The National Health Insurance Authority has suspended nine healthcare facilities and refunded more than ₦14.2 million to affected enrollees following complaints over services provided under Nigeria’s health insurance system.
The Authority also issued 368 warning letters to healthcare providers after resolving 3,878 complaints, as part of measures aimed at strengthening patient protection, enforcing service standards and holding providers accountable for breaches affecting insured Nigerians.
The Director-General and Chief Executive Officer of the NHIA, Dr Kelechi Ohiri, disclosed the figures in Abuja during the inaugural Civil Society Organisation-Led Mid-Year Review of Nigeria’s National Health Sector Reforms.
According to the Authority, the enforcement actions followed investigations into complaints lodged by enrollees concerning services received from healthcare providers operating under the national health insurance framework.
“NHIA has strengthened patient protection, resolving 3,878 complaints and refunding more than N14.2m to affected enrollees. It has also issued 368 warning letters and suspended nine healthcare facilities,” the Authority said.
The NHIA did not, in the statement, identify the nine suspended facilities or provide individual details of the infractions that resulted in the sanctions.
Beyond responding to complaints, the Authority said inspection teams had been deployed to healthcare facilities across the country to monitor compliance with patient-protection and quality-of-care requirements.
Particular attention is being paid to compliance with the NHIA’s one-hour treatment authorisation policy, which is intended to prevent prolonged delays in obtaining approval for medical treatment covered by insurance.
The regulatory action comes as the number of Nigerians enrolled in health insurance continues to rise.
According to the NHIA, national health insurance enrolment has increased from about 16 million at the beginning of the current administration to more than 23 million people.
More than 2.7 million poor and vulnerable Nigerians have also received health coverage support through the Basic Health Care Provision Fund.
Ohiri said the challenge facing the Authority had moved beyond simply expanding the number of people registered under health insurance schemes to ensuring that coverage produces tangible benefits when enrollees actually require medical care.
“We have moved from policy and legislation to measurable implementation. The next task is to move from coverage to reliable access, from reliable access to better health outcomes, and from insurance membership to genuine financial protection,” he said.
More than 7,500 healthcare facilities have also undergone digital assessment under the SafeCare quality framework, which is being used to assess service standards and promote continuous quality improvement across participating facilities.
More than 7,500 healthcare facilities have also undergone digital assessment under the SafeCare quality framework, which is being used to assess service standards and promote continuous quality improvement across participating facilities.
The Authority has additionally expanded financial protection for cancer patients, including through a cost-sharing arrangement with pharmaceutical company Roche covering selected oncology medicines.
Under the arrangement, Roche bears 50 per cent of the cost of designated medicines, the NHIA pays 30 per cent, while the patient is responsible for the remaining 20 per cent.
Eligible cancer patients requiring radiotherapy can also receive financial support ranging from ₦400,000 to full coverage, depending on the applicable arrangement.
Other cancer-related services covered under the programme include mammography, CT scans, MRI scans, bone scans, diagnostic investigations and radiotherapy.
Ohiri said the cancer programme illustrates why health insurance must ultimately be judged by the protection it provides when an enrollee becomes seriously ill.