Health
Lagos, Kano lead as states overtake FG in health insurance coverage
State health insurance agencies have overtaken federal programmes as the largest drivers of Nigeria’s health insurance coverage, with Lagos, Delta and Kano emerging as the leading states in enrolment, according to the National Health Insurance Authority’s fourth quarter 2025 dashboard.
An analysis of the NHIA data showed that State Social Health Insurance Agencies accounted for 9,744,758 beneficiaries, surpassing the 7,068,457 enrollees under NHIA-managed programmes and underscoring the increasing role of states in expanding access to healthcare.
The shift comes as Nigeria continues its push towards achieving Universal Health Coverage through state-owned insurance schemes, the Basic Healthcare Provision Fund and equity programmes targeting poor and vulnerable populations.
Among the states, Lagos recorded the highest health insurance coverage with 2,757,992 beneficiaries, followed by Delta with 2,925,353 and Kano with 1,232,683.
The Federal Capital Territory accounted for 956,664 beneficiaries, while Oyo recorded 671,298, Edo had 658,337, Katsina registered 603,238, Jigawa had 583,766, and Osun recorded 561,351 beneficiaries.
By contrast, states such as Taraba (213,935), Borno (266,762), Bauchi (271,438) and Yobe (320,526) recorded some of the lowest enrolment figures, highlighting persistent disparities in health insurance coverage across the country.
The NHIA data also showed that enrolment under state schemes was largely driven by the Formal Sector programme for state and local government workers, which covered 3,962,972 beneficiaries, making it the single largest component of state-managed insurance.
Coverage for vulnerable Nigerians also expanded significantly through the Equity Fund, which recorded 3,915,531 beneficiaries, while the Basic Healthcare Provision Fund programme increased to 2,757,025 enrollees, reflecting continued investment in extending health insurance to underserved communities.
Private sector participation also improved, with HMOs’ private plans covering 2,166,890 beneficiaries by the end of 2025.
Within NHIA-managed programmes, the Formal Public, Organised Private Sector and Federal Sector remained the largest federal scheme with 4,469,309 beneficiaries.
Other federal programmes included 1,702,874 beneficiaries under the Tertiary Institutions Social Health Insurance Programme, 369,136 under GIFSHIP for National Youth Service Corps members, 342,897 under the National Health Authority Community-Based Health Insurance programme, 93,480 under GIFSHIP General, 44,820 under the Police and DSS Retirees Health Insurance Scheme, and 35,468 beneficiaries under the Global Fund RSSH Grant.
The data further showed sustained growth in overall health insurance coverage throughout the review period, rising from 16,833,091 beneficiaries in the first quarter of 2024 to 21,737,130 by the fourth quarter of 2025, representing a 29.41 per cent increase over the two years.
The steady increase suggests that recent reforms encouraging states to establish and strengthen their own health insurance agencies are beginning to reshape Nigeria’s healthcare financing landscape, reducing dependence on federally managed schemes.
However, the wide variation in enrollment across states indicates that progress remains uneven, with several states yet to significantly expand insurance coverage despite the existence of state health insurance laws.
The enactment of the National Health Insurance Authority Act, 2022 transformed Nigeria’s health insurance system by replacing the National Health Insurance Scheme with the NHIA and providing a stronger legal framework for achieving Universal Health Coverage. The law also made health insurance mandatory for all Nigerians and strengthened collaboration between the Federal Government and states.
Since then, all 36 states and the Federal Capital Territory have established State Social Health Insurance Agencies, while the Federal Government has expanded the Basic Healthcare Provision Fund, Equity Fund and community-based health insurance programmes to improve financial protection and reduce out-of-pocket healthcare spending.
Despite the growing role of state schemes and the increase in total enrolment, health insurance still covers only a small proportion of Nigeria’s estimated population of more than 230 million, underscoring the scale of work still required to achieve universal health coverage.
Commenting on the figures, the Managing Director/Chief Executive Officer of SUNU Health Nigeria Limited, Dr. Moyosore Olomola, said the country’s slow pace of health insurance expansion was driven more by structural challenges than a lack of public interest.
He said, “The obstacles are structural, not attitudinal, and I want to push back on the narrative that Nigerians simply do not value health insurance. The evidence does not support that. What we see at SUNU Health is that when the product is accessible, affordable and claims are settled promptly, people enrol and they renew.”
Olomola added that while the National Health Insurance Authority deserved credit for reforms aimed at expanding coverage, significant barriers still stood in the way of achieving universal health coverage.
“The NHIA’s target of 44 million enrolled lives by 2030 is ambitious but not unreasonable if the right enabling conditions are in place. The recent tariff revisions, the push for state-level domestication of health insurance laws and active engagement with private HMOs are all steps in the right direction,” he said.
According to him, income volatility, inadequate provider networks and low public trust remain the biggest obstacles to wider enrolment.
“The first and most stubborn obstacle is income volatility. Approximately 80 per cent of Nigeria’s working population earns income that is irregular, seasonal or cash-based. A premium structure that demands monthly or annual upfront payment simply does not fit that reality,” Olomola said.
He added, “The second obstacle is provider access. In many states, particularly in the North, there are simply not enough NHIA-accredited facilities. The third is trust. When an enrolled beneficiary is asked to pay a deposit at the hospital gate despite holding a valid insurance card, that is a system failure that no amount of enrollment marketing can overcome.”
Olomola called for flexible premium collection mechanisms, greater investment in provider networks in underserved states and stronger accountability measures for both HMOs and healthcare providers to accelerate enrollment and support Nigeria’s drive towards universal health coverage.
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