In Nigeria, falling sick can be expensive for many as it is frightening. 75% to over 90% still pay for healthcare out-of-pocket, making it a significant financial burden for most families. Yet, there’s a system designed to prevent that financial shock: the National Health Insurance Authority. Over the past decade, the federal government has expanded coverage through this scheme, enrolling more than 20 million people nationwide. Still, many Nigerians don’t realise they’re entitled to subsidised care, or do not know how to access it.
This article explores how health insurance works in Nigeria, narrowing down to how it functions within the University of Ibadan and the University College Hospital (UCH). It examines why such an important safety net remains overlooked, what students actually gain from it often without realising and how understanding and properly using this system could make healthcare more accessible, affordable, and efficient for all.
Health insurance in Nigeria can be broadly classified, like anywhere else, into public and private systems. Each category serves different population groups and operates through distinct mechanisms of enrollment, funding, and service delivery.
Public health insurance
The public health insurance system in Nigeria is primarily overseen by the National Health Insurance Authority (NHIA), formerly known as the National Health Insurance Scheme (NHIS). The NHIA operates under the 2022 Act, which makes health insurance mandatory for all Nigerians. It offers several programmes targeted at different population groups:
The Formal Sector Health Insurance Programme (FSHIP) caters to employees in the public and organised private sectors. Enrollment is typically done through employers, with contributions shared between employers and employees. Beneficiaries, including the employee’s spouse and up to four children, enjoy coverage for consultations, hospital admissions, maternity services, preventive care and essential medications at accredited facilities.
For those outside formal employment, the Informal Sector Social Health Insurance Programme (ISSHIP) provides coverage for self-employed individuals. People can register individually or as a part of groups such as cooperatives or market associations through accredited Health Maintenance Organisations (HMOs). The package generally covers primary care, laboratory tests, treatment of common ailments, and emergency referrals with affordable flat-rate premiums depending on the chosen plan.
Students of tertiary institutions are covered under the Tertiary Institution Social Health Insurance Programme (TISHIP), which gives them access to subsidised healthcare services through their school clinics. For instance, the University of Ibadan’s Jaja clinic runs under this scheme, offering outpatient consultations, basic laboratory tests, and referrals to higher-level facilities like the University College Hospital. Similarly, individuals not captured under any organised scheme can voluntarily enrol in the Voluntary Contributors Social Health Insurance Programme (VCSHIP), now known as the Vital Contributor Social Health Insurance Programme (VCHIP), where they pay premiums directly to an HMO and receive flexible coverage based on their contribution level.
To ensure that the poor and vulnerable are not left out, the NHIA also operates the Vulnerable Group Fund (VGF), which provides free or highly subsidised healthcare for children under five, pregnant women, the elderly, persons with disabilities, and the indigent. This initiative, supported by government and development partners, focuses on essential services such as maternal and child health, immunisation, and chronic disease management. Complementing these national efforts are the State Health Insurance Schemes (SHIS), now active in many states like Lagos, Oyo, and Kano. These schemes allow residents to pay modest annual premiums for access to accredited hospitals and locally tailored health packages.
Private health insurance
Private health insurance is offered mainly through HMOs and Community-Based Health Insurance (CBIH) schemes. Private companies such as AXA Mansard, Hygeia HMO, Reliance HMO, and Leadway Health provide different plans for individuals, families, and corporate clients. Coverage varies according to plan level and may include consultations, diagnostics, emergency care, maternity services, and hospitalisation. CBHI schemes target low-income and rural populations who are often excluded from formal insurance. They are typically organised by community groups, cooperatives, or NGOs and operate on a solidarity basis, where members contribute small premiums to access basic primary healthcare and referral services.
These plans generally offer more flexibility and broader service options, including access to high-end private hospitals, shorter waiting times, and, in some cases, more comfortable amenities. They are particularly attractive to middle- and upper-income earners, as well as corporations that include health insurance as part of their employee welfare packages.
However, private health insurance remains largely inaccessible to most Nigerians. The cost of premiums, often ranging from ₦30,000 to over ₦200,000 per person annually, places it beyond the reach of low-income earners and those in the informal sector. Because of this, less than 5% of Nigerians are estimated to have private coverage, compared to roughly 10–15% enrolled under public or state schemes, while the majority of citizens still pay for healthcare out of pocket.
Still, private insurance holds an important place within Nigeria’s health system. It serves as an alternative for those who can afford it and provides a model for service quality and responsiveness that public schemes can learn from. In the broader picture, while public insurance remains the main vehicle for achieving universal health coverage, private plans complement it by expanding options for specialised or higher-tier services.
