Lagos State Health Insurance Scheme, popularly known as Ilera Eko, was launched in 2018 by the state government to provide universal health coverage for all residents, reduce high out-of-pocket medical expenses, and provide access to quality and affordable healthcare. Findings, however, showed that many residents who enrolled in the scheme are still battling with catastrophic medical bills and out-of-pocket payments at the state-owned hospitals. SODIQ OJUROUNGBE reports
Bosun Aderinoku sat quietly at the entrance of the maternity ward of Gbagada General Hospital, his eyes heavy with fatigue and disappointment. Every few seconds, he let out a hiss. In his hand was a crumpled hospital bill, one that mocked the very promise that encouraged him to register for the Ilera Eko health insurance scheme six months earlier.
Ilera Eko is a Social Health Insurance initiative of the Lagos State Government managed by the Lagos State Health Management Agency.
Aderinoku enrolled in Ilera Eko with the hope that his pregnant wife would get quality maternal care without the crushing bills that send many families into debt.
“The LASHMA officials told me that once I am registered, I don’t have to worry. I was told that caesarean sections and vaginal deliveries were covered. That was why I paid,” he recalled bitterly to our correspondent.
But on October 22, 2025, when his wife was rushed to the hospital in labour and doctors decided she needed an emergency CS, that promise began to crumble.
Nurses asked him to buy drugs and consumables required for the surgery. Confused but desperate to save his wife and unborn child, Aderinoku hurried to the hospital’s pharmacy and told the pharmacists on duty that he was under LASHMA (Ilera Eko).
“They gave me just a few items. Even the gloves were only ten pieces. I had to pay for almost everything else myself,” he said.
By the time the surgery was done and his wife stabilised, Aderinoku said he had spent over N115,000 from his pocket.
Six days later, when he thought the bills were over, the hospital handed him a final bill of 294,000.
“I went to the LASHMA office to complain, but they told me the policy has changed. I was told that the free CS package is no longer available to people who registered six months ago. Even when the healthcare providers themselves (the hospital) sent my case details to LASHMA for confirmation, the approval was rejected.
“I enrolled in Ilera Eko to reduce out-of-pocket medical expenses and not to suffer like this,” the Keke driver said, shaking his head in disbelief.
Bills rejected
Temitope Usman stood by the hospital bed, clutching his wife’s hand, his eyes darting between her pale face and the monitor beeping faintly beside her. Antiseptic smell filled the air, mingling with the faint cries of newborns from nearby wards. For a moment, he wondered if the dream of affordable healthcare he was promised had only existed on paper.
Eight months earlier, Usman had walked into a LASHMA registration centre with hope in his chest and N55,000 in his hand. His wife had just discovered she was pregnant, and like many young couples in Lagos, they feared the financial weight of childbirth. Ilera Eko health insurance scheme, he was told, would ease that financial burden.
He told PUNCH Healthwise, “They said once you are registered, you don’t have to worry. They assured me that everything concerning pregnancy, antenatal, delivery, and even surgery would be covered if I were registered. So, I didn’t think twice about registering.”
For months, his wife attended her antenatal sessions at a government hospital in Kosofe, her file stamped with the LASHMA logo. The nurses knew her name. The doctors commended her for registering under the insurance scheme. Every visit deepened their trust in a system that promised care without crippling cost.
On a Friday morning in late October, Usman’s wife woke up groaning with pain that signalled the onset of labour. By noon, the contractions had intensified, and the couple hurried to the hospital.
“The doctor checked her and said we should wait for them to monitor the progress. So, we waited, and she was admitted. By night, the pain was worse.
“By Saturday afternoon, it was obvious that the labour was not progressing. The baby was in distress, and time was running out. My wife was crying. She begged them to do something. The doctor said they needed to do a caesarean section,” he said.
It was supposed to be less expensive. Ilera Eko covered such procedures, he thought. That was the reason for the health insurance, but the nurse’s next words would shatter that illusion.
