The National Health Insurance Authority (NHIA) has reiterated the urgent need to strengthen actuarial capacity and institutionalise evidence-based policymaking within Nigeria’s healthcare financing landscape, as the country grapples with declining donor support and mounting pressures on its public health system.
Speaking at the recently held Nigerian Actuarial Society (NAS) conference, Kelechi Ohiri, director general of the NHIA, underscored the centrality of actuarial expertise in designing and sustaining financially viable health insurance schemes that can withstand long-term fiscal pressures. “Ohiri noted, ‘One of the critical things I want to highlight is the need for evidence to inform our decisions and policies. A lot of that evidence was lacking, particularly because we didn’t have actuaries in-house to do many of the things we needed to do.’”
He explained that prior to his appointment, the last time Nigeria’s health insurance tariffs, capitation, and service fees were reviewed was in 2011—a 14-year gap that created outdated pricing structures and growing discontent among providers. The NHIA, under his leadership, embarked on a comprehensive evidence-based review which resulted in the revision of capitation rates from ₦750 to ₦1,450 and a 378 percent increase in fee-for-service payments.
These revisions, he said, averted a brewing crisis in the health sector. “We calmed the crisis by engaging stakeholders—providers, HMOs, and others—openly and transparently, presenting the data as it was. It wasn’t manipulated. With that transparency, we earned the legitimacy to enforce better compliance.”
Highlighting a broader shift in global development assistance, Ohiri pointed out that donor funding particularly from USAID and other development finance institutions—has drastically reduced. This has left Nigeria to fill a growing financing gap in its health sector.
“That era is over. USAID is practically non-existent in terms of supporting countries now. This has created a huge gap. People who were previously on treatment were suddenly off it because donors pulled the plug,” Ohiri revealed.
To bridge the sudden financing gap, the federal government had to intervene with a ₦200 million emergency fund to sustain critical treatment programmes and absorb affected healthcare workers. While such interventions offer short-term relief, Ohiri warned that Nigeria must now shift its focus to long-term sustainability.
“In the medium to long term, we must rethink how we finance healthcare in Nigeria. We need to consider how we integrate more services into the health insurance benefit package, leverage existing risk pools, and create a sustainable financing structure,” he noted.
Emphasising the strategic role of actuaries in this transition, Ohiri outlined how actuarial collaborations have helped the NHIA in key areas such as product design, pricing, financial modelling, and policy guidance.
“Actuaries worked closely with us in developing and pricing health insurance products, modelling future costs, and analysing market trends—particularly in medications. They also supported us in ensuring we had the right data to inform our policy and decision-making,” he said.
Looking ahead, he identified four priority areas where actuarial expertise will be critical to the authority’s mandate: strengthening data collection and modelling; designing insurance products with appropriate pricing; supporting regulatory oversight and solvency standards; and building capacity across the ecosystem.
“It was painful going through the first round of actuarial work because of the paucity of data. In some cases, we didn’t even know the right format or type of data to collect. But with the aid of technology and tools like AI, we believe capacity in modelling will improve significantly,” Ohiri stated.
The enactment of the NHIA Act in 2022 marked a turning point for the agency, transforming it from merely a health insurance scheme operator into the apex regulator for health insurance in Nigeria. The law mandates the NHIA to bring all stakeholders—public and private—under a unified regulatory framework, paving the way for a more integrated, transparent, and accountable ecosystem.
With these expanded responsibilities, Ohiri emphasised the need for deeper partnerships and strategic reforms. “We need the right data, sound models, and expert projections on the long-term fiscal sustainability of our plans,” he said.
He also noted the need to embed a health insurance culture that reflects Nigeria’s demographic and epidemiological realities. “We are at a point where we can tap into what I call the ‘health insurance dividend,’” he said. “We don’t have an aging population that consumes all the healthcare resources. We have a young population. If we expand coverage now, we can afford much more than we will be able to decades from now.”
According to Ohiri, delaying reforms until the country’s population ages will place Nigeria on the same unsustainable path that many developed countries are now grappling with.
The NHIA DG further stressed the importance of strengthening regulatory oversight to ensure solvency and integrity in health insurance operations. This includes refining capital requirements, actuarial standards of practice, and creating a principles-based regulatory framework to replace what he described as a previously “wild west” health insurance environment.
“There are some health insurance organisations doing the right thing, but many have a lot to learn. We want to bring order and professionalism through better regulatory guidance,” Ohiri said.
He also called for a more intentional approach to professional development, both within NHIA and across the 37 sub-national health insurance schemes and Health Maintenance Organisations (HMOs). “Do we start with students? Do we facilitate secondments and joint projects between NHIA and institutions? We need to collaborate more on capacity building,” he said.
The goal, according to him, is to ensure that future policy decisions are anchored in robust evidence—not executive fiat or emotion. “Advocacy is important, but it must be balanced with data. The more experts we have who can support this, the stronger our industry becomes, and the more Nigerians we can cover.”
Ohiri also highlighted the need to correct a structural imbalance in Nigeria’s health insurance evolution, which he said has leaned heavily toward the health side, with little attention to core insurance principles.
“We’ve come at it from more health and less insurance,” he observed, adding “But the right balance needs to be struck. This is not about more health or more insurance—it’s about getting it right.”
He argued that Nigeria must also make the health insurance sector more attractive to actuaries and actuarial science students. “It does affect all of us, and it’s critical. If we build this together, it will contribute to Nigeria’s goal of achieving universal health coverage.”
Additionally, Ohiri urged stakeholders not to leave health policy decisions solely in the hands of medical professionals, stating,“Health is too important to leave in the hands of just doctors. We must lean in and ensure that the policies affecting us are grounded in solid evidence.”
He warned that the old model of paying for healthcare at the point of illness is no longer sustainable. “That era should be over. It is regressive. We must begin to think of better models for financial protection, and health insurance offers that. Let us collaborate more to ensure Nigerians have access to better care,” he said.