Issues
In one survey of NYSC members, 98.5% reported having heard about NHIS, but only 48.5% had adequate knowledge. Similarly, health workers enrolled in a federal facility in Niger state all had awareness, but fewer than half truly understood how the system worked, and just 22.8% used it regularly. Users often complain of drug stockouts at accredited facilities, forcing them to purchase medicines out of pocket. Delays in registration, referral processing, and questions about the quality of services further discourage full participation.
For university students, health insurance is unrecognised. Many subconsciously recognise it when they receive free treatment at campus health centres like Jaja Clinic, yet few stop to consider how it is made possible or how much they actually save through it. Only when referred to tertiary hospitals such as UCH do some begin to realise the real cost that the insurance offsets. Others, never having faced major illness or referral, remain unaware of its financial and practical value.
This gap between experience and understanding is precisely what the Tertiary Institutions’ Social Health Insurance Programme (TISHIP) seeks to address: making health insurance not just available to students, but meaningful, accessible, and better understood
TISHIP
Designed to extend health coverage to students in tertiary institutions, the Tertiary Institutions’ Social Health Insurance Programme (TISHIP) operates under the broader NHIS framework and ensures that students have access to basic healthcare services at no direct cost whenever they visit their campus clinics.
At the University of Ibadan, TISHIP is implemented through Jaja Clinic, which serves as the primary health centre for students. The clinic offers free consultations, laboratory investigations, and a range of drugs to enrolled students, all covered under the TISHIP plan. This is the most visible form of health insurance they experience, though few realise that these services are the direct result of the contributions embedded within their school fees.
The program also facilitates referrals to the University College Hospital (UCH) when cases require specialised attention. In such instances, the costs of consultations, diagnostic tests, and even surgical procedures are either fully covered or heavily subsidised under the NHIS framework. To appreciate the true value, one only needs to compare: what a private hospital might charge for a single specialist consultation or diagnostic scan could amount to tens of thousands of naira, yet under TISHIP, students receive the same at a fraction of that cost or completely free.
Beyond routine consultations, Jaja Clinic hosts a range of specialist clinics where doctors from UCH are delegated to attend to students and staff on specific days. These include the Eye Clinic, Dental Clinic, Mental Health Clinic, Asthma/chest Clinic, Gynaecology Clinic, and Orthopaedic Clinic, among others. Students often walk into these sessions without realising they are being seen by specialists whose private consultations elsewhere would cost significantly more.
A brief survey conducted by the press among University of Ibadan students further reflects this gap in awareness. Only one in five respondents knew that they are covered under a student health insurance scheme. When reminded of Jaja Clinic, many recognised it as their campus health centre but none were aware that the insurance coverage extends to the University College Hospital (UCH).
When asked where they would seek treatment if they ever needed hospital care, most initially said they would go to private hospitals, citing proximity or perceived quality. However, after considering the costs involved, about half said they would rather visit UCH, once informed that their student insurance could significantly reduce their expenses there.
Interestingly, only one respondent had any form of private health insurance, and that individual’s awareness stemmed from having a family member working within the insurance sector. This suggests that, without external exposure, most students remain unaware of the existence, scope, or advantages of the coverage they already pay for through their school fees.
Students experience its benefits—free consultations, subsidised drugs, and specialist access—without realising these are insurance provisions. As a result, the full value of TISHIP remains underappreciated, even by those who benefit most from it.
Why it’s overlooked
Part of the problem lies in communication gaps. Neither tertiary institutions nor student unions have done enough to educate students on how the program actually works, what it covers, how to navigate referrals, or how to address service lapses. The result is a cycle of quiet ignorance: students encounter inconveniences, assume that’s just how the system works, and stop engaging with it altogether.
Another reason is perception. Some students distrust the clinic’s efficiency, citing long waiting times, poor service delivery, or frequent drug shortages. While these complaints are not unfounded, they often stem from misunderstanding the process rather than the failure of the scheme itself. For instance, when a drug is out of stock at the clinic, students have to buy it from the external pharmacy, overlooking the fact that they would have had to do so without the privilege of the scheme, that is, after paying for their initial consultation and laboratory tests.
Impact and cost coverage
To understand the quiet impact of TISHIP, it helps to compare what students actually pay under the program versus what they would spend out of pocket.
