UNIVERSAL HEALTH COVERAGE IN NIGERIA: THE NHIA ACT AND SDG 3

Abstract

Universal Health Coverage sits at the heart of Sustainable Development Goal 3, which requires states to secure access to quality healthcare without financial hardship. Nigeria’s National Health Insurance Authority Act 2022 replaced the weak framework of the former National Health Insurance Scheme with mandatory participation, a dedicated fund for vulnerable persons and wider regulatory powers. Four years into implementation, enrolment has reached roughly 22 million people, out-of-pocket payments still account for more than 70 per cent of current health expenditure, and federal health allocations remain near four per cent of the budget. This article appraises the Act against Target 3.8 and finds the legal architecture sounder than anything Nigeria has had before, yet defective in three respects. The compulsion in section 14 is unenforceable in both directions, since no penalty attaches to a resident who fails to enrol and no clear remedy lies for a vulnerable person refused the free cover that section 13(7) requires states to provide. The Vulnerable Group Fund has no independent revenue and leans on a statutory fund created by other legislation. Enforcement content sits in operational guidelines rather than in the statute. Rwanda’s tiered subsidy and Ghana’s arrears crisis supply direct evidence for the second and third of these, and the article sets out what amendment and subsidiary regulation would each need to contain.