Nigeria’s quest to achieve Universal Health Coverage is being slowed by weak enforcement of health insurance regulations and poor compliance by some healthcare providers, the Managing Director and Chief Executive Officer of SUNU Health Nigeria Limited, Dr. Moyosore Olomola, has said.
Olomola said despite significant reforms introduced by the National Health Insurance Authority, operational bottlenecks and the conduct of some healthcare providers continue to undermine public confidence in the health insurance system and slow enrolment.
Speaking with our correspondent following an engagement with the Chairman of the House of Representatives Committee on Health Services on Friday, the SUNU Health boss said the meeting focused on practical measures to accelerate health insurance coverage across the country.
“Our meeting with the Chairman was purposeful and frank. We came with some specific areas of concern that we believe are directly responsible for the slow pace of health insurance expansion in Nigeria,” he said.
According to him, while the NHIA has demonstrated commitment to expanding health insurance through reforms such as the 2025 tariff review, implementation challenges continue to prevent those reforms from delivering the desired impact.
“I want to be clear, the NHIA under its current leadership has shown a genuine commitment to expanding coverage, and the 2025 tariff reforms alone reflect a level of regulatory boldness that the industry had been waiting years to see. The groundwork has been laid.
“Our concern is that structural and operational bottlenecks on the ground are preventing that policy ambition from translating into enrolment numbers at the pace Nigeria needs.”
Olomola said discussions with lawmakers highlighted funding gaps, inadequate premium structures for informal sector workers, uneven commitment by state governments and persistent provider practices that discourage Nigerians from trusting the health insurance system.
He described the conduct of some healthcare providers as one of the biggest threats to expanding health insurance coverage.
“Perhaps our most urgent concern was provider behaviour at the point of care. Providers are going outside regulatory controls to deny services to enrolled beneficiaries and demand huge financial deposits from HMOs as a condition of rendering care.
“When an enrollee arrives at a hospital and is turned away or made to pay out of pocket despite being on a valid scheme, it destroys trust in the entire system.”
He urged the National Assembly to support stronger legislation that would empower the NHIA to sanction erring providers through suspension, delisting and public disclosure.
“The organised private sector cannot function if providers operate outside the agreed framework with impunity,” he added.
Speaking on Nigeria’s low health insurance coverage, Olomola argued that the problem was largely structural rather than a lack of public interest.
“The obstacles are structural, not attitudinal. Nigerians value health insurance when the product is accessible, affordable and when claims are settled promptly,” he said.
He commended the NHIA’s target of enrolling 44 million Nigerians by 2030, describing it as ambitious but achievable with the right policy environment.
According to him, the current premium model does not adequately cater to the realities of the informal economy, where nearly 80 per cent of workers earn irregular incomes.
“The NHIA capitation and premium models were essentially designed around the formal salary worker. Approximately 80 per cent of Nigeria’s working population earns income that is irregular, seasonal or cash-based.”
He also identified inadequate access to NHIA-accredited healthcare facilities, particularly in many northern states, as another major barrier to enrolment.
“In many states, particularly in the North, there are simply not enough NHIA-accredited facilities. An enrollee who has to travel two hours to access a benefit they are paying for will not renew.”
To improve coverage among artisans, traders, farmers and other informal sector workers, Olomola said SUNU Health is developing flexible insurance products with weekly premium payments through USSD channels and community-based enrolment models using trade associations, cooperatives, market unions and religious organisations.
He also disclosed that the company is introducing entry-level health plans covering outpatient consultations, essential medicines, malaria treatment and maternal healthcare, while exploring hybrid insurance packages that protect enrollees against catastrophic hospital expenses.
Olomola added that the company’s partnership with telemedicine provider MobiHealth would enable subscribers, especially those in underserved communities, to consult doctors remotely and obtain prescribed medicines through partner pharmacies.
On policy reforms, he called for stronger collaboration between government and private health insurers through predictable tariff review mechanisms, stricter enforcement of compulsory employer enrolment under the NHIA Act, dedicated funding for vulnerable populations through the Basic Health Care Provision Fund and the establishment of a formal dispute resolution mechanism between HMOs and the NHIA.
“The relationship between the NHIA and private HMOs needs a fundamental reset—from a purely regulatory posture to a genuine partnership model,” he said.
He also recommended the creation of a unified national digital health insurance database, greater financial commitment by state governments to health insurance, deployment of community health workers as enrolment agents and faster digital processing of providers’ claims.
“Nigeria has the demographic foundation, the regulatory architecture and a growing political will to achieve Universal Health Coverage. What is needed now is disciplined execution and a private sector that sees itself as a genuine partner in a national health mission.”
Nigeria continues to rely heavily on out-of-pocket payments to finance healthcare, with more than 70 per cent of total health expenditure borne directly by households, according to recent government and international estimates. This has continued to expose millions of Nigerians to catastrophic health spending and limited access to essential healthcare services.
To reverse the trend, the National Health Insurance Authority has intensified efforts to expand health insurance coverage through implementation of the NHIA Act 2022, partnerships with state health insurance agencies, expansion of accredited healthcare providers, revised provider tariffs and ongoing reforms aimed at achieving Universal Health Coverage. The Federal Government has set a target of enrolling 44 million Nigerians into health insurance by 2030 as part of efforts to reduce out-of-pocket healthcare spending and improve access to quality healthcare nationwide.
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