NHIA, Roche deepen reform push to accelerate universal health coverage

Nigeria’s drive toward Universal Health Coverage (UHC) is gaining momentum as the National Health Insurance Authority (NHIA) ramps up reforms aimed at expanding access, improving quality, and reducing the financial burden of healthcare on citizens.

This push was reinforced at the conclusion of the Health Innovation Leadership Academy (HILA) in Lagos, a capacity-building initiative delivered in partnership with Roche. The programme is designed to equip NHIA’s leadership with the tools and mindset required to drive large scale transformation in Nigeria’s health insurance system.

Kelechi Ohiri, NHIA director general said Nigeria’s health insurance system has entered a new phase following the 2022 NHIA Act. For nearly 20 years, the former National Health Insurance Scheme (NHIS) operated as a voluntary programme largely limited to federal workers and the organised private sector, resulting in slow growth.

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“The Act made health insurance mandatory for all Nigerians and expanded our mandate to regulate and promote the sector,” Ohiri said.

Since then, enrolment has risen from about 16 million to 21.7 million Nigerians an increase of roughly 35 percent in two years.

NHIA’s reform agenda is anchored on four pillars: expanding coverage, ensuring equity, improving quality of care, and promoting sustainability. Expanding coverage remains critical, particularly in a country of over 200 million people.

While the law makes insurance mandatory, Ohiri noted that awareness and trust are essential to driving uptake. “Making it mandatory is not enough. People need to understand why it matters and trust that it will work,” he said.

Equity programmes are targeting vulnerable populations. Through the Basic Health Care Provision Fund, about 2.7 million Nigerians are currently covered. On quality, NHIA is strengthening provider standards and regulatory oversight, while sustainability efforts are focused on domestic financing and collaboration with private insurers and state agencies.

Low awareness and cultural perceptions continue to limit adoption. Many Nigerians still lack understanding of health insurance or hold misconceptions about it. “When people realise that insurance means access to care at any time without out of pocket payments at their most vulnerable moment, the value becomes clear,” Ohiri explained.

To close this gap, NHIA is investing in public education, digital enrolment channels such as USSD, and stronger enforcement. The Authority has also expanded its monitoring teams and deployed staff in hospitals to support enrollees and address complaints.

On the measurable Impact, NHIA’s interventions are already delivering results. Over 40,000 women have benefited from free emergency cesarean sections, while about 3,900 women have received treatment under the Free Fistula Programme. These initiatives, alongside broader coverage expansion, are helping reduce catastrophic health spending a major driver of poverty in Nigeria.

For Roche, the partnership reflects the importance of shared responsibility in healthcare delivery.

Dr. Bolarinwa Oyedeji, general manager, Roche, said strengthening leadership capacity is critical to achieving UHC. “Healthcare is a shared responsibility. When the system works, families are protected and the economy benefits,” she said.

A key collaboration is the Roche-NHIA cancer initiative, which uses a cost sharing model to make treatment more affordable. Under the arrangement, Roche and NHIA subsidise costs while patients pay a reduced portion sometimes as low as 20 percent.

The programme focuses on high burden cancers such as breast and prostate cancer, addressing the growing rise of non-communicable diseases in Nigeria.

“Many Nigerians are just one illness away from financial catastrophe. Access to timely care is critical,” Oyedeji added.

While partnerships are helping to bridge immediate gaps, long term sustainability depends on expanding the insurance pool. A larger enrollee base increases available funds and enables broader benefits.

NHIA is also strengthening its regulatory oversight of Health Maintenance Organisations (HMOs) and providers to ensure compliance and service quality.

Ohiri noted that enforcement has been scaled up, with clearer guidelines on benefit packages and mechanisms for patients to report violations.

The Health Innovation Leadership Academy represents a strategic investment in execution capacity. Participants developed ideas focused on improving awareness, enrolment, and service delivery.

“These are practical solutions to long standing challenges. They will be embedded in our work plans and funded for implementation,” Ohiri said.

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The programme also emphasised collaboration across stakeholders, recognising that achieving UHC requires coordinated effort beyond NHIA alone.

As Nigeria seeks to close its healthcare access gap, NHIA’s reform agenda signals a shift toward a more coordinated, mandatory, and innovation driven system.

If sustained, analysts say the reforms could reduce financial hardship, improve health outcomes, and strengthen productivity across the economy.

For now, the NHIA and Roche partnership highlights a clear direction, building a health insurance system that prioritises access, equity, and sustainability placing Nigerians at the centre of care.