The National Health Insurance Scheme (NHIS) of Nigeria was established over a decade ago with
the aim of achieving universal health coverage within ten years of inception. Currently the
population coverage is less than 10%. Beneficiaries are primarily the formal sector employees. An
assessment of the three dimensions of universal health coverage in the South West geo-political
zone of Nigeria is essential to determine the gaps in these areas. These will be of assistance for
policy makers in efforts to expand the scheme.
Methods: Secondary data on health indices such as life expectancy at birth, infant and under - 5
mortality rates, maternal mortality ratio and infectious diseases prevalence, were accessed from the
World Bank website. The premium paid per enrollee was obtained from the Strategic Review of
Nigeria’s National Health Insurance Scheme Population figures was obtained from the Nigerian
population census from the National Population Commission website, while data on the number of
enrollees, accredited facilities and the distribution of these by State in the South West geo-political
zone was obtained from the NHIS South West Zonal Office in Ibadan, Oyo State Nigeria. The
available data were manually analyzed with the aid of the MicroSoft – Excel. Appropriate tables to
align with the study objectives were generated. Ethical approval to use some of the data was
obtained from the NHIS southwest zonal office, Ibadan Nigeria.
Results: Poor health indices exemplified by low life expectancy at 54 years, high infant and under 5
mortality rates of 88 and 143 per 1000 live births respectively. Maternal mortality ratio was 630 per
100,000 live births. Estimated percentage of enrollees of the population was 1.7. At an annual
growth rate of 2.7%, the estimated population of the southwest zone in 2016 is over 35 million
people of which only 1.7% were enrollees under the scheme. Seventy-five per cent or above of
enrollees in the zone were registered with just over 10% of all the accredited health facilities.
Funding of the scheme was solely limited to contributions from the federal government while
beneficiaries contribution was nil, with a resultant shortfall of about one-third of the expected total
fund. The population coverage of the scheme in the southwest zone was poor, the, distribution of
the enrollees across accredited health facilities was grossly skewed, and funding of the scheme
was inadequate. These findings have negative implications on efficiency of service delivery, and
equitable access to quality health care services. Stakeholders must address these gaps if universal
health coverage is to be achieved.