Towards universal coverage: a policy analysis of the development of the National Health Insurance Scheme in Nigeria

This article examines why and how a national health insurance (NHI) proposal targeting universal health coverage (UHC) in Nigeria developed over time. The study involved document reviews, in-depth interviews, a further review of preliminary analysis by relevant actors and use of a stakeholder analysis approach. The need for strategies to improve healthcare funding during the economic recession of the 1980s stimulated the proposal. The inclusion of Health Maintenance Organizations (HMOs) as financing organizations for national health insurance at the expense of sub-national (state) government mechanisms increased credibility of policy implementation but resulted in loss of support from states. The most successful period of the policy process occurred when a new minister of health (strongly supported by the president that displayed interest in UHC) provided leadership through the Federal Ministry of Health (FMOH), and effectively managed stakeholders’ interests and galvanized their support to advance the policy. Later, the National Health Insurance Scheme (the federal government’s implementing/regulatory agency) assumed this leadership role but has been unable to extend coverage in a significant way. Nigeria’s experience shows that where political leaders are interested in a UHC-related proposal, the strong political leadership they provide considerably enhances the pace of the policy process. However, public officials should carefully guide policymaking proce...
Source: Health Policy and Planning - Category: Health Management Authors: Tags: Original articles Source Type: research