Health insurance complaints trigger N14m refunds, nine hospitals suspensions – NHIA

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.

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 agency’s Director-General and Chief Executive Officer, Dr Kelechi Ohiri, disclosed this in Abuja during the inaugural Civil Society Organisation-Led Mid-Year Review of Nigeria’s National Health Sector Reforms.

The statement said, “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.”

It also said inspection teams had been deployed to healthcare facilities to monitor compliance with its one-hour treatment authorisation policy and other patient-protection and quality-of-care requirements.

The enforcement measures came as national health insurance enrolment increased from about 16m at the beginning of the current administration to more than 23m.

More than 2.7m poor and vulnerable Nigerians have also received support through the Basic Health Care Provision Fund.

Ohiri said the authority was moving beyond policy and legislation towards ensuring that insurance coverage translated into access to healthcare and financial protection.

“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 in the statement.

The NHIA said recent reforms had resulted in a 93 per cent increase in capitation and a 378 per cent rise in fee-for-service reimbursements, while more than 7,500 healthcare facilities had undergone digital assessment under the SafeCare quality framework.

The authority also expanded support for cancer patients through a cost-sharing partnership with pharmaceutical company Roche for selected oncology medicines.

Under the arrangement, Roche covers 50 per cent of the cost, the NHIA bears 30 per cent, while patients pay 20 per cent.

Eligible radiotherapy patients can also receive financial support ranging from N400,000 to full coverage. 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.

The authority also said more than 51,000 people had been covered under its HIV and tuberculosis programme across Anambra, Ebonyi, Gombe and Kwara states as of September 3, 2026.

They include more than 38,000 people living with HIV, over 7,400 drug-sensitive TB patients and 594 drug-resistant TB patients.

The NHIA has also 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, the authority said its interventions had reached more than 93,000 women and newborns, including 79,221 women, 7,500 newborns and 6,044 women treated for fistula.

It added that case fatality at participating maternal health facilities declined 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.

“We have made substantial progress, but we are not where we need to be. Over 23 million Nigerians covered is significant, but it also tells us that there are many more Nigerians who are still outside the system,” Ohiri said.