The Managing Director and Chief Executive Officer of Ultimate Health, a Health Maintenance Organization, Lekan Ewenla, discusses in an interview with OLASUNKANMI AKINLOTAN the advantages of health insurance, the obstacles hindering faster participation in the program, and potential strategies for the sector to improve the nation's weak health statistics.
In what ways can health insurance enhance access to medical services in Nigeria?
Throughout the world, especially in advanced countries where health insurance became compulsory many years back, individuals enjoy unrestricted access to specified, high-quality healthcare services. After enrolling in a health insurance plan, you can visit your selected institution to receive the care outlined for you. It should be noted that 80 percent of healthcare services are utilized at the primary care stage. The initiative to implement health insurance in Nigeria aimed to render healthcare more affordable, available, and fair. Around the world, most people find they cannot cover medical expenses from their own funds. Medical treatment tends to be costly. This is why the health insurance model was created to support the healthcare requirements of less privileged and ill individuals through contributions from wealthier and healthier members. The objective of launching health insurance in Nigeria is to shift the trend of our weak health indicators by guaranteeing uninterrupted access to quality medical attention. Upon registration, your policy remains valid for twelve consecutive calendar months.
Which key developments occurred in the healthcare insurance industry during 2025?
One of the key developments this year, in 2025, was the statement made by the President highlighting the necessity for all active government ministries, departments, and agencies under the Federal Government to promptly enroll their employees into the national public healthcare scheme. On September 14, 2025, the Secretary to the Government of the Federation sent out an official notice to all MDAs and relevant parties, emphasizing that these governmental bodies must register their personnel with the nationwide public health coverage program. It should be noted that the directive particularly focused on revenue-producing federal entities which, historically, had opted to provide private medical benefits to their staff rather than enrolling them in the state-sponsored health insurance system.
The release of the directive in September marked a crucial milestone for the nation and the health insurance industry since the legislation making health coverage compulsory was enacted in 2022. I would like to emphasize once again that it has posed a considerable difficulty for us, the key players involved, in implementing the planned enrollment of Nigerians into this health insurance scheme according to the law. This challenge primarily stemmed from insufficient adherence to national laws by citizens. The president’s responsibility was to stress this matter clearly.
Which additional groups are impacted by the government's order?
It is crucial to mention at this point that the requirement was not confined solely to federal government agencies but also applied to the organized private sector; all employers must strive to enroll their employees in a health insurance scheme and then seek a certification of adherence from the National Health Insurance Authority for verification and documentation. According to this instruction, private businesses are required to register their staff via their designated health management organization, which will subsequently officially apply for a Compliance Certificate on behalf of the company.
You may find it interesting to learn that the law clearly requires every employer who has at least five employees to enroll their workforce in a health insurance plan. In essence, employers within this group must include a medical allowance as part of each employee’s salary and use this amount to cover the cost of health insurance premiums for all staff members. This requirement applies to everyone employed.
Medical insurance will not burden workers financially...
As I mentioned earlier, each employer of labor has a duty to address the healthcare requirements of their employees. Providing health insurance coverage for workers isn’t an act of kindness from employers. Legally, when you employ five or more people, you must provide a medical allowance. Signing up for health insurance essentially involves converting this medical allowance into a health insurance payment for the employees. This doesn’t mean that employers will have to seek loans to cover health insurance costs. What is provided to the employee as a medical allowance should be used toward purchasing their health insurance. It won’t result in financial loss for any employer.
What additional advantages does health insurance provide?
This will result in a faster development of our healthcare system, with high premiums collected from millions of Nigerians leading to the influx of several trillion naira into the healthcare sector. This will naturally attract significant investments within the field. The main cause behind Nigerian physicians and nurses relocating abroad isn’t due to any specific issue but rather because these destination countries implemented compulsory health insurance many years back, which has proven effective. It also boosted the net income of workers in this area. We have the potential to achieve similar outcomes here if everyone commits to addressing challenges head-on. That’s exactly what we're aiming to do right now.
What obstacles hinder the expansion of health insurance in Nigeria?
One major obstacle hindering the expansion of the enrollment procedure in Nigeria is the lack of immediate recognition or attention. Awareness levels remain minimal. In August, the Federal Ministry of Health held an event in Abuja titled "Re-emerging Healthcare Funding in Nigeria." Key participants attended this gathering. Among the main issues discussed was the necessity for the regulatory body, the NHIA, along with important players such as Health Maintenance Organizations, to launch targeted advertising initiatives aimed at increasing public consciousness among citizens. The advantages offered by the health insurance scheme are significant. Once individuals become aware of these potential gains, they will start requesting participation in the registration process.
Some information may intrigue Nigerians: there exists a framework outlining how Nigeria could achieve Universal Health Coverage, created by Nigerians both within the nation and abroad. The document is titled "One Nation, One Health." According to this paper, all 36 states along with the Federal Capital Territory should implement an identical foundational healthcare strategy for everyone in Nigeria. It further identifies 83 million citizens as at-risk individuals and suggests setting aside two percent of the Federal Government’s total revenues specifically for delivering fundamental medical care to these groups. If you've come across mention of the Basic Health Care Provision Fund for those in need, that refers to this initiative. The essential healthcare scheme aims to ensure every Nigerian has equal access to similar levels of medical service throughout the 36 states and the Federal Capital Territory. Indeed, the private health coverage schemes typically adopted by most organized businesses and profit-oriented government departments are known as Additional or Secondary Healthcare plans. This implies that each citizen must be registered under the core Healthcare program.
At its core, one aspect of the federal government's approach involved using participation in the program to create a centralized database for the nation. This is why every individual enrolled in the health insurance scheme is required to submit their National Identification number as part of the registration process.
With that being said, what we're currently lacking the most is the necessity for every state health insurance agency, under the leadership of each governor, to recognize that regardless of their current objectives at the state level, there must be an urgent return to fundamentals. We should reassess the acceptance, launch, and execution of the core healthcare plan across all states within the federation. Only once this has been accomplished will we be able to genuinely promote the expansion of health insurance coverage.
One significant issue we face is that the organized private sector has gradually begun adopting health insurance by purchasing private health care plans through health management organizations. This wasn’t an appropriate way to promote health insurance in Nigeria. Currently, most of the organized private sector, individual private citizens, and small and medium-sized enterprises find it difficult to afford these private health insurance options. According to current legislation, enrollment in the basic plan should be reasonably priced. The basic plan offers comprehensive coverage. This implies that everyone must revisit the initial stage and start enrolling their employees under the basic plan. Only once your staff is enrolled in the basic plan at the state level, organizational level, and for SMEs will those interested be able to sign up for additional or secondary plans. With the updated law, and as part of restructuring how the program operates, regulators are required to authorize and categorize all supplemental or ancillary offerings from HMOs prior to them being available to members within the organized private sector.
Additionally, it is essential to explain that health insurance involves managing health risks and differs from medical care services.
Some people mistakenly believe that health insurance refers to healthcare services themselves. In reality, health insurance involves grouping individuals' health risks and offering specific services outlined in a contract, with each person paying a set fee annually. Conversely, healthcare service relates to receiving treatment within a designated medical establishment according to rates determined by the provider.
Although healthcare appears on the concurrent list in our constitution, health insurance falls under the exclusive list. The regulatory authority for this program is the NHIA. Only the NHIA has the power to oversee it; no state government is allowed to do so.
Supplied by SyndiGate Media Inc. ( Syndigate.info ).
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