“She told me, ‘You’ll have to buy the consumables and drugs yourself. Approval from LASHMA will take time, and this is an emergency,” Usman said.
He was running between the pharmacy and the ward, buying endless consumables including gloves, syringes, drips, theatre packages, and antibiotics, among others, demanded by the nurses for the surgery. Each item chipped away at his savings. By the time the operation started that evening, he had spent nearly everything he had on him.
The surgery was successful. His wife and child survived, but peace did not return due to catastrophic medical bills.
When discharge day came, Usman approached the hospital’s accounts office, confident that LASHMA would settle the bill. Instead, he was told his claim had been rejected.
He explained to our correspondent, “At first, I thought it was a mistake. They said LASHMA didn’t approve it. Not even one naira.
“I sought help from the consultant gynaecologist who had handled my wife’s case. The doctor intervened and wrote a medical note on why they went ahead with the CS. She even reached out to LASHMA officials to explain that it was an emergency, that it had saved two lives. But the agency stood its ground.
“They said the policy has changed, and procedures previously covered are no longer covered.”
The helpless father further recounted, “Nobody told us that when we registered, nor when we started using the insurance scheme. Now, instead of relief, I am left with a stack of receipts and a debt I never planned for. The total cost of the surgery and hospital stay ran into hundreds of thousands of naira.
“I enrolled in Ilera Eko because I didn’t want to beg or borrow when my wife delivered. Now I am indebted. I have borrowed from friends. I don’t even know how to repay the money I borrowed.”
Hailed as a people-centred initiative designed to make healthcare affordable for all Lagosians, findings by PUNCH Healthwise revealed that the state’s insurance scheme is now leaving many of its enrollees stranded.
A scheme established to provide relief
LASHMA was established by a law signed in May 2015, but the mandatory health insurance scheme it manages, called Ilera Eko, was officially launched in December 2018.
When it was launched in 2018, the initiative was celebrated as a step toward achieving universal health coverage in Nigeria’s commercial nerve centre.
The scheme was designed to ensure that every resident, regardless of social class, had access to quality healthcare at an affordable cost.
Under the plan, individuals and families could register with a modest premium and access a range of medical services in both public and private hospitals across the state.
From maternity care to treatment for common ailments, surgeries, and emergency services, the scheme was sold as a safety net for the vulnerable — a way to bridge the gap between the rich and poor in healthcare access.
Then-Governor Akinwunmi Ambode, while signing the scheme into law, had declared that the initiative would “end the era of people selling property or begging for funds to pay hospital bills”.
The idea was to create a pool of health financing sustained by government contributions, premiums from residents, and support from donor agencies.
For the first few years, the scheme gained traction. Market women, artisans, commercial drivers, and even civil servants began to embrace it. The packages were affordable, and enrollees could access outpatient care, laboratory tests, surgeries, maternity services, and even emergency procedures like cesarean sections at little or no extra cost.
As of the end of September 2025, over 1.3 million people are registered under the Ilera Eko health scheme.
Hospitals under the LASHMA umbrella were expected to receive prompt reimbursement for services rendered to enrollees, creating a sustainable cycle of trust between the public and the government.
Promises fading amid policy shifts
In recent months, an investigation by PUNCH Healthwise revealed that new policy adjustments quietly introduced by the agency have left many enrollees blindsided.
Some of the enrollees who spoke with our correspondent stated that they were unaware of any policy changes until they arrived at the hospital, only to discover that certain services now require prior approval from LASHMA.
According to them, some of their requests for coverage, once automatically guaranteed, are now being rejected outright.
They added that services that were once fully covered now require partial or full payment, especially for maternal and emergency care.
Health workers who spoke with PUNCH Healthwise under anonymity said the policy changes were introduced in mid-2025, following what the agency described as a “review of coverage and funding structure”.
A midwife at a government hospital in Lagos explained, “We used to call LASHMA patients ‘government patients. Once they brought their card, we knew CS, delivery, or emergency care would be handled. But since the policy changed, we are not aware of what is covered anymore. People come expecting help, and we have to tell them to go buy things themselves.”