A consultation at a private hospital in Ibadan typically costs around ₦5,000, while specialist consultations can range from ₦15,000 to over ₦30,000 or more, depending on the speciality and hospital. Fees are influenced by the hospital’s location and the specific type of specialist, with some facilities offering package prices or higher rates for express or emergency services. Patients have to be aware of other charges as well, such as registration fees, annual renewal fees, and fees for any diagnostic tests or procedures performed during the visit. At Jaja Clinic, the same service is free for students enrolled under TISHIP.
Similarly, basic laboratory tests such as malaria, urinalysis, or full blood count cost ₦3,000 to ₦7,000, with increasing costs for more complex profiles or specialised tests. Under TISHIP, these are fully covered or heavily subsidised, depending on the test.
Beyond saving students money, TISHIP quietly reduces the financial stress of unexpected illness, allowing students to access care early instead of delaying treatment for lack of funds. The program turns what could have been a financial emergency into an affordable or cost-free experience.
Beyond students: the broader picture
The usefulness of health insurance extends far beyond university campuses. Across Nigeria, civil servants and federal employees enrolled under the National Health Insurance Scheme benefit from coverage. For many, this means the difference between receiving timely medical care and postponing treatment due to cost.
This is partly why hospitals like University College Hospital (UCH) continue to see a steady influx of patients. It’s not only because public hospitals are cheaper than private ones, but also because many Nigerians actively use their NHIS coverage there. The system, in principle, works, reducing direct costs and expanding access to quality care.
However, real-world execution is less seamless, with patients often encountering delays and bureaucracy. At major hospitals, long queues, paperwork backlogs, and limited manpower create frustrating experiences for both patients and health workers. There are simply not enough doctors or administrative staff to meet the growing number of insured patients seeking affordable care.
The documentation process itself can also be cumbersome. For example, patients needing insured laboratory tests at UCH must go through a series of steps: obtaining forms, getting them stamped and signed, making photocopies, and submitting them several days in advance to process an authorisation code before they can proceed with the test. This time-consuming system, though designed to ensure accountability, often discourages patients who would otherwise rely on their insurance, pushing them to pay out-of-pocket for convenience.
These are important lapses that point to the need for reform. Streamlined processes, digital verification, and better public education could make the system smoother and more transparent. Beyond infrastructure, consistent communication through orientation programs, student unions, and staff networks would help Nigerians understand not just that they are insured, but how to fully benefit from it.
Call to action: making the most of it
For all its challenges, TISHIP works best when students know how to use it. At the University College Hospital, the NHIS Service Desk is located down the hall from the entrance of the General Outpatient Department (GOP) and is where students can process their insurance documents, make enquiries, and confirm referrals.
Students can use their NHIA insurance even when they are away from school, provided they visit an NHIA-approved health facility. Before seeking treatment, it’s important to confirm that the hospital or clinic is accredited by the National Health Insurance Authority or the State Social Health Insurance Agency. For planned visits, students should inform the NHIA office in advance or soon after receiving care. In emergencies, they must report to the nearest NHIA or SSHIA office within 48 hours to ensure coverage. They should also obtain and present their student insurance or TISHIP identification card at the new facility and complete any necessary documentation. This process helps confirm eligibility and ensures the bills are processed correctly under the scheme.
However, students should be aware of certain limitations. Delays can occur if referral documents are incomplete or submitted late, and some treatments or drugs might not be fully covered, especially in private hospitals. In such cases, students may need to pay part of the costs out of pocket.
Across Ibadan, several NHIS-accredited hospitals accept referred patients under this scheme. Among them are Highland Specialist Hospital, Molly Specialist Hospital, LAD Medical Centre, and St. Mary’s General Hospital, Eleta—all listed by the NHIA as accredited providers. For instance, Molly Specialist Hospital operates an NHIS-approved laboratory, allowing insured patients to run tests at subsidised rates, while Highland Specialist Hospital’s accreditation extends to specialist consultations. In principle, this means that a student referred from Jaja can access these services without paying full private hospital fees.
Students are encouraged to ask questions about what their insurance covers to understand where their contributions go and how to make those contributions work for them. The responsibility, however, does not lie with students alone. The university administration and student unions must play active roles in promoting awareness through orientations, campaigns, and regular reminders. Better communication can turn an underused system into a lifesaving one. Similarly, advocating for improved pharmacy supply chains and smoother referral systems will ensure that the insurance works as intended.
Ultimately, health insurance is not charity, but a right already paid for, through fees in the case of students. The more students understand and use it, the stronger the case becomes for improving it.