Bridging the equity gaps in Nigeria’s path to universal health coverage: the role of National Health Insurance Authority Act.
1
Community Medicine and Primary Care, Olabisi Onabanjo University, Sagamu, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Nigeria faces persistent health inequities reflected in high morbidity and mortality indices, particularly among rural and peri-urban poor populations and other marginalized groups. Significant disparities exist in access to quality and affordable healthcare across different strata of society. Despite multiple policy efforts by successive governments, health insurance coverage has remained abysmal. This study examined the current status of universal health coverage in Nigeria, the enabling policy environment, and the measures introduced to enhance its attainment.
METHODS:
A desk review and analysis of the national health policy, relevant health sector documents, implementation guidelines, and the National Health Insurance Authority (NHIA) Act were conducted. A review of existing scholarly publications was also undertaken using predefined keywords across major search engines. The Act was assessed using a universal health coverage framework, with emphasis on population coverage, financial risk protection, and equity in access to essential health services.
RESULTS:
Out-of-pocket expenditure accounting for over 70 percent of total health expenditure was identified, alongside high levels of catastrophic health spending associated with reduced utilization of essential services. The former health insurance scheme achieved less than 10 percent population coverage and largely excluded the informal sector. The enactment of the NHIA Act seeks to address these gaps through compulsory health insurance, expanded risk pooling mechanisms, strengthened regulatory oversight, and the establishment of a vulnerable group fund to subsidize coverage for poor and marginalized populations. However, challenges persist, including weak enforcement within the informal sector, revenue generation constraints, uneven sub-national implementation capacity, and ongoing supply-side weaknesses in primary healthcare delivery.
CONCLUSIONS:
The NHIA Act represents a critical policy instrument for bridging equity gaps and advancing universal health coverage in Nigeria. Sustained financing, effective enrolment of informal populations, and a robust regulatory framework are essential to ensure its long-term viability and impact.
Nigeria faces persistent health inequities reflected in high morbidity and mortality indices, particularly among rural and peri-urban poor populations and other marginalized groups. Significant disparities exist in access to quality and affordable healthcare across different strata of society. Despite multiple policy efforts by successive governments, health insurance coverage has remained abysmal. This study examined the current status of universal health coverage in Nigeria, the enabling policy environment, and the measures introduced to enhance its attainment.
METHODS:
A desk review and analysis of the national health policy, relevant health sector documents, implementation guidelines, and the National Health Insurance Authority (NHIA) Act were conducted. A review of existing scholarly publications was also undertaken using predefined keywords across major search engines. The Act was assessed using a universal health coverage framework, with emphasis on population coverage, financial risk protection, and equity in access to essential health services.
RESULTS:
Out-of-pocket expenditure accounting for over 70 percent of total health expenditure was identified, alongside high levels of catastrophic health spending associated with reduced utilization of essential services. The former health insurance scheme achieved less than 10 percent population coverage and largely excluded the informal sector. The enactment of the NHIA Act seeks to address these gaps through compulsory health insurance, expanded risk pooling mechanisms, strengthened regulatory oversight, and the establishment of a vulnerable group fund to subsidize coverage for poor and marginalized populations. However, challenges persist, including weak enforcement within the informal sector, revenue generation constraints, uneven sub-national implementation capacity, and ongoing supply-side weaknesses in primary healthcare delivery.
CONCLUSIONS:
The NHIA Act represents a critical policy instrument for bridging equity gaps and advancing universal health coverage in Nigeria. Sustained financing, effective enrolment of informal populations, and a robust regulatory framework are essential to ensure its long-term viability and impact.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