The nurse added that the sudden shift had created confusion and frustration, both for patients who trusted the system and for healthcare providers who now bear the burden of explaining these frustrations.
Enrollees groan
PUNCH Healthwise’s findings showed that many enrollees of Ilera Eko requiring care are struggling to pay for services that were once fully covered.
Several enrollees at different hospitals recounted experiences that illustrate the challenges under the new policy to our correspondent.
Salau Adekale sank into the hard plastic chair outside the maternity ward of Lagos Island General Hospital, a bundle of receipts clutched tightly in his hands. His eyes were rimmed red from fatigue, worry, and sleepless nights.
Just days earlier, his wife had undergone an emergency caesarean section, and what was meant to be a moment of joy had turned into a financial nightmare.
“I spent over N150,000 buying all the consumables and drugs they asked for before the operation could be carried out. I thought LASHMA was supposed to cover all of this. I registered my wife six months ago, hoping she could deliver safely without me losing sleep over the money. But now they say I am not eligible because I registered less than six months ago. And they gave me a bill of N300,000 on top of everything I had spent earlier,” he said.
Fatima Mohammed said she spent her savings buying consumables such as gloves, drapes, syringes, and antibiotics before her Caesarean section.
“It was supposed to be free. I registered under LASHMA so I wouldn’t have to beg for money, but now, I have no idea how I will pay the remaining bills since things have changed,” she said
Similarly, Amina Bello said her husband had registered her with LASHMA before her pregnancy.
During an emergency, she said a hospital staff member insisted she purchase items that were previously covered.
She added, “I didn’t even have N50,000 at that moment. We had to borrow from neighbours just to save my life and the baby’s.”
Chukwuma Okeke, a father of three, stated that his wife’s delivery at Randle General Hospital was almost entirely paid from his own pocket.
“I was sure LASHMA would cover the delivery. But they asked me to pay for almost everything. I had to take out a loan because the claim was not approved immediately,” he said.
52-year-old Abiola Salami said she found herself grappling with unexpected medical expenses despite being enrolled in Ilera Eko.
Salami, who has a history of hypertension, was prescribed both anti-hypertensive drugs and medication for severe back pain by her attending physician. She assumed that as a registered LASHMA patient, all necessary medications would be fully covered.
However, when her prescription was submitted for approval, only the anti-hypertensive drugs were sanctioned. The back pain medication, which doctors said was critical for her mobility and daily functioning, was rejected.
“I was shocked. I rely on both prescriptions to function. I didn’t expect to pay for part of my treatment out of my own pocket,” Salami said.
Salami said sourcing funds for the rejected drugs has been a major challenge, leaving her to shoulder the cost of essential medication.
“I have been a loyal enrollee. I pay my premiums regularly, but now it feels like the insurance only helps partially. I am left struggling to find the money for what my doctor says I need,” she added.
Experts worry over persistent out-of-pocket payments
Health insurance is important for pregnant women because it provides financial protection against high medical costs, ensures access to quality prenatal and delivery care, and encourages timely treatment and preventive care, which leads to better maternal and infant health outcomes.
The World Health Organisation emphasised the need for greater insurance coverage to help women meet its recommended minimum of eight antenatal care visits.
While LASHMA officials insist that recent policy adjustments are necessary to maintain financial sustainability, policy experts cautioned that the reforms were creating a significant financial burden for enrollees.
Analysts argued that when residents enroll with the expectation that essential services, such as Caesarean sections and maternal care, are guaranteed, sudden denials not only impose financial strain but also erode trust in the scheme.
A health economist, Dr. Ifeoma Okonkwo, noted that some of the most vulnerable residents, those who register late in pregnancy or in emergencies, are disproportionately affected.
She said, “Once people realise the benefits they were promised are no longer automatic, the whole idea of prepaid health coverage collapses in practice.
