The National Health Insurance Scheme (NHIS) is a social health insurance programme designed by the Federal Government of Nigeria to complement sources of financing the health sector, and to improve access to health care for the majority of Nigerians

The evolution of the National Health Insurance Scheme dates back to 1962, when the need for health insurance in the provision of health care to Nigerian citizens was first recognized. However, several factors militated against its establishment.

The Government had initially provided "free health care" for its citizens funded by its earnings from oil exports and general tax revenue. However, the global slump in oil prices in the 1980's greatly affected Nigeria's major source of income. Government could therefore no longer afford to provide free health, and subsequently introduced several cost recovery mechanism like user charges and Drug Revolving Funds. Furthermore the introduction of the structural adjustment programme in 1986 adversely affected the health sector allocation. Other factors that led to the establishment of the National Health Insurance Scheme include:

• The general poor state of the nation's health care services
• The excessive dependence and pressure on government provided health facilities
• The rising cost of health care services
• The inadequate participation of private health services and
• Inappropriate distribution of the health facilities in the country

History

The concept of Social Health Insurance was first mooted in 1962 by Halevi Committee, which passed the proposal through the Lagos Health Bill. Unfortunately it was truncated.
In 1984, forced by the desire to source more funds for health care services, the National Council on Health under Admiral Patrick Koshoni then Minister of Health. The committee chaired by Prof. Diejomoah advised government on the desirability of Health insurance in Nigeria and recommended its adoption.
In 1985, Dr. Emmanuel Nsan, the Minister of Health set up a committee on National Health Review headed by Mr. L. Lijadu. This committee also reported that Health insurance is viable in Nigeria.

Later in 1985, Prof. Olikoye Ransome-Kuti, Minister of Health then raised a Consultative Committee on National Health Insurance Scheme. The Committee was made of the Nigerian Labour Congress (NLC), Nigerian employers Consultative Association (NECA), Nigerian Medical Association (NMA), Pharmaceutical Society of Nigeria (PSN), United Nations Development Programme (UNDP), Armed Forces Medical Directorate, National Planning commission (NPC), Federal Ministry of Labour, and the Presidential Advisory Committee (PAC). Upon submission of their report another committee chaired by Dr. E. Umez-Eronin was set up to recommend an acceptable model for the implementation of a Social Health Insurance in Nigeria.

At the 28th meeting of the National Council on Health, another committee was set up on National Health Insurance Scheme. After the submission of its report, the Federal Government approved the establishment of the National Health Insurance Scheme in 1989.
In 1991, the Federal Government signed an agreement with the UNDP and the International Labour Organization for planning and implementation of the scheme. Studies carried out involved Actuarial analysis, computerization requirement, Financial procedure, Management Information System (MIS), Guideline and Draft Law on the National Health Insurance Scheme.

In 1993, the Federal ministry of Health presented a memorandum to the Federal Executive Council (FEC) praying for immediate implementation of the National Health Insurance Scheme.
In 1995, the National Health summit endorsed the need to setup the National Health Insurance Scheme as soon as possible. At its 42nd meeting, the National Council on Health (NCH) approved the repackaging of the NHIS to ensure full private sector participation. This model ensured the introduction of Health Maintenance Organization (HMOs) and financial managers of the scheme.

On October 15th, the National Health Insurance Scheme was finally launched. The enabling law Decree 35 of 1999 (now Act 35 of 1999) was signed in May 1999. National council on Health Special meeting on NHIS held in Port Harcourt in July 2001 recommended the need for the scheme to take off. There after an implementation Planning Committee was set up which met in September 2001 and submitted its report recommending the immediate take off of the Scheme.

• Ensuring that every Nigeria has access to good health care services
• Protecting families from the financial hardship of huge medical bills
• Limiting the rise in the cost of health care services
• Ensuring equitable distribution of healthcare cost among different income groups
• Limiting the rise in the cost of health care services
• Maintaining high standard of health care delivery services within the Scheme
• Ensuring efficiency in healthcare services
• Improving and harnessing private sector participation in the provision of healthcare services
• Ensuring equitable distribution of health facilities within the country
• Ensuring appropriate patronage of all levels of health care
• Ensuring the availability of funds to the health sector for improved services