Reported by Ariajegbe Sylvia Esezobor
The National Health Insurance Authority has refunded more than N14.2 million to enrollees and suspended nine healthcare facilities following complaints over services provided under the country’s health insurance system, in the most extensive enforcement action yet undertaken by the regulator since the transition from the National Health Insurance Scheme to the NHIA.
The authority also issued 368 warning letters to healthcare providers after resolving 3,878 complaints, according to a statement issued by the agency on Sunday. The disclosure was made by the NHIA Director-General and Chief Executive Officer, Dr Kelechi Ohiri, in Abuja during the inaugural Civil Society Organisation-Led Mid-Year Review of Nigeria’s National Health Sector Reforms. The statement said the NHIA had strengthened patient protection, resolving 3,878 complaints and refunding more than N14.2 million to affected enrollees, while also issuing 368 warning letters and suspending nine healthcare facilities.
The complaints that triggered the refunds and sanctions centred on the most fundamental failures in the patient-provider relationship: unavailability of medicines, denial of services, demands for out-of-pocket payments for services already covered by insurance, and failure to provide payment explanations. Complaints against Health Maintenance Organisations included delays or denial of referral authorisation codes, delays in settling agreed reconciled payments and inadequate monitoring of quality assurance at healthcare facilities. For thousands of enrollees, the insurance card that was supposed to open the door to treatment instead became a source of frustration, with patients caught between hospitals and HMOs over what should be covered, how much should be paid and who should approve a treatment.
The figures represent a marked escalation in enforcement compared with the previous year. The authority’s 2024 complaints report, released in 2025, showed that it handled 3,507 complaints during the year, with 2,273 lodged against healthcare facilities and 1,232 against HMOs. Of the total, 2,929 complaints, representing 84 per cent, were resolved. Four healthcare facilities were suspended and six were delisted following investigations, while 35 HMOs received warning letters and corrective-action directives. In all, 54 enrollees received N4.38 million in refunds from 39 healthcare facilities, while 12 HMOs were directed to refund N748,200 to 15 enrollees. The latest figures show the authority has resolved 3,878 complaints with an 87 per cent resolution rate, with 95 per cent concluded within prescribed timelines. “We have moved from policy and legislation to measurable implementation,” Ohiri said in the statement. “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”.
The enforcement measures were accompanied by the deployment of inspection teams to healthcare facilities to monitor compliance with the NHIA’s one-hour treatment authorisation policy and other patient-protection and quality-of-care requirements. Under the policy, treatment for enrollees requiring urgent care must commence within one hour of arrival. The authority has also deployed compliance officers to accredited healthcare facilities as part of efforts to strengthen regulatory oversight, improve service delivery and protect enrollees from illegal charges and denial of healthcare services. The compliance officers are tasked with preventing delay or denial of approved services, stopping illegal out-of-pocket payments, ensuring the availability of medicines and consumables, and reporting compliance issues for necessary action. They do not interfere with clinical decision-making, according to the NHIA.
The refunds and sanctions come as national health insurance enrolment increased from about 16 million at the beginning of the current administration to more than 23 million, representing a 35 per cent year-on-year growth. More than 2.7 million poor and vulnerable Nigerians have also received support through the Basic Health Care Provision Fund. The NHIA said recent reforms had resulted in a 93 per cent increase in capitation payments and a 378 per cent rise in fee-for-service reimbursements, measures designed to enable providers to invest in personnel, equipment and infrastructure while delivering better care to patients. More than 7,500 healthcare facilities have undergone digital assessment under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement across the country.
The authority also announced significant progress in the coverage of cancer treatment and other critical health services. Under a cost-sharing partnership with pharmaceutical company Roche for selected oncology medicines, Roche covers 50 per cent of the cost, the NHIA bears 30 per cent, while patients pay 20 per cent. Eligible radiotherapy patients can receive financial support ranging from N400,000 to full coverage, and other covered cancer services include mammography, CT and MRI scans, bone scans, diagnostic tests and radiotherapy. “For us, coverage has to mean something when people become ill. Cancer is one of the clearest examples of why health insurance matters,” Ohiri said. More than 51,000 people have been covered under the NHIA’s HIV and tuberculosis programme across Anambra, Ebonyi, Gombe and Kwara states as of September 3, 2026, and the authority has begun accrediting more than 2,000 healthcare facilities ahead of a planned nationwide expansion of HIV/AIDS and TB coverage in 2027. In maternal and newborn healthcare, NHIA interventions have reached more than 93,000 women and newborns, including 79,221 women, 7,500 newborns and 6,044 women treated for fistula, with case fatality at participating maternal health facilities declining by 22 per cent from 1,042 in the 2024 baseline to 810 as of August 2026.
Despite the expansion, Ohiri acknowledged that most Nigerians remained outside the health insurance system. Nigeria’s health insurance coverage, at roughly 23 million out of a population exceeding 200 million, remains among the lowest in Africa, and the authority has said universal health coverage can only be achieved if every Nigerian, regardless of income or location, has access to quality healthcare services. The enforcement actions disclosed on Sunday are designed to address a persistent gap between coverage and actual access to care. For the thousands of enrollees who filed complaints, the refunds represent a measure of redress. For the suspended facilities and warned providers, the actions signal that the NHIA intends to enforce the standards it has set. Whether those standards will translate into a system where an insurance card reliably opens the door to timely, quality care remains the central test of the authority’s reform agenda.
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