“Telling people they must enroll by a certain date to get full benefits without a proper grandfathering system creates inequity. You end up with families who need immediate care being forced to pay out-of-pocket for services that should have been covered.”
Speaking earlier with our correspondent on the benefits of health insurance, a consultant gynaecologist at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Prof. Ernest Orji, identified out-of-pocket payments as a major factor contributing to the high maternal mortality rate in the country.
According to him, many women die during childbirth because their families are unable to afford the costs associated with delivery.
Orji, who has over 40 years of experience in the medical field, proposed a system of pooled resources, similar to an insurance model, where pregnant women contribute a small fee towards their delivery costs.
This, he noted, could ensure that necessary funds are available for complications, reducing financial barriers to accessing quality maternal care.
He urged the government to prioritise maternal health, suggesting that making delivery free at government hospitals could be a step toward reducing the number of deaths.
He cited the example of a former governor of Ondo State, who successfully implemented a policy of low-cost or free maternity care, attracting women from all over the country.
“The key is early registration and proper preparation for childbirth. If more women access proper medical care early, many of these tragic deaths can be avoided,” he noted.
LASHMA defends policy change
On October 31, when PUNCH Healthwise reached out to the Permanent Secretary of LASHMA, Dr. Emmanuella Zamba, for comments on the development, she requested that questions be sent to her for an official response.
After about five hours without a reply to the sent questions, PUNCH Healthwise made a follow-up call to the Permanent Secretary, who explained that the state’s Ministry of Health was in the process of drafting a formal response, adding that it might take up to a week to finalise.
However, our correspondent informed her that there was an urgent need to obtain a response, as it was crucial to balance the story scheduled for publication within two days.
When pressed further on the reasons behind the policy change and the alleged lack of proper notification to enrollees, Zamba defended the agency’s decision, insisting that adequate announcements were made before the new policy was implemented.
She maintained that the agency followed due process and ensured that information about the changes was disseminated through multiple channels.
According to her, the policy changes, which reportedly affect some aspects of the health insurance benefit package, particularly in areas such as maternal services, were properly communicated to both service providers and the public.
“Of course, we communicated with them. We are a very responsible organisation. It was even posted on social media. It was sent to the providers. There were messages sent. So we will not just come up with a policy overnight and start implementing it,” she said.
Following her comments, our correspondent contacted all the enrollees interviewed earlier to verify the claim that they had been duly informed of the policy change. Responding, all the respondents respectively maintained that they did not receive any message or official notification from LASHMA regarding the new policy.
Similarly, some healthcare providers who spoke with PUNCH Healthwise on the condition of anonymity also confirmed that there was no clear or formal communication to them from the agency about the policy changes before implementation.
Responding to some of the other complaints raised, Zamba explained that part of the misunderstanding often arises from enrollees’ limited attention to policy details of their benefit packages.
She stressed that the agency consistently informs subscribers about changes, but that many fail to pay attention to important information.
“Let’s just be clear on one thing. Many customers, when they come and buy, they will not always ask for all the details. And even when you explain the details to them, part of it goes away. That’s part of the problem that we have always had. It is not about us not explaining,” she said.
The Permanent Secretary, however, acknowledged that it was necessary to properly explain the policy shift with data, saying she had directed the Director of Public Relations for the state’s Ministry of Health, Olatunbosun Ogunbanwo, to compile relevant figures that would explain the rationale behind the change.
She noted that LASHMA was open to clarifying any misconceptions and ensuring that the public was adequately informed.
At about 7:24 p.m. on October 31, Ogunbanwo also contacted our correspondent, explaining that LASHMA was in the process of drafting a detailed response on the issue.
When informed of the urgency and the need to have the response before the weekend, he said he would reach out to the Permanent Secretary to see how they could expedite the process and ensure the agency’s position was communicated as soon as possible.
Copyright PUNCH
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten, or redistributed in whole or in part without prior express written permission from PUNCH.
Contact: [email protected]
