Edino Chubiyo Cornelius 
ABUJA, Nigeria – For millions of Nigerians, getting sick is not just a health emergency—it is a financial one. A hospital visit can mean borrowing money, selling family belongings, withdrawing children from school or delaying treatment because the cost is simply unaffordable. Although Nigeria has recorded a steady rise in health insurance enrolment, the vast majority of citizens still pay for healthcare directly from their own pockets, leaving them vulnerable to financial hardship whenever illness strikes. In this report, Edino Cornelius examines why millions of Nigerians remain outside the health insurance system, the barriers preventing wider coverage, and what must change if the country is to achieve universal health coverage and protect families from being pushed into poverty by the cost of healthcare.
Health Insurance Is Growing, But So Is the Coverage Gap
According to the NHIA, 22.03 million Nigerians are now enrolled in one health insurance scheme or another, representing a 35 per cent increase over the previous year.
While the growth marks significant progress, it also reveals the scale of the challenge ahead. With Nigeria’s population exceeding 200 million, the overwhelming majority of citizens still pay for healthcare directly from their own pockets whenever they fall ill.
Earlier NHIA data showed that 21.73 million people were enrolled by the end of the fourth quarter of 2025. The latest figures indicate continued progress in 2026, but experts say enrolment alone does not guarantee access to affordable healthcare.
When Illness Becomes a Financial Emergency
For many Nigerians, especially those working in the informal sector, health insurance remains out of reach.
Aisha Ibrahim, a trader, said daily survival often takes priority over planning for medical emergencies.
“I know health insurance is important, but there are many things I have to provide for with the little money I make. When someone falls sick, we normally look for money at that particular time. If there was a simple and affordable way for traders like us to register, I would be interested.”
Like many traders, Aisha earns an irregular income, making it difficult to commit to regular insurance contributions even when she understands the benefits.
One Illness Can Mean Two Losses
For commercial driver Musa Abdullahi, sickness does not only bring medical expenses—it also stops his income.
“When I don’t work, I don’t earn. So, when I become sick, it becomes difficult because I need money for treatment and I am also losing income. Most times, I depend on relatives or friends. I will prefer to have insurance if I know exactly how it works and what it covers.”
His experience reflects the reality faced by millions of self-employed Nigerians, whose livelihoods depend on working every day.
Awareness Remains Low in Rural Communities
Even where health insurance schemes exist, many people still know little about them.
Grace Okoro, a farmer, said misconceptions continue to discourage enrolment.
“People have heard about health insurance, but many don’t know where to register or what they will get after registration. Some people also believe it is mainly for government workers. More people need to be educated about the schemes available to them.”
Public health experts say limited awareness remains one of the biggest barriers to expanding coverage, particularly in rural communities.
NHIA Says Reforms Are Expanding Coverage
The NHIA attributes the increase in enrolment to stronger collaboration with State Social Health Insurance Agencies, organised labour, employers, government institutions and private-sector partners.
NHIA Director-General, Dr. Kelechi Ohiri said the country was moving beyond policy discussions towards practical implementation of health insurance reforms.
The agency also stressed that expanding enrollment must go hand in hand with improving healthcare quality, access to services and consumer protection if Nigerians are to fully trust the system.
Building Trust Is as Important as Expanding Numbers
Former Director-General of the Plateau State Contributory Healthcare Management Agency, Dr. Jemchang Yildam Fabong, believes winning the confidence of informal-sector workers will determine the future success of health insurance.
According to him, many Nigerians are reluctant to join insurance schemes because they are uncertain whether they will actually receive quality healthcare when they need it.
Without public trust, he argued, enrolment targets will remain difficult to achieve.
Making Health Insurance Easier to Access
Public health researcher Dr Ibrahim Danjuma believes registration must become simpler and more accessible.
“The government needs to take registration closer to the people. Traders should be able to get information in markets, drivers in motor parks and farmers in their communities. The process should be simple enough for someone without a lot of education to understand.”
He said reducing administrative barriers would encourage more Nigerians to participate.
Leaving No One Behind
Disability rights advocate Maryam Yusuf said expanding coverage must also mean making healthcare accessible to vulnerable groups.
“Registration is only the first step. People living with disabilities and other vulnerable Nigerians need to know that they can actually access the services they are entitled to. Facilities must also be accessible and the treatment available when they arrive.”
She argued that universal health coverage should focus not only on enrolment figures but also on whether people can receive quality care without discrimination.
Beyond the Numbers
Nigeria’s rise to 22.03 million health insurance enrollees represents important progress, but it also highlights the magnitude of the challenge ahead. In a country of more than 230 million people, according to the World Bank estimation, the vast majority of citizens still lack health insurance and remain exposed to the financial shock of illness.
For millions of households, falling sick can still mean borrowing money, selling assets, withdrawing children from school or delaying treatment because they simply cannot afford care. As long as healthcare depends largely on out-of-pocket payments, illness will continue to push vulnerable families deeper into poverty.
Expanding coverage will require more than increasing enrolment figures. It demands greater public awareness, easier registration, stronger primary healthcare, improved service delivery and sustained investment in a system that people can trust.
Health experts also argue that Nigeria’s pursuit of Universal Health Coverage (UHC) will remain incomplete without ensuring that every resident is protected, regardless of income, occupation or place of residence. A mandatory national health insurance system, backed by adequate government funding for poor and vulnerable populations, would spread health risks more equitably, reduce catastrophic medical spending and move the country closer to healthcare as a right rather than a privilege.
For a nation of more than 230 million people, universal health coverage cannot remain an aspiration for a few. It must become a guarantee for all. Until that happens, millions of Nigerians will remain just one illness away from poverty.
About the Author
Oluwatobi Adu 
Oluwafunbi Bello 
Mirian Gom 
Korede Abdullah