National Health Insurance Authority (NHIA) is targeting evidence-driven reforms to expand health insurance coverage and strengthen financial protection for Nigerians, Director-General of the authority, Dr Kelechi Ohiri, has said.
Ohiri spoke on Monday in Abuja at the inaugural Nigeria Health Finance Research and Learning Forum, themed ‘Evidence and Learning for Nigeria’s Health Financing Future: Building a Locally Led Research and Learning Ecosystem.’
He said the authority was shifting towards locally generated research to guide health financing reforms, arguing that Nigeria could no longer depend mainly on episodic studies designed and commissioned outside the country.
‘For far too long, our health financing initiatives in Nigeria have been shaped by well-meant studies designed, commissioned, analysed, reported, synthesised and presented to us at the finish line,’ Ohiri said.
‘While these studies have provided valuable insights, we have come to understand that episodic research can’t build the enduring policy foundation that is needed in Nigeria to sustain and inform long-term reforms and policies.’
According to him, the new approach would place Nigeria in the driver’s seat in defining its research questions, commissioning studies and embedding learning directly into implementation.
‘Research sovereignty doesn’t mean isolating ourselves from support and partners globally, but rather it means putting Nigeria in the driver’s seat in terms of defining our own questions, pushing to commission our own research, embedding learning directly into implementation, so that context-relevant outputs and outcomes guide policies and implementation,’ he said.
Ohiri said international partnerships remained important, but should support domestic priorities and build Nigeria’s research capacity.
He said the two-day forum would review five NHIA-commissioned studies on embedded learning and examine lessons from health financing experiences in Ethiopia, Ghana and India.
‘This forum is not an academic exercise. It’s not held in isolation. It doesn’t cater to just the researchers, but it’s also one that policymakers can benefit from,’ he said.
‘Evidence must serve reform, and our reform agenda and all the bold things that His Excellency Mr. President is trying to drive in the health sector must be supported and based on evidence that transforms health financing into an economic infrastructure that protects Nigerian households.’
The NHIA boss identified mandatory health insurance coverage, equity, quality of care and sustainability of health insurance as key areas of the authority’s research agenda.
He said the NHIA Act 2022 made health insurance mandatory in Nigeria, adding that the Federal Government had strengthened enforcement by linking valid compliance certificates to the whole-of-government approach.
‘We’ve been able to drive an increase in insurance coverage, but we’re just starting. So, one of the research questions we have is: How do we actually learn more, and how do we accelerate such?’ he said.
Ohiri said expanding coverage must also deliberately target poor and vulnerable Nigerians, stressing that the country’s path to universal health coverage could not depend on benefits eventually reaching disadvantaged groups.
He said the authority was also studying ways to improve quality of care and reduce waiting times for patients.
On the sustainability of health insurance, Ohiri said Nigeria’s health insurance landscape remained highly fragmented, with 37 government health insurance schemes and more than 95 private health insurance companies.
‘That has resulted in a lot of fragmented things that question sustainability. And so one of the areas of our research focus is really how do we enhance the sustainability of health insurance and financial protection,’ he said.
He said every reform being undertaken by the NHIA, including tariff adjustments, digital verification, quality standards, expansion of coverage and targeting of vulnerable groups, required rigorous locally generated evidence.
Ohiri disclosed that the authority had identified 15 studies linked to its strategic priorities and was working with national research institutions, universities and other partners to develop a broader health financing research ecosystem.
He also announced plans for a national health financing observatory, a national research agenda for health financing, 15 research action plans and regional collaboration frameworks.
He urged participants to scrutinise the research findings and develop concrete commitments that could strengthen health financing reforms beyond the forum.
In a goodwill message, the World Health Organisation (WHO) representative, Pavel Ursu, described health financing as foundational to universal health coverage, saying implementation research was needed to answer questions arising from health sector reforms.
He said global progress towards universal health coverage had slowed, with challenges persisting around service availability, quality and affordability.
‘The topic of how to evolve the health systems, how to use the tools of the health system financing, including service delivery and primary healthcare, to achieve acceleration, to achieve better outcomes, is very relevant for all the countries,’ Ursu said.
