Key points
- Nigeria runs a mixed system: health insurance is mandatory on paper under the NHIA Act 2022, but most care is still paid for out of pocket.
- The old voluntary scheme enrolled only about 5% of the population after nearly two decades; enrolment has risen to over 21 million since the 2022 Act (NHIA, August 2025).
- Care is delivered by public facilities at federal, state and local level and by a private sector that provides about 60% of services.
- Households paid 71.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 62.9 years in 2023, among the lowest in the world, and health spending was 4.2% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
Direct answer: Nigeria runs a mixed system: health insurance is mandatory on paper under the National Health Insurance Authority Act 2022, but most care is still paid for out of pocket. The old voluntary scheme enrolled only about 5% of the population after nearly two decades; enrolment has risen to over 21 million since the 2022 Act (NHIA, August 2025). Care is delivered by public facilities at federal, state and local level and by a private sector that provides about 60% of services. Households paid 71.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 62.9 years in 2023, among the lowest in the world, and health spending was 4.2% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — mandatory insurance (NHIA), out-of-pocket in practice |
| Who pays | Mostly out-of-pocket (71.9% of spending, 2023); NHIA mandatory insurance, Basic Health Care Provision Fund |
| Who delivers | Public facilities (federal, state, local) and the private sector (about 60% of service delivery) |
| What is free at the point of use | Basic Health Care Provision Fund minimum package for the publicly insured; essential drugs carry a 10% co-payment |
| Life expectancy at birth | 62.9 years (2023, WHO Global Health Estimates) |
| Health spending | 4.2% of GDP (2023, World Bank, WHO Global Health Expenditure Database) |
| Source for the model and coverage | Commonwealth Fund — Nigeria country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Nigeria’s health system is three-tiered: the federal government runs teaching hospitals and specialist centres, the states run general hospitals, and local governments run primary health care facilities — about 30,000 of them, of which only about 20% are fully functional. The private sector, from large hospitals to small clinics and patent medicine vendors, provides about 60% of services. Health workers are scarce: Nigeria had 38 doctors per 100,000 people in 2023, against an estimated need of about 240,000 doctors in total, and at least 2,000 doctors emigrate every year (Commonwealth Fund).
The law changed in 2022. The National Health Insurance Authority Act, signed on 19 May 2022, replaced the old voluntary National Health Insurance Scheme — which after nearly two decades had enrolled fewer than 5% of Nigerians — and made insurance mandatory for every resident, aiming at universal health coverage by 2030. The Act created the National Health Insurance Authority with stronger regulatory powers, and a Vulnerable Group Fund for people too poor to pay premiums. Enrolment has risen since: over 21 million people were enrolled by August 2025 (NHIA), against a government target of 44 million by 2030 — still under a tenth of a population of about 240 million.
Who pays, and what people pay
Households pay most of the bill directly: out-of-pocket spending was 71.9% of total health spending in 2023 (WHO Global Health Expenditure Database), the highest share in this set. Formal-sector workers contribute through the NHIA — the employer pays 10% of basic salary and the employee 5%, covering the contributor, a spouse and four children under 18. Private insurance covers only about 2% of the population. The Basic Health Care Provision Fund, created by the 2014 National Health Act, sets aside at least 1% of the federal Consolidated Revenue Fund for primary care for the poorest, and funds the Vulnerable Group Fund, which is meant to cover 83 million indigent Nigerians.
What is free, and what is not
The Basic Health Care Provision Fund pays for a minimum package for the publicly insured — preventive care, outpatient care, maternity care up to four births, and inpatient care up to 15 days a year — and essential drugs under the package carry a 10% co-payment. Outside that package, almost nothing is free at the point of use: patients pay for consultations, tests, medicines and hospital stays, often before treatment begins. That is why the out-of-pocket share is so high, and why illness so often means debt or forgone care.
How it compares
Nigeria spends 4.2% of GDP on health (2023), below the OECD average of 9.3% (2024), and its life expectancy of 62.9 years is 18.2 years below the OECD average of 81.1 years (2023) — among the lowest in the world (WHO Global Health Estimates). Nigeria is not in the OECD tables, so its figures come from WHO and World Bank sources for 2023 rather than the OECD’s 2024 dashboards. Its distinguishing feature is the gap between the law and the reality: insurance has been mandatory since 2022, yet nearly three-quarters of health spending is still paid directly by households, and most people remain outside any insurance scheme. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is health insurance mandatory in Nigeria?
Yes, on paper: the National Health Insurance Authority Act 2022 made insurance mandatory for every resident. In practice most people are still uninsured — the old voluntary scheme enrolled only about 5% of the population, and enrolment under the new Act had reached just over 21 million by August 2025, under a tenth of the population.
What do Nigerians pay for healthcare?
Mostly out of pocket: households paid 71.9% of health spending directly in 2023. Formal-sector workers contribute through the NHIA — the employer pays 10% of basic salary and the employee 5% — and the Basic Health Care Provision Fund pays for a minimum package for the poorest.
Why is Nigerian life expectancy so low?
Life expectancy at birth was 62.9 years in 2023, among the lowest in the world (WHO Global Health Estimates). The causes are many — infectious disease, maternal and child mortality, weak primary care and a severe shortage of health workers — and no single figure explains it.