… Says 70% of healthcare spending comes from patients’ pockets
… Only 10–13% of Nigerians covered by insurance
… Seeks flexible premiums, prompt claims settlement
By Chioma Obinna
The HealthCare Providers Association of Nigeria (HCPAN), Lagos Branch, has called on the Federal and state governments to expand health insurance coverage, review tariffs paid to healthcare providers and ensure prompt settlement of claims, warning that low insurance penetration continues to expose millions of Nigerians to crippling medical expenses.
The association said only about 10 to 13 per cent of Nigerians were covered by health insurance, while out-of-pocket payments accounted for approximately 70 per cent of healthcare expenditure, leaving many households financially vulnerable whenever illness occurs.
HCPAN also called for flexible premium arrangements and community-based insurance schemes to bring market traders, artisans, transport workers, micro-entrepreneurs and other informal-sector workers into the health insurance system.
The association made the call at its Scientific Conference and Annual General Meeting, AGM, held in Lagos, with the theme, “Expanding Health Insurance Coverage in Nigeria: Improving Community-Based Insurance Schemes in the Informal Sector.”
Speaking at the event, the Chairman of HCPAN Lagos Branch, Pharmacist Biola Paul-Ozieh, said the country’s high dependence on direct payments for healthcare remained a major obstacle to achieving universal health coverage, despite the mandatory health insurance provisions of the National Health Insurance Authority, NHIA, Act, 2022.
“Currently, it is reported that about 10 to 13 per cent of the Nigerian population is covered by health insurance. The out-of-pocket expenditure is still huge at roughly 70 per cent despite the mandatory clause in the NHIA Act 2022,” she said.
Paul-Ozieh added that coverage of vulnerable groups stood at about 3.8 million, while participation among informal-sector workers remained limited, with enrolment concentrated mainly in Lagos and Abuja.
She identified delayed claims payments, tariffs that failed to reflect prevailing economic realities, negative attitudes among some enrollees and the exclusion of certain healthcare professionals from insurance programmes as challenges undermining providers’ participation.
“The other concern we have as providers is the various challenges faced by varied professionals in not being included in the provision of health services in the health insurance programme,” she said.
The HCPAN chairman said sustainable community-based insurance schemes would require stronger collaboration between government and private healthcare providers, alongside policies that addressed the financial realities of informal-sector workers.
Informal sector holds key to wider coverage
The Chief Executive Officer of DrugStoc Limited, Dr Chibuzo Opara, who delivered the keynote address through his representative, Dr Damilare Ojo, said expanding enrolment alone would not guarantee universal health coverage unless insurance schemes enabled beneficiaries to obtain the treatment and medicines they needed.
“What does it mean to have health insurance if, when illness occurs, the person cannot access the care needed?” he asked.
Opara said insurance coverage remained concentrated in the formal sector, leaving traders, artisans, transport workers and small-business owners inadequately protected against healthcare costs.
He explained that irregular incomes made fixed insurance contributions difficult for many informal-sector workers, stressing that schemes must be designed around their economic circumstances.
“We cannot close this gap by simply increasing enrolment in existing schemes. If we genuinely want to achieve universal health coverage, we must develop insurance models that address the needs of the people we intend to cover,” he said.
He advocated flexible contributions, appropriate benefit packages and group enrolment through trusted associations to encourage participation.
Opara also called for community pharmacies to be integrated into insurance networks, describing them as accessible points where residents could obtain initial healthcare advice and medicines.
He urged stakeholders to assess the effectiveness of insurance schemes through measurable outcomes, including access to medicines, service utilisation, referral outcomes, claims processing times, policy renewals and reductions in out-of-pocket expenditure.
Lagos expands grassroots enrolment
Meanwhile, the Lagos State Government has reaffirmed its commitment to expanding health insurance through affordable premiums, grassroots enrolment and the integration of community pharmacies and diagnostic centres into the healthcare network.
The state Commissioner for Health, Professor Akin Abayomi, represented by the Deputy Director of the Research Unit at the Lagos State Ministry of Health, Dr Tolu Babatope, said the informal sector accounted for a significant proportion of Lagos residents who often struggled to pay for medical treatment.
He said the Lagos State Health Management Agency, LASHMA, was expanding affordable premium options and grassroots enrolment initiatives in line with the state’s policy on mandatory health insurance.
Abayomi described community pharmacies as important entry points into the healthcare system, noting that their integration into insurance schemes could bring services closer to residents and strengthen access to treatment.
“Community pharmacies, therefore, are no longer merely places where medicines are dispensed. They can serve as important points of contact for healthcare services and entry points into the health insurance network,” he said.
He disclosed that the state was also working to strengthen links between pharmacies, hospitals and diagnostic centres, while addressing concerns about tariffs, delayed claims payments and inadequate digital infrastructure.
Delivering the sub-theme, the Lagos Zonal Coordinator of the National Health Insurance Authority (NHIA), Pharmacist Femi Adeoye, who was represented by the State Coordinator, NHIA, Yaba Office, Pharmacist Chinenye Nwaohiri, highlighted opportunities for different healthcare professionals to participate in expanding health insurance.
Adeoye said the NHIA operated programmes covering formal-sector workers, informal groups, private-sector participants and state health insurance schemes, with health maintenance organisations also supporting service delivery.
He explained that initiatives such as the Basic Health Care Provision Fund and the Vulnerable Group Fund were designed to improve access to healthcare for people who might otherwise struggle to afford treatment.
He called for fair tariff reviews that reflected the cost of providing services and urged healthcare professionals to take advantage of opportunities within the insurance system.
“Fair tariff reviews and timely payment for services are essential to encouraging healthcare providers to participate in health insurance schemes and ensuring sustainable service delivery.”
He stressed that public confidence depended on enrollees receiving timely and appropriate care, adding that reliable service delivery was essential to sustaining participation in insurance schemes.
In his goodwill message, the National President of HCPAN, Dr Austin Aipoh, called for stronger collaboration among stakeholders and flexible payment arrangements to make health insurance more accessible to informal-sector workers.
Aipoh said community-based approaches could help reach people whose incomes were irregular and who might not be able to afford conventional insurance contributions.
He also urged policymakers to create an enabling environment for healthcare providers, stressing that insurance schemes must be structured to support both patients and the professionals responsible for delivering care.
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