He commended Nigeria for establishing the research and learning forum, saying it provided an opportunity to translate global commitments into concrete country-level action.
‘The establishment of the Nigeria Health Financing Research and Learning Forum platform is really a great institutional opportunity, which will help us to a great extent with really unpacking the research questions and increasingly drive Nigeria’s own policy and implementation steps,’ he said.
Representing the Nigerian Institute of Social and Economic Research (NISER), Dr Yetunde Aluko said Nigeria needed relevant evidence developed within the country to guide health financing decisions.
Aluko, who conveyed the goodwill message of NISER Director-General, Prof. Antonia Simbine, said research should become part of a continuous national learning system rather than remain limited to reports and academic publications.
‘For too long, research in many development sectors has been developed outside of Nigeria and is funded by short-term grants,’ she said.
‘While partnerships with development partners remain very valuable, Nigeria needs an enduring national system in which policymakers, all stakeholders, researchers, implementers, communities and practitioners will jointly identify the questions that matter most, then generate the evidence and learn from implementation continuously, and then continuously adapt the policy.’
She said health financing research should establish what works, who benefits, under what circumstances and at what cost, while considering equity and sustainability.
Aluko said NISER would support efforts to strengthen institutional capacity for setting research priorities, conducting rigorous research, synthesising evidence, facilitating policy dialogue and supporting implementation learning.
Also speaking, GIZ Cluster Manager and Head of Programme, Fatima Zannah, said locally generated evidence was critical to developing health financing approaches that reflected the realities of Nigerians.
Zannah, who spoke on behalf of development partners, said decisions on healthcare financing must take into account factors influencing how Nigerians seek care.
‘These realities shape the choices that people make about their care. We need to better understand how Nigerians find, where and how they seek care, and what influences barriers to the decisions that they are making,’ she said.
She identified culture, religion, geography, income, education, gender and social networks as some of the factors influencing healthcare decisions.
Zannah said Nigeria could combine domestic evidence generation with lessons from countries facing similar health financing challenges.
‘We do not need to learn every lesson from scratch. There is tremendous opportunity to learn from our colleagues and partners from countries that are navigating similar challenges, testing different approaches, and generating valuable evidence of their own,’ she said.
She urged stakeholders to use evidence to improve decision-making, transparency, equity and accountability in the health system.
The Executive Director of the WHO Alliance for Health Policy and Systems Research, Dr Kumanan Rasamathan, said research and learning should be treated as essential components of health systems rather than luxuries.
He expressed concern that many research institutions in developing countries remained heavily dependent on external funding, warning that declining development assistance could weaken domestic knowledge systems.
‘Research cannot be a luxury. Learning cannot be a luxury. It is the foundation for health systems. If you don’t have your own knowledge, if you don’t know your own problems, if that is not preserved for future generations, you cannot be sovereign,’ Rasamathan said.
He advocated a system where communities, policymakers, implementers and researchers jointly identify problems, generate evidence, develop solutions and continuously learn from implementation.
Rasamathan cited experiences from Thailand, Ethiopia, India and South Africa as examples of how embedded research could support health policy and implementation.
He also advocated stronger domestic institutions capable of producing and preserving knowledge, saying such institutions should be sustainably financed and integrated into national policy processes.
On international cooperation, he said global partnerships remained necessary because pandemics, climate change, pollution and cross-border disease outbreaks could not be addressed by individual countries alone.
‘What we need is knowledge for genuinely global health,’ he said, adding that global cooperation should focus on areas requiring collective action while allowing countries to determine their own priorities.
Rasamathan also highlighted the potential of artificial intelligence and rapid evidence synthesis in making research more accessible to policymakers and communities, while stressing the importance of verification and quality assurance.
He said Nigeria’s emerging research ecosystem should move from externally determined research agendas to nationally and sub-nationally determined priorities and from short-term projects to sustained learning institutions.
‘If you don’t have your own research and learning system, you don’t have a map,’ he said. ‘And if someone else owns the map, you’re certainly not in charge of your journey.’