State health insurance enrolment hits 16.95m as agencies target 20m by year-end

…enrolment rises by 1.2m in Q3 as states intensify efforts to expand coverage

State social health insurance agencies have increased the number of people enrolled in health insurance schemes to 16.95 million, representing a 7.6 percent increase from the previous quarter, as they target 20 million enrollees by the end of 2026.

Mohammed Safana, Director General of the Katsina State Contributory Healthcare Management Agency (KTSCHMA) and Chairman of the Forum of Chief Executives of State Social Health Insurance Agencies of Nigeria, disclosed this on Wednesday in Abuja at the third-quarter review meeting of the forum.

Safana said enrolment rose from 14.13 million in the first quarter to 15.75 million in the second quarter, before reaching 16,948,464 in the third quarter.

The Q3 figure represents an increase of 1,196,098 enrollees from the previous quarter, while the increase between Q1 and Q3 stood at more than 2.8 million.

He said the forum was working towards achieving the 20 million enrolment target by year-end, noting that the expansion of state-level health insurance schemes was critical to moving Nigeria towards universal health coverage.

“For each state, every state is mandated to ensure that all residents of that state have easy access to health. The only way to do that is to enrol people, especially the poor and the vulnerable, into the scheme such that we protect those targeted populations from financial risk,” Safana said.

According to him, increasing health insurance coverage would help reduce the amount Nigerians pay directly for healthcare and protect vulnerable households from financial hardship.

He said out-of-pocket expenditure on healthcare remained a major challenge in Nigeria, adding that the forum was exploring ways to convert part of such spending into insurance premiums paid directly to state health insurance agencies.

Safana said the agencies were also prioritising pregnant women and children under five as part of efforts to reduce maternal and child mortality.

He noted that while the 20 million target represented progress, it remained relatively small compared with Nigeria’s population of more than 200 million.

“What we have done so far, looking at the time we started the state social health insurance agencies, the total health insurance coverage in Nigeria is a single digit. And I believe with the advent of the state social health insurance agency, we have made it to double digit,” he said.

The chairman said the agencies were also developing strategies to mobilise more domestic resources for health insurance and strengthen payment mechanisms for healthcare providers.

He explained that increased funding would enable health facilities to address gaps in human resources, basic equipment, drugs and other essential medical consumables.

Safana said state health insurance programmes had contributed to improvements in healthcare facilities through strategic purchasing and provider payment mechanisms.

Under the system, he explained, healthcare providers receive advance payments through capitation for enrolled patients, allowing facilities to procure drugs and consumables and prepare for service delivery.

He said quality assurance teams across the states regularly monitor healthcare facilities to assess service quality and compliance with operational guidelines.

“We have quality assurance teams across the states. They do go to the healthcare facilities to check the quality of care that is given,” he said.

The agencies, he added, also conduct public sensitisation and operate monitoring structures that track healthcare providers on a monthly and quarterly basis.

Safana attributed the increase in enrolment to stronger collaboration among state agencies, noting that the forum had provided a platform for chief executives to share experiences and adopt solutions to common challenges.

He identified peer review as one of the major strategies being used by the agencies to improve performance and address challenges across states.

He said the forum’s collective approach had helped individual agencies return to their respective states with resolutions and strategies that could be implemented to expand coverage.

On funding, Safana said states were leveraging the Basic Health Care Provision Fund (BHCPF) and state equity funds to expand health insurance coverage.

He said many states were contributing directly from their consolidated revenues into equity funds to support health insurance for vulnerable populations.

Safana also pointed to increased investment in primary healthcare facilities by state governments, saying some states were working towards having two primary healthcare centres per ward.

He said funding from the BHCPF and other state investments could help address shortages of health workers and provide basic equipment needed by primary healthcare facilities.

The forum chairman expressed optimism that these investments would improve public confidence in primary healthcare and encourage more Nigerians to seek treatment at the primary level.

He added that investments in tertiary health institutions across states could also help address the country’s human resource gap in the health sector.

Safana said some primary and comprehensive health facilities had expanded their services to include elements of secondary healthcare, describing the development as a positive step towards establishing fully functional primary healthcare centres.