How weak health information systems undermine Nigeria’s push for iniversal health coverage

In recent months, widely reported cases of alleged medical negligence across Nigeria have sparked public outrage, with families demanding accountability for avoidable deaths and questionable clinical decisions.

Yet beyond individual responsibility lies a deeper systemic issue: in many cases, hospitals struggle to produce reliable records of what care was provided, when decisions were made, and why outcomes deteriorated. When a patient dies and no one can clearly reconstruct the chain of care, the problem is not only negligence—it is the absence of a functioning information system.

Nigeria’s ambition to deliver universal health coverage (UHC) is colliding with a quieter, deadlier problem: we do not truly know what is happening in our health system. When utilisation, outcomes, and costs are poorly measured, reforms become educated guesses, fraud hides in plain sight, and scarce resources leak away instead of saving lives.

The National Health Insurance Authority (NHIA) and National Health Insurance Scheme (NHIS), now central to Nigeria’s UHC agenda, aim to expand coverage beyond employer-based models to broader population enrollment. In practice, however, the system still relies on fragmented and delayed data to determine who uses services, what care is provided, and at what cost. Claims arrive in inconsistent formats—from paper files to basic electronic documents—making it difficult to distinguish legitimate utilization from fraud or overbilling. Enrollment may rise, yet the system often cannot confirm whether the poorest enrollees actually receive care. Coverage risks becoming more statistical than real.

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In some states, facilities struggle to reconcile patients seen with payments received; in others, insurers cannot flag clinics billing for services on days they were barely open. Without reliable medical records and encounter-level data, the system cannot credibly reward performance or penalize fraud. The cost of not knowing is that money flows regardless of impact.
Fraud and waste thrive in such conditions. Globally, health systems lose an estimated 6–7% of spending to fraud and abuse, and Nigeria is no exception. Where claims remain largely manual, it becomes easier to submit duplicate invoices, bill for services not performed, or exaggerate admissions. Without standardized coding and electronic verification, even diligent insurers struggle to detect patterns—clinics claiming high-end diagnostics without capacity, unexplained spikes in admissions, or unusually long stays for minor conditions. Each unverified claim diverts funds from genuine care.

The problem extends beyond hospitals. At the primary care level, Nigeria’s routine health information system suffers from late reporting, missing data, and inconsistent definitions. If DHIS2 data shows rising antenatal visits but cannot be linked to NHIA claims, policymakers cannot determine whether insured women are benefiting. Parallel reporting systems only deepen the problem, leaving multiple versions of the truth and no reliable baseline for planning.

By contrast, the United States treats health information as infrastructure. Documentation is standardized and enforceable. Clinicians record diagnoses and procedures within electronic health records, while coders translate them into systems that drive reimbursement, quality measurement, and population health analytics. Claims must be supported by documentation, and discrepancies can be audited and penalized. While imperfect, this integration of documentation, coding, and payment shows what becomes possible when data supports performance.

Nigeria need not replicate this model wholesale, but the lesson is clear. For NHIA and NHIS reforms to succeed, three shifts are essential.

First, encounter-level data must become non-negotiable. Every insured visit should generate a basic digital record capturing who was seen, for what, and what was done. This does not require complex systems everywhere—simple standardized tools, including tablet-based or USSD-linked solutions, can feed a central platform. Once visits are reliably recorded, utilization becomes measurable rather than assumed.

Second, Nigeria must move toward coding accuracy. Training health information officers to use standardized diagnosis and procedure codes would transform claims processing and performance monitoring.

Instead of inconsistent free-text descriptions, the system could compare like with like—tracking deliveries, surgeries, or malaria admissions across states and identifying anomalies more effectively.
Third, payment must be tied to verified data. Capitation and fee-for-service models can be complemented by performance-based incentives—rewarding facilities that meet quality and reporting standards while penalizing persistent gaps or suspicious patterns. When accurate data is linked to predictable revenue, reporting culture improves.

Ultimately, universal health coverage is not just about enrolling more people; it is about knowing, with confidence, that they receive effective, affordable care. Weak health information systems make that knowledge impossible. The cost of not knowing is paid in wasted resources, eroded trust, and lives lost to preventable failures. If Nigeria is serious about UHC, building data integrity into the core of NHIA and NHIS reforms is not optional—it is the only way to ensure that coverage on paper translates into real health outcomes.

Dr. Babajide Adewumi is a medical doctor and subject matter expert in healthcare systems, clinical data integrity, and health information management, with over 15 years of experience improving healthcare delivery through technology-driven solutions.