Historical development, legal framework, and institutional structure of National Health Insurance Scheme in Nigeria.

Abstract

The National Health Insurance Scheme (NHIS) in Nigeria was established to provide financial risk protection and improve healthcare accessibility. Despite its potential, the scheme faces persistent challenges such as low enrollment, weak regulatory enforcement, financial instability, and administrative inefficiencies. This study critically examines the policy and institutional framework of NHIS, tracing its historical evolution, governance structure, and operational mechanisms. A comparative analysis with international models, particularly Ghana’s NHIS, highlights key policy gaps and best practices that Nigeria can adopt. The findings reveal that the voluntary nature of NHIS enrollment has significantly limited participation, while inconsistent government funding and poor regulatory oversight have affected financial sustainability and service delivery. Additionally, bureaucratic bottlenecks, weak accountability measures, and inefficiencies in fund management have further hindered NHIS effectiveness. To address these challenges, the study recommends mandatory enrollment, strengthened regulatory enforcement, diversified funding sources, and improved transparency in fund allocation and utilization. Expanding public awareness and leveraging digital health technologies can enhance efficiency and service delivery. By implementing these reforms, NHIS can achieve its intended goal of providing equitable and sustainable healthcare financing, ultimately moving Nigeria closer to universal health coverage. The study contributes to existing literature on healthcare financing and policy development, offering insights for policymakers and stakeholders to enhance NHIS efficiency and sustainability.