For almost two decades, health insurance coverage in Nigeria barely moved. It hovered around a few percent of the population, almost all of them federal workers and employees of large companies. Since the National Health Insurance Authority Act of 2022 made insurance mandatory, enrolment has grown faster than at any time in the scheme’s history. The latest figures put it above 23 million people. That is real progress, and it is also a reminder of how far there is to go in a country of more than 220 million.
The numbers, read carefully
According to the National Health Insurance Authority (NHIA), the number of insured Nigerians has climbed in a steady staircase:
Late 2023: about 16.2 to 16.7 million enrollees
End of 2024: 19.2 million, which the agency said exceeded its presidential target for the year
Q4 2025: 21.7 million, across 13 programmes in all 36 states and the FCT
Q3 2026: 23.06 million, a 42% rise on late 2023
Bar chart of health insurance coverage in Nigeria rising from 16.7 million to 23.06 million enrollees
Enrolment growth since the NHIA Act, as reported by the National Health Insurance Authority.
Growth of that pace deserves credit. Before the 2022 Act, NHIA leadership has said coverage had stagnated at roughly 7% of the population for close to three decades. The new law requires all Nigerians to be insured, empowers states to run their own schemes, and created the Basic Health Care Provision Fund pathway to subsidise care for vulnerable people.
But even at 23 million, health insurance coverage in Nigeria reaches only around one person in ten. Nine out of ten Nigerians still pay for care directly from their pockets, at the moment they are sick and least able to bargain.
Where the growth is coming from
The new enrolment is not evenly spread. State Social Health Insurance Agencies (SSHIAs) account for much of it, often by enrolling civil servants and their dependants. Delta State led the country at the end of 2025 with about 2.93 million enrollees, followed by large states such as Kano with 1.23 million. In several states, more than half of all coverage sits in the state scheme.
Federal programmes add to the picture. The Basic Health Care Provision Fund, the Group Individual and Family Social Health Insurance Programme (GIFSHIP) and the Tertiary Institutions Social Health Insurance Programme (TISHIP) each cover specific groups, while private HMO plans serve mainly urban, salaried workers.
That pattern matters. It means growth is being driven largely by public payrolls and subsidised programmes, not by the informal workers who make up most of Nigeria’s labour force. Traders, artisans, transport workers and small business owners remain the hardest people to enrol and the most exposed to catastrophic health costs.
Insured but not covered
Enrolment is a number on a register. Coverage is what happens when a patient walks into a clinic. The gap between the two is the most important issue in Nigerian health financing today.
Patients frequently report long waits for authorisation, facilities that turn away insured patients, medicines marked out of stock, and pressure to pay top-up fees. Providers, for their part, have long complained that capitation payments were too low to cover care. The NHIA has responded with several reforms:
Higher provider payments. From April 2025, capitation fees rose by 93% and fee-for-service rates by 378%, the first major review in years.
Faster approvals. The authority began monitoring compliance with a one-hour deadline for HMOs to issue pre-authorisation codes.
Medicine tariffs. The NHIA announced a review of medicine tariffs in response to the surge in drug prices.
Digital tools. New tools aim to help enrollees understand their benefits and complain when they are denied care.
These are the right levers. Their success depends on enforcement and on whether payments reach providers on time.
The medicine problem nobody prices properly
For HMOs, the biggest unmanaged cost is not surgery or hospital admission. It is chronic disease. Hypertension, diabetes, asthma and other long-term conditions generate a prescription every month for years. When patients cannot get those medicines reliably, or stop taking them, the cost does not disappear. It returns later as a stroke, a kidney failure or an amputation, which is far more expensive to treat.
Most Nigerian schemes are not designed around this reality. Pharmacy benefits are often limited to whatever is in stock at the primary care facility, medicines are dispensed a few weeks at a time, and nobody follows up when a refill is missed. For an insurer, that is a slow leak in the balance sheet.
Insurance coverage in Nigeria: the opportunity for HMOs and providers
Health insurance coverage in Nigeria will keep growing, partly because the law now requires it and partly because government has committed to doubling coverage within three years. The organisations that win in that market will be the ones that solve for cost and experience at the same time. Four moves stand out:
Build a real pharmacy benefit. Contract with specialist pharmacies that can guarantee availability, deliver to the patient’s home and refill on schedule, instead of relying on facility stock.
Manage chronic care actively. Identify members with long-term conditions, enrol them in adherence programmes and track whether their medicines are actually being collected and taken.
Design for informal workers. Smaller, more frequent premium payments through mobile money, sold through cooperatives, markets and trade associations, will reach people that payroll schemes cannot.
Measure experience. Publish waiting times, refusal rates and complaint resolution. Trust is the product an insurer really sells.
What enrollees can do today
Patients do not have to wait for the system to fix itself. If you are enrolled, a few steps make your cover work harder for you:
Confirm your status. Ask your employer, state scheme or HMO for your enrolment number and the name of your registered primary care facility.
Know your benefit package. Ask for the list of covered services and medicines, especially if you live with a long-term condition.
Ask about chronic medicines. Find out whether your plan supplies monthly refills, and where they can be collected or delivered.
Keep records. Note dates, names and what you were told whenever care is delayed or refused.
Escalate. If your HMO or facility does not respond, the NHIA operates complaint channels for enrollees, and using them creates the data regulators need to act.
An informed enrollee is the cheapest quality control the system has.
From the HubPharm pharmacy desk. HubPharm Africa works with hospitals and HMOs as a chronic care partner: verified medicines, scheduled home delivery and pharmacist follow-up that has improved adherence by 42% among the patients we serve. If you run an HMO or hospital and want to see how a managed pharmacy benefit would work for your members, send the code HC-HB02 on WhatsApp to +234 705 050 5001. Insured patients struggling to get their monthly medicines can use the same code.
The bottom line
Nigeria has moved from stagnation to steady growth in health insurance, and the NHIA deserves credit for it. But health insurance coverage in Nigeria will only mean something when an insured patient can get the right care and the right medicine without a fight. The next phase is not about adding names to a register. It is about making coverage real, and the chronic care pharmacy benefit is where that work should start.
Nairametrics. NHIA increases capitation fees by 93%, fee-for-service by 378%, effective April 2025. 4 February 2025.
Federal Republic of Nigeria. National Health Insurance Authority Act, 2022.
BusinessDay. Tinubu congratulates NAFDAC on retaining WHO ML3 (includes the commitment to double health insurance coverage within three years). August 2025. https://businessday.ng/?p=1008556
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