Posted on: Mon 30-06-2025

In a determined stride toward enhancing the quality of healthcare delivery for Nigerians, the National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 health maintenance organisations (HMOs) in 2024. This bold move, anchored in the agency’s operational guidelines and in line with the NHIA Act 17 of 2022, reflects the Authority’s renewed commitment to ensuring that enrollees receive the standard of care they deserve.

The sanctions followed a rigorous process of investigation into complaints lodged by patients enrolled in both state and national health insurance schemes. The NHIA, through its Enforcement Department, meticulously handled a total of 3,507 complaints during the year. Of these, 2,929 cases—representing 84 percent—were successfully resolved. The bulk of these complaints, numbering 2,273, were directed at healthcare facilities, while 1,232 targeted HMOs. Only two complaints originated against enrollees themselves.

According to a statement signed by Emmanuel Ononokpono, Acting Director of Media and Public Relations, the grievances brought forward by enrollees painted a troubling picture of service delivery failures. Patients reported issues ranging from unavailability of prescribed medicines and denial of covered services to being forced into out-of-pocket payments for treatments meant to be insured. Some facilities failed to provide proper payment narrations, further muddying transparency. HMOs were not left out; they were flagged for delays in referral authorization codes, slow settlement of reconciled payments, and poor oversight of quality assurance at their affiliated facilities.

The NHIA’s response was decisive. A total of 84 formal warnings were issued to healthcare providers. In cases where financial injustice had occurred, the Authority ensured restitution 54 enrollees received refunds amounting to N4,375,500 from 39 erring HCFs. Moreover, four facilities were suspended, while six were delisted entirely from the scheme. The hammer also fell on HMOs: 35 were issued warning letters with directives for corrective action, and 12 were ordered to refund N748,200 to 15 affected enrollees.

Ononokpono emphasized that all complaints were investigated and responded to within the standard timeline of 10 to 25 days, with the average resolution time standing at 15 days. Where complex cases extended beyond this period, complainants were kept informed as investigations continued. He noted that complaints flowed in through multiple channels—including in-person visits, letters, email, telephone calls, and the NHIA call center reflecting the Authority’s open-door policy and commitment to accessibility.

The NHIA Complaint and Grievance Management Protocol, the framework guiding this process, mandates timely responses and clear escalation paths for serious or complex issues. These mechanisms are vital, as the NHIA strives to uphold its mission of fostering transparency and accountability within Nigeria’s health insurance landscape.

Reflecting on these developments, NHIA Director General, Dr. Kelechi Ohiri, underscored the deeper purpose behind the sanctions. “Our complaints management process is central to our efforts to enhance accountability, rebuild trust, and improve quality of care,” he remarked. Dr. Ohiri stressed that these measures are not merely punitive, but part of a broader strategy to encourage health providers to elevate their service delivery standards. “Enrollees deserve the best care, and we will continue to do our best to ensure they get it. The sanctions are meant to send a clear message that the NHIA will not tolerate substandard service for enrollees,” he concluded.

In the end, the NHIA’s actions in 2024 stand as a testament to its resolve: a healthcare system where accountability reigns, and every enrollee can expect and receive the care they are entitled to.

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