Health Insurance in Nigeria: What the NHIA Act Changed
Twenty years of voluntary insurance never got past 5% coverage. Making it compulsory has moved the number, but not yet the majority.
Most Nigerians pay for healthcare out of pocket, at the moment they need it. That is the most expensive and most dangerous way to finance health, because it means a serious illness is also a financial catastrophe, and it means people delay treatment until it is severe.
Health insurance is the mechanism intended to fix that, and Nigeria's has been rebuilt.
What changed in 2022
The National Health Insurance Authority Act 2022, signed in May 2022, replaced the National Health Insurance Scheme Act of 1999.
Three substantive changes:
- Health insurance became mandatory for all Nigerians and legal residents. Under the old scheme it was voluntary, and in practice covered mostly federal civil servants.
- The scheme became an Authority — a regulator with enforcement powers rather than an administrator of a scheme.
- States are required to establish state social health insurance schemes.
It also created a Vulnerable Group Fund.
Where enrolment stands
Over 23 million people as at 21 September 2026, up from 22 million reported in July 2026. Director-General: Dr Kelechi Ohiri.
Against a population of roughly 230 million, that is about 10%. That arithmetic is ours, not the Authority's.
For context: under the old NHIS, coverage remained below 5% of the population for nearly two decades. So the trajectory has changed, and it is changing month to month. But nine in ten Nigerians still have no health insurance.
The Vulnerable Group Fund
This is the part that matters most in the north, where the ability to pay a premium is lowest.
The Fund is financed largely through the NHIA gateway of the Basic Health Care Provision Fund — 48.75% of the BHCPF — plus other sources. It pays premiums on behalf of:
- the poor
- children under five
- pregnant women
- the elderly
- persons with disabilities
- other defined vulnerable groups
Targeting uses the National Social Register. 2.7 million poor and vulnerable Nigerians have been enrolled through the BHCPF.
The dependence on the National Social Register is worth flagging. If a household is not on the register, it is not reached, and register coverage has been uneven across states.
What was added in 2026
The benefit package has been extended in several directions:
- Cancer treatment cost-sharing with Roche — Roche covering 50%, NHIA 30%, the patient 20% — and radiotherapy support up to ₦400,000
- Over 38,000 people living with HIV enrolled under Global Fund support
- Over 8,000 TB patients — 7,400 drug-sensitive, 594 drug-resistant
- Over 51,000 enrolled for HIV and TB support across four states, as at 3 September 2026
What we could not establish
Two things worth being honest about.
We could not obtain a breakdown of the 23 million between formal sector, informal sector and vulnerable group enrolees. That breakdown matters, because an insurance scheme that covers civil servants and the destitute but not the trader in between has a structural gap.
We could not find evidence of enforcement. The Act makes enrolment mandatory. We found nothing on penalties actually being applied to anyone for not enrolling. A mandate without enforcement operates, in practice, as an invitation.
We have also not described the basic minimum package in detail, because we could not verify its current contents.
What to do if you are not covered
Check whether your state has a social health insurance scheme — the 2022 Act requires one, and several states operate schemes with low annual premiums. If you are in a category covered by the Vulnerable Group Fund, enrolment should be free, and your nearest primary healthcare centre is the place to ask.
Frequently asked questions
Is health insurance compulsory in Nigeria? Yes, under the NHIA Act 2022, for all Nigerians and legal residents. Enforcement is another matter.
How many people are covered? Over 23 million as at September 2026 — around 10% of the population.
Do I have to pay if I am poor? The Vulnerable Group Fund pays premiums for defined vulnerable groups, targeted through the National Social Register.
Does it cover cancer treatment? Partially, under a 2026 cost-sharing arrangement, with the patient bearing 20% and radiotherapy support capped at ₦400,000.
Sources
- Enrolment at 23 million and 2026 benefit expansion — ThisDay, 21 September 2026
- Enrolment at 22 million, July 2026 — Vanguard
- Coverage below 5% under the old NHIS — Nigeria Health Watch
- BHCPF gateway funding the Vulnerable Group Fund — NPHCDA