr. Kelechi Ohiri, has revealed that the agency has launched enforcement discussions with state governments and private sector employers across Nigeria to guarantee the implementation of the mandatory national health insurance scheme. This move follows the amendment of the NHIA Act two years ago, which shifted health insurance from a voluntary to a compulsory policy.

In an exclusive interview with Frontpage Health, Dr. Ohiri explained that Nigeria’s previous voluntary approach contributed significantly to the low health insurance coverage, especially within the informal sector and among private employers. Now, with the law backing mandatory participation, the NHIA is prioritising enforcement while simultaneously building public awareness and trust in the system.

Enforcement Now a Legal Obligation

According to Dr. Ohiri, the NHIA is no longer treating health insurance enrollment as a choice. With the new legal framework, every Nigerian must be covered under one health insurance platform or another. To bring this vision to life, the agency is collaborating with the Office of the Secretary to the Government of the Federation, as well as state governments like Lagos, to design and operationalise effective compliance systems.

“For you to get people to enrol, the first step is that it must be mandatory, and that mandate must be enforced,” Dr. Ohiri stated.

He emphasized that health insurance is not just a health initiative but a financial safety net that protects Nigerians from the crippling impact of out-of-pocket medical expenses.

Raising Awareness and Building Trust

Enforcement alone, however, is not enough. Dr. Ohiri explained that many Nigerians still underestimate the value of health insurance until they face overwhelming hospital bills.

“It is even more cost-effective to prepay for health insurance than to wait until you are sick and then pay hospital bills,” he said.

In response, the NHIA has embarked on a nationwide public sensitisation campaign to educate citizens about the benefits of health insurance. The campaign targets not just individuals and families, but also key institutions such as schools, small businesses, artisans, and trade associations.

Dr. Ohiri stressed that for enforcement to succeed, there must be a shift in public perception. He noted that improving trust in the system was one of NHIA’s top priorities.

Upward Tariff Review for Better Healthcare Experience

One of the recent moves to build this trust, according to the DG, was the upward review of provider tariffs, which saw a near doubling of capitation and fee-for-service payments to health care providers. This, he said, is designed to ensure better quality of care, reduce complaints from enrollees, and give people real value for their contributions.

“When patients go to the hospital and receive proper care, it builds confidence in the insurance system,” Ohiri added.

The goal, he explained, is to turn the health insurance scheme into a dependable system that Nigerians can trust and rely on — one that is capable of delivering quality, timely care without financial stress.

Private Sector Engagement and Inclusiveness

The NHIA is also engaging private sector stakeholders, including employer bodies such as the Nigeria Employers’ Consultative Association (NECA) and other industry leaders, to secure buy-in and ensure broad-based compliance.

Acknowledging that private sector uptake has historically been poor, Dr. Ohiri said the Authority is combining enforcement with advocacy to drive voluntary compliance and broaden participation.

“We are not waiting for enforcement alone. We are making it easier for individuals, small businesses, and groups to sign up,” he said.

Whether it’s a trader in a local market, a student in a tertiary institution, or a mechanic in a motor park, the NHIA is working to simplify the sign-up process and allow people to enrol through structured platforms like associations, cooperatives, and schools.

Multi-Pronged Approach for Sustainable Reform

Dr. Ohiri described the NHIA’s strategy as multi-dimensional, combining regulation, advocacy, partnerships, technology, and system design. The aim is to build a health insurance framework that is inclusive, affordable, and sustainable for Nigeria’s diverse population.

He noted that public sensitisation remains one of the most important pillars of this strategy, calling on the media, civil society, and development partners to amplify efforts to raise awareness.

“We are making it easy for everyone — individuals, families, and SMEs — to sign up. Whether you are a mechanic, student, or trader, we are creating structures and platforms for everyone to get covered, either individually or through groups and associations,” he said.

Rapid Growth in Coverage: 3 Million New Enrollees in One Year

Despite the challenges of the past two decades, Dr. Ohiri reported that Nigeria has witnessed its fastest growth in health insurance coverage in the last year. When the current leadership took office in 2023, about 16.7 million Nigerians were covered by health insurance. That figure has since grown to 19.4 million — a net gain of 2.7 million people in just 12 months.

This impressive increase, he said, is a testament to strategic partnerships with state governments and aggressive public education campaigns, both of which have helped demystify health insurance and drive uptake.

“We are seeing strong momentum, and our goal is to keep expanding coverage, especially to the most vulnerable populations,” Ohiri said.

Challenges Ahead and the Way Forward

Even as momentum builds, the NHIA faces several challenges — including skepticism, poor infrastructure in rural areas, limited provider networks, and resistance from employers unaccustomed to contributing to staff healthcare.

However, the Authority is determined to overcome these obstacles through innovation, collaboration, and stronger regulatory oversight. Plans are underway to digitise enrollment processes, enhance data monitoring systems, and expand the network of certified healthcare providers.

Dr. Ohiri also hinted at future initiatives aimed at integrating health insurance into the country’s social protection framework, including programmes for students, retirees, and workers in the informal sector.

A Call for National Support

To ensure the sustainability of these reforms, Dr. Ohiri called on all Nigerians — including the media, NGOs, state actors, and community leaders — to support the NHIA’s enforcement and awareness drive.

“This is not just about insurance. It’s about building a healthcare system where no Nigerian has to choose between getting treatment and going broke. That’s what we’re working towards,” he said.

Conclusion: Insurance as a Health and Economic Safety Net

As Nigeria edges closer to universal health coverage, the NHIA’s renewed push for enforcement, supported by inclusive enrolment strategies and awareness campaigns, marks a significant turning point in the country’s healthcare journey.

Health insurance is no longer optional. It is now a legal, moral, and economic imperative — one that could protect millions from medical poverty and help reshape the nation’s public health landscape. With over 19 million Nigerians already covered and more systems being put in place, the NHIA is laying the groundwork for a more equitable and accessible healthcare system that truly leaves no one behind.