**Abstract**

This chapter aims to show that extending social health insurance is a possible road to universal health coverage in Nigeria. We suggest that allowing states to set up and operate their own insurance schemes, which presents a unique opportunity to swiftly scale up prepaid coverage for Nigerians. This paper review various healthcare insurance towards achieving universal health coverage in Nigeria. The paper concluded by suggesting other insurance scheme to be covered towards achieving universal coverage.

**Keywords:** universal health coverage, Coverage, healthcare insurance, health access, and Nigeria

### **1. Introduction**

"Health is the most fundamental human right on which all other rights can be enjoyed. Universal Health Coverage is its guarantee." Dr. Githinji Gitahi [1].

One of the most normal measures of healthcare access is whether an individual has healthcare coverage insurance\_ percentage of the population with and without health insurance either by public or private [2]. Health insurance promotes good health by improving access to healthcare. Sufficient access to healthcare encourages individuals to seek health maintenance services more regularly than they otherwise would, thereby prevent potentially serious illnesses. Also, health insurance protects individuals from financial catastrophe that may result from large or unexpected medical bills [3]. In Nigeria, health insurance can be obtained from private organizations or from government agencies [3]. Agencies of the Federal Ministry of Health (FMOH) regulate the National Health Insurance Scheme (NHIS). The NHIS provides health insurance coverage for employees of the federal government. While some state government have adopted social insurance regulated by NHIS because they feel excluded from the scheme [4]. However, only 3% of men and women age 15–49 have health insurance coverage [3]. To achieve universal health coverage expansions have to be made to include other health insurance schemes [4].

#### **2. Structure of Nigeria health system**

Nigeria is a lower-middle-income country with a population of 174 million with 36 states, a federal capital territory and a total of 774 local government areas


**Table 1.**

*An illustration of various healthcare facilities regulate by tiers of government in Nigeria.*

(LGAs) across the country. The healthcare system in Nigeria is mainly regulated by public sector, and partly private sector involvement in the provision of health services. There are more than 34,000 health facilities, 66% of which were owned by the three tiers of government (federal, state, and LGAs). The secondary and tertiary level health facilities are mostly found in urban areas, whereas rural areas are predominantly served by primary health care (PHC) facilities. The federal government owns many of the tertiary level health facilities and some secondary health facilities operated by federal agencies. Most of the publicly-owned secondary health facilities are owned by the states. Primary health care is largely led by government departments and agencies, but also by non-governmental organizations. **Table 1** illustrates various health facilities regulate by tiers of government in Nigeria.
