By Confidence Obiahu
Nigeria’s health insurance enrolment has risen to more than 22 million, but millions of Nigerians remain without financial protection against the cost of medical care, highlighting the gap between rising enrolment and the country’s universal health coverage ambitions.
According to the National Health Insurance Authority (NHIA), 22.03 million Nigerians were enrolled in health insurance schemes as of July 2026, representing a 35 per cent increase from the previous year.
The growth has been driven largely by federal and state-backed health insurance programmes, with state social health insurance agencies accounting for a substantial share of enrolment.
The NHIA’s fourth-quarter 2025 dashboard recorded about 9.74 million beneficiaries under state schemes and approximately 7.07 million under NHIA-managed programmes.
Despite the increase, insurance coverage remains low relative to Nigeria’s population, leaving millions exposed to potentially high out-of-pocket healthcare costs.
For uninsured Nigerians, illness can quickly become a financial burden as they may have to pay directly for consultations, laboratory tests, medicines, hospitalisation and other forms of care.
The burden is particularly heavy for low-income households and informal-sector workers, many of whom have irregular incomes and may find conventional monthly or annual premium payments difficult to sustain.
A recent study on health insurance among Nigerian women also found significant inequalities in enrolment, with coverage more concentrated among wealthier, better-educated and urban residents. The researchers called for greater efforts to subsidise insurance for poor and underserved populations.
The NHIA Act, signed into law in 2022, replaced the former National Health Insurance Scheme and established a framework for expanding health insurance coverage among Nigerians and legal residents.
The framework provides for coverage of formal-sector workers, private-sector employees, vulnerable groups and other categories of residents, while state health insurance agencies are expected to play a key role in expanding coverage at the sub-national level.
However, stakeholders say increasing enrolment alone will not be enough to achieve universal health coverage.
The Managing Director and Chief Executive Officer of SUNU Health Nigeria Limited, Dr Moyosore Olomola, attributed the slow expansion of health insurance to structural challenges rather than a lack of interest among Nigerians.
He identified income volatility, inadequate healthcare provider networks and low public trust as major barriers to wider enrolment.
According to Olomola, a large proportion of Nigeria’s workforce earns irregular, seasonal or cash-based incomes, making conventional premium payment systems difficult for many workers.
He called for more flexible premium collection methods, greater investment in healthcare providers in underserved areas and stronger accountability among health maintenance organisations and healthcare providers.
Nigeria’s continued reliance on out-of-pocket healthcare spending underscores the challenge. Despite the growth in insurance enrolment, many Nigerians still depend on personal income and savings to pay for treatment when they fall ill.
Experts warn that such spending can result in catastrophic health expenditure, particularly when families face expensive illnesses or prolonged hospitalisation.
The latest enrolment figures therefore represent progress, but also underscore the scale of the challenge. Millions more Nigerians need to be brought into the insurance system, particularly poor households, informal workers and people living in underserved communities.
Stakeholders have urged the government to focus not only on increasing enrolment but also on making health insurance affordable, accessible and reliable.
Ultimately, they say, the success of Nigeria’s health insurance reforms will be measured not simply by the number of people registered but by whether ordinary Nigerians can access quality healthcare without being pushed into financial hardship.
